Labor Group Research Articles

Zonulin: can it be used as a marker for preterm labor?

Inflammation has been reported to increase zonulin levels, a protein that regulates intestinal permeability. The aim of this study was to investigate the association of serum zonulin levels with preterm labor in pregnant women. A total of 180 pregnant women between 32-42 weeks of gestation were included in the study. Among those whose gestational week is less than 37, preterm labor (group 1), normal course pregnant (group 2), and gestational weeks between 37-42 pregnant women with normal course (group 3), term labor (group 4) groups were formed. Zonulin levels were not statistically different between groups. Among the inflammation markers, only C-reactive protein levels were significantly higher in group 1 compared to groups 2 and 3. There were a total of 18/90 (20%) pregnant women with premature rupture of membranes (PROM) in the delivery groups. The mean zonulin level was higher in those with PROM (155.3±50.2 ng/ml) than those without PROM (128.8±59 ng/ml). However, there was no statistically significant difference between them. In conclusion, serum zonulin levels were not useful as a marker for predicting preterm labor. However, examining large-scale studies about the relationship between PROM and zonulin is still needed.

Child labour in cocoa growing regions of Ghana and Côte d’Ivoire: an analysis of academic attainment in children engaged in hazardous labour.

ABSTRACT This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour.

The effect of slow-release vaginal dinoprostone on maternal and fetal oxidative stress in term pregnancies complicated by oligohydramnios: Prospective cohort study.

To evaluate changes in oxidant status using thiol/disulfide homeostasis in mothers and fetuses after induction of labor with slow-release vaginal dinoprostone inserts. A total of 70 pregnant women were divided into two groups. Thirty-five women in whom labor was induced with slow-release vaginal dinoprostone inserts (10 mg of prostaglandin E2, group A) were compared before and after the administration. The other 35 women, who were followed up spontaneously during labor (group B), were included as a control group. Both groups were diagnosed with isolated oligohydramnios without signs of placental insufficiency. The thiol/disulfide homeostasis parameters were calculated before medical induction and after removal of the insert at the beginning of the active phase of labor. Maternal and cord blood values were measured in both groups. Although the balance shifted to the antioxidant side after the slow-release vaginal dinoprostone insert was applied, there was no significant difference in maternal oxidative load compared to the pre-application status (5.32 ± 014/5.16 ± 0.15, p = 0.491). Despite the shift toward the antioxidant side, maternal antioxidants were still significantly lower in the group that received slow-release vaginal dinoprostone at the beginning of the active phase of labor than in the control group (295.98 ± 13.03/346.47 ± 12.04, respectively, p = 0.009). There was no statistically significant difference in terms of oxidative balance or newborn Apgar score ( p > 0.05). Induction of labor with slow-release vaginal dinoprostone inserts in pregnancies with isolated oligohydramnios does not cause further oxidative stress and is safe for both mothers and neonates in terms of oxidant load by thiol/disulfide homeostasis.

Responding to the economic consequences of COVID 19 in Pakistan: lessons learnt

This paper discusses the impact of COVID-19 on production and trade in Pakistan. The paper finds that Pakistan’s outbreak preparedness and response has been a success story, but there are still some gaps that need to be addressed in order to better prepare for future crises. We recommend that the policy makers: conduct frequent structured dialogues with small firms to better understand the type and magnitude of unanticipated costs that increase during health crises; regularly source information to determine if the design of fiscal support is benefiting the beneficiaries; convene dialogues with businesses (which should include labour groups) to address the stringency of temporary trade measures; support smaller firms for adoption of online technologies; expedite the implementation of e-commerce policy, information security policy, and personal data protection law; and cut down business and trade costs during crisis through a more liberal tariff policy and rationalization of regulatory burden on firms.

Factors contributing to preterm birth in patients presenting at tertiary care hospitals in Punjab.

To determine the various causes and factors leading to preterm birth in women presenting at tertiary care hospitals. The cross-sectional, prospective study was conducted from June 19, 2021, to January 19, 2022, at the Central Park Teaching Hospital, Lahore, Pakistan, in collaboration with other tertiary care teaching hospitals in Lahore, and comprised pregnant women aged 15-45 years with preterm birth. Demographic and obstetric data was collected. Depending on the factors contributing to preterm birth, the subjects were categorised as spontaneous labour group A, preterm prelabour rupture of membrane group B, and iatrogenic preterm birth group C. Data was analysed using SPSS 25. Of the 1,300 recorded births, 200(15.38%) were preterm. Group A had 86(43%) women with mean age 28.55±4.68 years, group B had 43(21,5%) women with mean age 27.14±3.25 years, and group C had 71(35.5%) women with mean age 28.28±3.74 years (p>0.05). There was significant difference among the groups with respect to body mass index (p=0.001) and parity (p=0.021). Vaginal and urinary tract infections were significantly higher in group A compared to the other groups (p<0.05). In group C, pre-eclampsia was the main reason for preterm birth 45(63.38%). Medically indicated preterm birth rate was found to be high, and pre-eclampsia was noted as the main cause in iatrogenic preterm birth.

Utilising the communication for development approach to prevent online child trafficking in Thailand

In Thailand, predators use online and offline methods to exploit migrant children as forced labourers in various industries, including shrimp and seafood processing, construction and agriculture. This study examines the current status of online child trafficking and considers how the communication for development (C4D) approach can be utilised to prevent these crimes. This study reviews papers and reports published in Thailand and abroad on online child and human trafficking, prevention methods and C4D. Moreover, the study used purposive sampling and interviewed Thai government officials and representatives from non-government organisations (NGOs) with expertise in migration issues. The findings reveal that human traffickers deceive migrant children into online child labour and trafficking through unregulated online channels. However, the Thai government has collaborated with local and international NGOs to apply C4D to reach out to children seeking employment in safe online spaces to prevent child trafficking. This paper argues that C4D is helpful for raising public awareness of the threats posed by human trafficking. Simultaneously, specific labour groups employ C4D Plus, which may be applicable in the prevention of online child trafficking.

Modified pustulotic arthro-osteitis diagnostic guidance 2022 - Modified Sonozaki criteria - Secondary publication.

The concept of pustulotic arthro-osteitis (PAO) was first reported by Sonozaki et al. in 1979, with diagnostic criteria (Sonozaki criteria) proposed in 1981. These criteria have served as the gold standard for PAO diagnosis for over 40 years. In recent years, there has been an increasing emphasis on maximizing the quality of life of patients with PAO. This is achieved by striving for clinical remission, structural remission, and functional remission through early diagnosis and appropriate therapeutic intervention from an early stage. This article is an English translation of a summary of the 'Modified PAO Diagnostic Guidance 2022', edited by the Japan Ministry of Health, Labour and Welfare's Research Group on improvement of medical standard and quality of life of patients with spondyloarthritis and related diseases represented by ankylosing spondylitis and the Japan Spondyloarthritis Society. This guidance is intended to be helpful to both Japanese and global communities in rheumatology and spondyloarthritis.

ПРОЦЕСУАЛЬНИЙ ХАРАКТЕР ГРОМАДЯНСЬКОГО ВИХОВАННЯ

The content and procedural nature of the implementation of civic education are analyzed. The need to direct the process of civic education to the result was revealed — the object of education should acquire civic qualities and values, which he is able to implement in social life. It has been found that the process of civic education can be effectively carried out both within educational institutions and labor groups, and through the involvement of educational facilities in various socially significant programs of a national and regional nature. The correlation of the concepts «chivalric education», «national-patriotic education», «national education» is demonstrated. It is summarized that the traditions of knightly education should be most actively reproduced in preschools, schools and universities, based on the traditions of the national liberation struggle of the Ukrainian people in different periods of history. The role of extracurricular forms of patriotic education is noted. The problem of raising patriotism among the adult population has been revealed, since it is difficult to influence the formed worldview of an adult. It was found that the process of raising the defender of the Motherland must be approached comprehensively, taking into account the institutional and non-institutional mechanisms, methods and forms of work with youth existing in the state.

An overview insight into employment of disabilities at workplaces around the world: A review of the literature

Many people with disabilities still face difficulties and obstacles trying to secure employment. Organizations are doing more and more to improve employment opportunities for people with disabilities (PWD), because it is in their best interests, due to factors such as a dearth of skilled workers, a lack of trained workers, a rise in the prevalence of disability among their labor groups, as well as in the laws and public attitudes supporting workplace fairness and diversity. This article used a qualitative methodology and conducted a thorough evaluation of the existing literature using a variety of different databases such as Science Direct, Springer, Google Scholar, JSTOR, and Elsevier, which were used to identify various research articles related to the employment of PWD. We looked at research on the advantages of hiring people with disabilities, as well as HR management procedures with reference to recruiting persons with disabilities, and also investigated the methodology this literature used. Our findings demonstrate that the advantages of employing disabled individuals are many. To better understand how advantages may differ by disability type, industry, and work type, more research is required.

Robson Classification System: An Essential Tool for Evaluating Caesarean Section Indications and Implications at LUMHS

Background: The rise in the number of caesarean section (CS) deliveries worldwide has raised questions about its suitability and effects on the health outcomes of mothers and newborns. Consequently, healthcare professionals have been exploring standardized approaches for assessing the necessity of CS procedures to promote efficient use of this surgical intervention. The Robson Classification System has become a beneficial resource for classifying CS indications and supporting efforts to enhance the quality of obstetric care. Objective: To evaluate the utility of the Robson Classification System in assessing caesarean section indications and its implications at LUMHS. Study Design: Cross-sectional study. Settings: This study was done at Gynae and OBS department of Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro Pakistan. Duration: Three-month period from November 2020 to February 2021. Methods: Women who underwent CS deliveries with available data necessary for categorizing them into the ten groups of the Robson Classification System were included. After undergoing cesarean sections, patients were screened to classify them according to the Robson 10-group system. The information obtained was strictly used for the study's objectives and treated with confidentiality. Subsequently, the collected data were inputted into SPSS version 26 for analysis. Results: The overall rate of CS was 51.2%. Mean age of the patients was 36.73+2.43 years. The highest contributors to the CS rate were in women with preterm singleton cephalic term pregnancies (group 10) 31.7% and multiparous; single term pregnancy with one and more previous caesarean section around 5 a and b) 31.9%, followed by nulliparous, single, cephalic, ≥37 weeks, spontaneous labor (group 1) 11.2%, (group 2b) 8.1%, (group 3) 5.7% and (group 4) 4.0%. Conclusion: The CS rate was observed to the highly frequent, with Robson groups 5 and 10 being the primary drivers of this heightened rate. Initiatives aimed at decreasing the initial CS occurrence by enhancing the management of both spontaneous and induced labors, as well as strengthening clinical protocols to promote vaginal birth after CS, are anticipated to yield the most substantial impact on reducing the CS rate.

Cost and Time Analysis of the Construction of the 275 Kv 2cct Quadruple Zebra Sutet Project Gumawang – Gitet Lampung 1 Using the Time Cost Trade Off Method

Indonesia as an archipelago state is still need an equality development with the intention in achieving the goals to fulfil the requirement of structure and infrastructure. The economy that has experiencing growth, it can be see with the rising of the demand for supply of electricity power whether it is coming from domestic moreover from industrial usages. Lampung Province, as one of the regions which in a continuation to develop, requires the support of electric power, which at its peak load reaches 1200 MW, while the capacity of existing power plant can only produce 700 MW, therefore the construction of a 275 kV Gumawang-Lampung 1 SUTET interconnection network with a capacity of up to 2000 MW was established to meet these requirement.Based on the time schedule which noted that the duration of foundation work started with the excavation, concreting until the reaches of it’s curing time in 28 days is 42 days in 2023 December 13th is on try to speed up can be curing in 2023 December 8th, so the schedule tower installation in 2023 December 9th will be on time. Due to this delay, the researcher intends to carry out an acceleration analysis starting with preparing a network diagram using the Microsoft Project software, followed by the crashing process by adding groups of workers and tools of any activities on the critical path. The next step is to calculate the crash cost and cost slope values ??using the time cost trade off (TCTO) method.From the results of the analysis carried out, it was found that the normal project duration was 42 days after the crashing process was carried out to 36 days, with a normal work cost of Rp. 1,774,462,352.84 and after the crashing process was carried out with the alternative of adding labor groups and equipment the cost became Rp. 1,849,762,666.92. It was concluded that with the time cost trade off method there was a reduction in duration and an increase in costs.

Known in Europe, Unknown in Bulgaria (To the 150th Anniversary of the Birth of Christian Rakovsky)

The article is dedicated to the 150th anniversary of the birth of Christian Rakovsky (1873-1941) – a prominent figure in the international socialist movement, politician, statesman, diplomat, Chairman of the Council of People’s Commissars of Ukraine (1919-1923), Ambassador Extraordinary and Plenipotentiary of the USSR in London (1923-1925) and Paris (1925-1927), one of the leaders of the Trotskyite bloc, and an opponent of Stalin. While Rakovsky’s life has been the subject of some research, many of its aspects remain unexplored. Drawing on a wealth of new documents discovered in the archives of Bulgaria, Great Britain, France, Ukraine, and Russia, the author sheds new light on little-known episodes of Rakovsky’s life – particularly the years of his youth, when he joined the international student socialist movement and spoke at international congresses. The article considers Rakovsky’s contacts with Plekhanov’s Emancipation of Labor group in Geneva, where Rakovsky studied medicine and achieved some prominence among Russian social democrats. His connections with famous Western European revolutionaries are discussed – including Rosa Luxemburg, Karl Liebknecht, Jules Guesde, Karl Kautsky, and other figures of the Second International. It is noted that Rakovsky was the only member of the Bolshevik government who was also a member of the Bureau of the Second International. The article touches on a subject that has long been neglected by historians – Rakovsky’s efforts to solve the problem of Russian-Romanian relations in 1918, the resulting bilateral treaty, and his special position regarding the annexation of Bessarabia to Romania. Considerable attention is given to the question of Rakovsky’s so-called ‘Jewish’ origin and his alleged membership in the worldwide Masonic lodge, disproven on the basis of Rakovsky’s papers in the Bulgarian Historical Archive. The author also dwells on the problem of the so-called ‘Rakovsky protocols’, published by Iosif Landovsky in the book “Red Symphony: Confessions of the Trotskyist Rakovsky.” The author draws on Rakovsky’s NKVD case file and interrogation records, which he has published in full in his book “The Bloody Farce,” to demonstrate that no such protocols exist. Finally, the author addresses the rumor that Rakovsky was not executed, but spent the last years of his life in the Soviet Union. This rumor is proven false based on the analysis of extensive archival materials and memoirs of Rakovsky’s comrades; most notably, Rakovsky’s case file in the Central Archives of the KGB of the USSR contains a certificate of his execution on 11 September 1941 in the Oryol Central Prison.

Управление агропромышленным комплексом северного региона

The article considers the management approach of the agroindustrial complex via determining the significance level of agricultural production development, includes the results of calculations based on a point-rating system using the additive method for differentiating the municipalities of the Komi Republic by production, socio-geographic and labor groups of factors.

Surf & Turf: The role of intensification and surplus production in the development of social complexity in coastal vs terrestrial habitats

Social complexity in coastal and terrestrial environments both emerge as forms of subsistence intensification on previous foraging patterns but take different trajectories because of differences in the spatial and temporal structure and density of harvestable biomass between the two ecozones. Norms and values surrounding standards of living motivate households to intensify production above what is needed for mere survival (i.e., surplus), which in turn has the effect of providing a buffer against unpredictable shortfalls and longer-term population-resource imbalances caused by population growth. Economies of scale introduced by increasing labor group size and differentiation as well as technology fund the production and consumption of surplus and drive the emergence of social complexity among foragers and cultivators alike.

A Cross Sectional Study on Prevalence of Bacterial Vaginosis in Preterm and Term Labor

Background: The aim is to examine bacterial vaginosis (BV) in women with preterm and term labor, explore the link between bacterial vaginosis and preterm labor (PTL), and analyze complications for both mother and baby related to bacterial vaginosis. Design: Hospital based cross sectional study. Materials and Method: We had conducted an observational study at Basaveshwara Medical College and Hospital, involving 100 pregnant patients with preterm and term labor (50 patients in each group). Eligible patients attending the Obstetrics and Gynecology Outpatient Department (OBG OPD) and inpatient department will be included. Bacterial vaginosis will be determined using Amsel's criteria, which include evaluating discharge characteristics, vaginal pH, amine odor with KOH test, and presence of clue cells under microscopic examination. Additionally, vaginal swabs will undergo Gram staining. Results: The percentage of patients meeting Amsel's criteria for diagnosing bacterial vaginosis was significantly higher in the preterm labor group compared to the term labor group, with a statistically significant difference. According to Amsel's criteria, the prevalence of bacterial vaginosis was 30% in the preterm labor group and 2% in the term labor group. Conclusion: Bacterial vaginosis is a significant risk factor for preterm labor. Hence, conducting tests for bacterial vaginosis and promptly treating it can help reduce the risk of preterm labor.

Correlation of Body Mass Index and Work Profile on Hand Grip Strength and Endurance in Healthy Adults

Background and need of research: Hand Grip Strength (HGS) is an integral part of performing precise and refined fine motor activities. Many professions necessitate lifting and holding heavy loads with a proportionately static grip or repetitive or forceful gripping movements. Hence it is important to consider measurement of handgrip endurance (HGE) as an important component of assessment of physical performance. Most of studies have shown that HGS and BMI is associated with mortality and cardiovascular disease. So, need of this study is to fulfill the lacunae of literature. Method: A cross-sectional study-conducted on 80 healthy adults(age:18-40) after obtaining Institutional Ethical Committee clearance. Participants who met with the inclusion criteria were invited for study. BMI was calculated using the formula weight(kg)/height(m)2.HGS and HGE were measured in office worker and labourer using hand grip dynamometer. Results: Mean age, BMI, strength and endurance of office worker is (32.78+5.96), (26.15+5.36), (29.04+9.34), (44.63+28.53) and labourer is (32.47+4.46), (25.35+3.33), (37.26+8.57), (32.82+29.44) respectively. Spearman correlation test was used for analysis. Significant negative correlation (r=-0.507, p&lt;0.05) is found between labourer BMI and HSG and very weak correlation found between BMI and HGE (r=-0.010, p&gt;0.05). Weak and very weak correlation found between office worker’s BMI, HGS and HGE (r=-0.274, p&gt;0.05 and r=0.110, p&gt;0.05) respectively. Conclusion and clinical implication: There is significant negative correlation found between BMI and grip strength in labour group. This result supports that HGS can be effective tool for predicting physical fitness. Moreover, through normative value of HGS, clinician can detect low level of physical fitness at early stage in order to prevent future health problems. Keywords: BMI, hand grip strength, hand grip endurance, work profile

Multi-channel electrohysterography enabled uterine contraction characterization and its effect in delivery assessment

Uterine contractions are routinely monitored by tocodynamometer (TOCO) at late stage of pregnancy to predict the onset of labor. However, TOCO reveals no information on the synchrony and coherence of contractions, which are important contributors to a successful delivery. The electrohysterography (EHG) is a recording of the electrical activities that trigger the local muscles to contract. The spatial–temporal information embedded in multiple channel EHG signals make them ideal for characterizing the synchrony and coherence of uterine contraction. To proceed, contractile time-windows are identified from TOCO signals and are then used to segment out the simultaneously recorded EHG signals of different channels. We construct sample entropy SamEn and Concordance Correlation based feature ψ from these EHG segments to quantify the synchrony and coherence of contraction. To test the effectiveness of the proposed method, 122 EHG recordings in the Icelandic EHG database were divided into two groups according to the time difference between the gestational ages at recording and at delivery (TTD). Both SamEn and ψ show clear difference in the two groups (p<10−5) even when measurements were made 120 h before delivery. Receiver operating characteristic curve analysis of these two features gave AUC values of 0.834 and 0.726 for discriminating imminent labor defined with TTD ≤ 24 h. The SamEn was significantly smaller in women (0.1433) of imminent labor group than in women (0.3774) of the pregnancy group. Using an optimal cutoff value of SamEn to identify imminent labor gives sensitivity, specificity, and accuracy as high as 0.909, 0.712 and 0.743, respectively. These results demonstrate superiority in comparing to the existing SOTA methods. This study is the first research work focusing on characterizing the synchrony property of contractions from the electrohysterography signals. Despite the very limited dataset used in the validation process, the promising results open a new direction to the use of electrohysterography in obstetrics.

Neutrophil Elastase as a Predictor of Delivery in Pregnant Women with Preterm Labour.

No previous study has been conducted in Nigeria on the role of neutrophil elastase in predicting preterm birth. The present study aimed to determine the role of the neutrophil elastase test in predicting birth in women with preterm labor. The present prospective cohort study recruited 83 pregnant women with preterm labor between 28 and 36+6 weeks of gestation, and followed up these subjects for 14 days. The controls comprised 85 pregnant women without preterm labor. The cervicovaginal fluid was collected and tested using the neutrophil elastase test. Then, the sensitivity, specificity, and positive and negative predictive parameters were determined. Afterward, the data were scrutinized using the SPSS arithmetic software (Sort23). Among the 168 pregnant women analyzed in the present study, 83 pregnant women were assigned to the preterm labor group, and 85 pregnant women were assigned to the control group. Furthermore, among the 83 pregnant women in the preterm labor group, 11 women had spontaneous preterm delivery, leading to a spontaneous preterm birth proportion of 13.3%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the neutrophil elastase test within 14 days post-enrollment were 93.8%, 61.2%, 36.6%, 97.6%, and 67.5%, respectively, for the general population, and 87.5%, 66.7%, 35.0%, 96.3%, and 70.2%, respectively, for subjects at <35 weeks of gestation. The positive and negative likelihood ratios for preterm birth prediction were 2.62 and 0.19, respectively. The neutrophil elastase test exhibited high predictive accuracy in pregnant women with preterm labor, when compared to the controls, based on the sensitivity and negative predictive value, but this had poor positive predictive values. The neutrophil elastase test may be used as a screening test, but not as a potential predictive test, in the routine clinical setting.

Emotional labor mediates the associations between self-consciousness and flow in dancers

Emotional labor has been a focal point in occupational well-being literature, but studies have long overlooked an important group of emotional laborers: performers. This research represents a pioneering effort to examine dancers’ adoption of emotional labor strategies, their antecedent of self-consciousness, and the outcome of flow experience. We explored these elements both in the traditional setting of stage dancing and in the novel context of online dance classes without on-site spectators during the COVID-19 pandemic. The results revealed that dancers employed all three common emotional labor strategies: surface acting, deep acting, and expression of naturally felt emotions, with deep acting being the most frequent. In the traditional setting, only the expression of naturally felt emotions mediated the positive effect of private self-consciousness and the negative effect of public self-consciousness on flow experience. In contrast, in the online setting, only private self-consciousness impacted flow through the mediation of deep acting and expression of naturally felt emotions. This exploratory study bridges dramaturgy-originated theories of emotional labor with empirical performing arts research, preliminarily advancing knowledge in the relevant fields of dance education, self-presentation, and flow studies.

Challenges in improving the quality of medical examination and treatment and the goal of universal health insurance

An abstract is a summary of entire paper should be written in Cambria with font size- 10. Author can select Normal According to the Health Sector Overview Report of the Ministry of Health, 3.9% of households (equivalent to 3.5 million people) face financial difficulties due to the cost of medical examination and treatment. The report also found that direct out-of-pocket household spending accounts for 50 percent of total health expenditures, while on average worldwide, this cost is only about 30 percent. In addition, due to the advancement of science and technology in the medical industry, methods are also born more and more, drugs and medical supplies are increasingly modern, prices tend to increase. Therefore, the increasing cost of medical examination and treatment is an inevitable trend. That will become a burden on the budget of each family, especially families with people with serious and chronic diseases that require long-term treatment. According to Vietnam Social Insurance data, by the end of December 2022, the coverage rate of Health Insurance reached over 92.06% (equivalent to nearly 91.1 million people). However, one thing worth. However, one thing worth note that easily exploited objects such as those participating in health insurance under labor contracts or groups paid by social insurance organizations and the State budget have almost absolute coverage. The remaining target groups have not high coverage and exploiting these groups is not easy because the health insurance participation fee is mainly paid by the beneficiaries. Therefore, achieving 100% coverage is not easy.