Rational Allocation Of Health Resources Research Articles

[Prevalence and Influencing Factors of Isolated Diastolic Hypertension in Tibetan Population in Tibet].

To investigate the prevalence and influencing factors of isolated diastolic hypertension (IDH) in the Tibetan population in Tibet and to provide some evidence for the prevention and control of hypertension and other related diseases in high-altitude areas. A multistage stratified whole-group random sampling method was used to enroll participants from Ngari Prefecture, Nagqu City, Shannan City, and Lhasa City, Tibet. A total of 3918 native Tibetans with complete data were enrolled in the survey between June 2020 and August 2023. The participants were aged from 18 to 80. The demographic data, life habits, and chronic disease prevalence of the participants were collected. Fasting venous blood samples were collected to perform the routine blood tests and blood biochemistry tests. The prevalence of IDH in subgroups with different characteristics was analyzed and the influencing factors were analyzed by multivariate logistic regression, accordingly. The predictive value of influencing factors on the prevalence of IDH was analyzed by the receiver operating characteristic (ROC) curve and the findings were compared with those of the previous prediction models for IDH. The prevalence of hypertension in the participants was 33.7% (n=1321), among which, 395 had IDH, accounting for 29.9% of the hypertensive patients. The results of multivariate regression showed that age, heart rate, body mass index, waist circumference, hemoglobin, and low-density lipoprotein cholesterol were associated with risks of developing IDH (P<0.05). The area under the ROC curve (AUC) was 0.71, which indicated improved accuracy for predicting the risks for IDH in comparison with previous predictive models for IDH. Among the influencing factors, BMI showed the best predictive value for IDH risks. The prevalence of IDH is high among Tibetans in Tibet, suggesting the necessity for rational allocation of health resources in accordance. Compared with the previous IDH prediction models, the model proposed in this study is more suited for the Tibetan population. Targeted interventions should be carried out for the high-risk populations, such as young and middle-aged adults and populations suffering from overweight/obesity, central obesity, high-altitude polycythemia, and dyslipidemia, so as to effectively control the occurrence and development of IDH.

Comparative examination of breast cancer burden in sub-Saharan Africa, 1990–2019: estimates from Global Burden of Disease 2019 study

ObjectivesIn view of the widening gap in survival data between high-income and low-income countries, this study aimed to evaluate the most up-to-date burden of female breast cancer and analyse the...

[Analysis on liver cancer mortality and cause eliminated life expectancy in key areas of 4 provinces, China, 2008-2018].

Objective: To explore the changes of liver cancer mortality and the effect of liver cancer on life expectancy in key areas of four provinces in China from 2008 to 2018 and provide the basis for the evaluation of comprehensive prevention and control of cancer and promotion of the rational allocation of health resources. Methods: Based on the national cause-of-death surveillance in key areas of the 4 provinces from 2008 to 2018, we analyzed the mortality of liver cancer, cause eliminated life expectancy (CELE) and potential gains in life expectancy (PGLEs). Software Joinpoint 4.9.0.0 was used to calculate the average annual percentage change (AAPC). Arriaga's decomposition method was used to estimate the contribution of the changes of liver cancer mortality in each age group to life expectancy. Results: The standardized mortality of liver cancer in key areas of the 4 provinces showed a downward trend from 2008 to 2018 (AAPC=-4.37%, P<0.001). The changes of liver cancer mortality had a positive effect on the increase of life expectancy, with a contribution value of 0.240 years and a contribution degree of 5.62%. The positive effect was greatest in age group 45-49 years (0.041 years, 0.96%), and the negative effect was greatest in age group 50-54 years (-0.015 years, -0.35%). Compared with 2008, the life expectancy increased by 4.27 years (AAPC=0.59%, P<0.001), the liver cancer CELE increased by 4.20 years (AAPC=0.58%, P<0.001), the PGLEs decreased by 0.07 years (AAPC=-0.62%,P<0.001), and life loss rate decreased by 0.13% (AAPC=-1.18%, P=0.001). The liver cancer PGLEs increased in Yongqiao district, Anhui province (0.09 years), and decreased in other districts (counties), with the largest decline was in Fugou county, Henan province (-0.21 years). Conclusions: From 2008 to 2018, the standardized mortality rate of liver cancer in key areas of the 4 provinces decreased gradually, contributing to the growth of life expectancy. The life loss caused by liver cancer decreased gradually, but the PGLEs varied with districts (counties).

How is the medical service efficiency in China? An empirical analysis using stochastic frontier approach and gravity models.

The COVID-19 has heightened the focus of medical services. Scientifically evaluating the efficiency of medical services and defining their spatial transmission relationship is crucial for the rational allocation of health resources and the accomplishment of balanced regional medical service growth. We used a Stochastic Frontier Model to calculate medical service performance in Chinese provinces and the Gravity Model to study the spatial relationship of medical service performance across provinces using data from 2009 to 2018. We discover that: (1) population density and proportion of technical personnel are significantly positively correlated with the efficiency of regional medical services, whereas health institution density has a significantly negative influence. Their respective influence coefficients were 1.717, 0.647, and 0.407. (2) In China, the regional development of medical service efficiency is unbalanced. The east, middle, and west multi-year average medical service efficiency were 0.65, 0.46, and 0.53, respectively, and their gaps were narrowing; the south and north average efficiency were 0.591, 0.516, respectively, and their gaps were widening. (3) Our medical efficiency network is not yet widespread in the country. Hubei, Henan, Shandong, Jiangsu, Zhejiang, and Beijing were at the centre of the medical efficiency network, driving and connecting the nation's medical service. Our findings offer specific recommendations for better understanding and improving the efficiency of medical services.

Application of the ARIMA Model in Forecasting the Incidence of Tuberculosis in Anhui During COVID-19 Pandemic from 2021 to 2022.

ObjectiveForecasting the seasonality and trend of pulmonary tuberculosis is important for the rational allocation of health resources. In this study, we predict the incidence of pulmonary tuberculosis by establishing the autoregressive integrated moving average (ARIMA) model and providing support for pulmonary tuberculosis prevention and control during COVID-19 pandemic.MethodsRegistered tuberculosis(TB) cases from January 2013 to December 2020 in Anhui province were analysed using traditional descriptive epidemiological methods. Then we used the monthly incidence rate of TB from January 2013 through June 2020 to construct ARIMA model, and used the incidence rate from July 2020 to December 2020 to evaluate the forecasting accuracy. Ljung Box test, Akaike's information criterion(AICc), Bayesian information criterion(BIC) and Realtive error were used to evaluate the model fitting and forecasting effect, Finally, the optimal model was used to forecast the expected monthly incidence of tuberculosis for 2021 and 2022 to learn about the incidence trend.ResultsA total of 255,656 TB cases were registered. The reported rate of tuberculosis was highest in 2013 and lowest in 2020. The peak incidence was in March, Tongling (71.97/100,000), Chizhou (59.93/100,000), and Huainan (58.36/100,000) had the highest number of cases. The ratio of male to female incidence was 2.59:1, with the largest proportion of people being between 66 and 75 years old. The main occupation of patients was farmer. ARIMA (0, 1, 1) (0, 1, 1)12 model was the optimal model to forecast the incidence trend of TB.ConclusionTongling, Chizhou, and Huainan should strengthen measures for TB. In particular, the government should pay more attention on elderly people to prevent tuberculosis infections. The rate of TB patient registration and reporting has decreased under the pandemic of COVID-19. The ARIMA model can be a useful tool for predicting future TB cases.

[Cost-effectiveness analysis of Qilong Capsules in treatment of ischemic stroke based on prospective real-world cohort study].

In this study, TreeAge Pro was used to build a decision tree model for Qilong Capsules in the treatment of ischemic stroke. We compared the economy between Qilong Capsules + conventional therapy vs conventional therapy in the treatment of ischemic stroke to guide the rational allocation of health resources in clinical practice. The cost parameters in the study were obtained from Menet and the relevant literature published recently. Meanwhile, the efficacy parameter [mean reduction in National Institute of Health stroke scale(NIHSS) score after treatment] was employed to evaluate the short-term economic performance of the two therapies based on a prospective real-world cohort study. The time span of simulation was 24 weeks, and the robustness of this study was verified by sensitivity analysis. Qilong Capsules + conventional therapy and conventional therapy had the direct medical costs of CNY 22 546.50, 21 160.50 and the effectiveness of 2.08, 1.59 points, respectively. The incremental cost-effectiveness ratio(ICER) of the two groups was CNY 2 811.36. That is, compared with conventional therapy, Qilong Capsules + conventional therapy in the treatment of ischemic stroke costed CNY 2 811.36 for each additional point reduction in NIHSS score. If the patient is willing to pay more than CNY 2 811.36, Qilong Capsules + conventional therapy is more economical. The result of sensitivity analysis verified that the ICER was robust. Thus, on the basis of the assumption that per capita disposable income in 2020 is the threshold of patients' willingness to pay, Qilong Capsules + conventional therapy is more economical than conventional therapy alone in the treatment of ischemic stroke.

Change trend in disease burden of stroke and its risk factors in China, 1990 – 2017

Objective  To analyze change trend in disease burden of stroke and its risk factors in China from 1990 through 2017 and to provide evidences for rational allocation of health resources and the development of targeted stroke prevention and treatment strategies. Methods  Data on disease burden of stroke during the period from 1990 through 2017 in China were extracted from the Global Burden of Disease (GBD) Study of 1990, 2000, 2010 and 2017. Years lived with disability (YLDs), years of life lost (YLLs), disability adjusted life years (DALYs) were used to evaluate the disease burden of stroke and population attributable fraction (PAF) was adopted to analyze risk factors of stroke-related disease burden. Disparities in disease burden of stroke between China and the world were compared. Results  During the period of 1990 – 2017 in China, the YLLs rate and DALYs rate of stroke increased gradually; the YLLs rate also increased generally but with a temporary decline in 2010. In 2017 in China, the age-specific YLDs, YLLs, and DALYs rate of stroke increased with the increment of age and the highest rates were observed among the population aged ≥ 70 years (2 617.2/100 000 for YLDs, 16 789.4/100 000 for YLLs, and 16 773.4/100 000 for DALYs); the YLDs rate was lower for the males than that for the females (475.5/100 000 vs. 530.9/100 000) but the YLLs and DALYs rate were higher for the males than those for the females (3 181.7/100 000 vs. 2 060.9/100 000 and 3 657.1/100 000 vs. 2 591.8/100 000); the age-standardized YLDs, YLLs, and DALYs rate of stroke were higher than those in the world (374.5/100 000 vs. 235.0/100 000, 1 967.8/100 000 vs. 1 422.2/100 000, and 2 342.3/100 000 vs. 1 657.2/100 000). Compared to those in 1990 in China, the age-standardized YLDs rate of stroke increased by 30.9%; while, the age-standardized YLLs rate and DALYs rate decreased by 38.8% and 33.1%; the change trend of the three rates were consistent with the changes in global stroke burden (5.9% for YLDs, = – 34.5% for YLLs, and – 30.7% for DALYs). Among the 16 risk factors associated with DALYs (million person-years), PAF, and DALYs rate of stroke, the top five were hypertension (24.974, 56.4%, and 1 768.1/100 000), excessive sodium intake (17. 060, 38.5%, and 1 207.8/100 000), insufficient fruit intake (10.717, 24.2%, and 758.7/100000), insufficient cereal intake (10.690, 24.1%, and 756.8/100 000), and smoking (10.037, 22.7%, and 710.6/100 000) for the population in China in 2017; from 1990 to 2017, PAF for the 10 of the 16 stroke risk factors increased and the other 6 decreased, with the highest increase (90.0%) for high body mass index and the greatest decrease ( – 71.3%) for indoor air pollution. Conclusion In China, the disability caused by stroke is increasing gradually and although being effectively controlled, stroke-related premature death is still the main contribution of disease burden. Primary prevention strategies should be promoted to alleviate the disease burden of stroke.

Disease Burden and Attributable Risk Factors of Ovarian Cancer From 1990 to 2017: Findings From the Global Burden of Disease Study 2017.

Aim: We aimed to estimate the disease burden and risk factors attributable to ovarian cancer, and epidemiological trends at global, regional, and national levels.Methods: We described ovarian cancer data on incidence, mortality, and disability-adjusted life-years as well as age-standardized rates from 1990 to 2017 from the Global Health Data Exchange database. We also estimated the risk factors attributable to ovarian cancer deaths and disability-adjusted life-years. Measures were stratified by region, country, age, and socio-demographic index. The estimated annual percentage changes and age-standardized rates were calculated to evaluate temporal trends.Results: Globally, ovarian cancer incident, death cases, and disability-adjusted life-years increased by 88.01, 84.20, and 78.00%, respectively. However, all the corresponding age-standardized rates showed downward trends with an estimated annual percentage change of −0.10 (−0.03 to 0.16), −0.33 (−0.38 to −0.27), and −0.38 (−0.32 to 0.25), respectively. South and East Asia and Western Europe carried the heaviest disease burden. The highest incidence, deaths, and disability-adjusted life-years were mainly in people aged 50–69 years from 1990 to 2017. High fasting plasma glucose level was the greatest contributor in age-standardized disability-adjusted life-years rate globally as well as in all socio-demographic index quintiles and most Global Disease Burden regions. Other important factors were high body mass index and occupational exposure to asbestos.Conclusion: Our study provides valuable information on patterns and trends of disease burden and risk factors attributable to ovarian cancer across age, socio-demographic index, region, and country, which may help improve the rational allocation of health resources as well as inform health policies.

Examining geographical accessibility to multi-tier hospital care services for the elderly: A focus on spatial equity

BackgroundWith the rapid demographic shift towards an ageing society, it is a concerted effort to facilitate elderly's access to healthcare in order to maintain and improve their quality of life. In China, hospital care services dominate the healthcare market, which requires a better understanding of accessibility to hospitals in order to rationally allocate resources in spatial and land use planning. However, little attention has been paid to analysing the geographical accessibility to hospitals specific to the elderly population. ObjectivesThe objective of this study is to examine the spatial access to multi-tier – primary, secondary, and tertiary – hospital care services for older adults with an explicit focus on equity – the (un)even distribution of geographical accessibility. MethodsBuilding on the revealed travel patterns of elderly's medical trips, this study measures the level of accessibility at the sub-district level and assesses the inter- and intra-district disparities in Nanjing, China. To this end, we draw on the city's GIS database and the 2015 Nanjing Travel Survey. A two-step floating catchment area method was utilised to measure accessibility and the Gini coefficient was applied to show inequity. ResultsIt is found that spatial distribution plays a significant role in the accessibility to hospital services. Upper-tier hospitals are more aggregated and thus more unevenly accessible than the lower-tiers. In addition, accessibility to different tiers of hospitals varies greatly throughout the city, with pockets of deprived access identified on the outskirts. Imbalance and inequality of access to hospitals are also present within districts, displaying an increasing trend from the city centre to periphery. ConclusionsThese empirical findings provide insights for health interventions in order to improve equitable access and rational allocation of health resources. This paper also bears relevance for strategically advancing the hierarchical healthcare systems in China from a geographical perspective.

Application of GIS Spatial Analysis and Scanning Statistics in the Gynecological Cancer Clustering Pattern and Risk Screening: A Case Study in Northern Jiangxi Province, China.

ObjectiveThe incidence of gynecological cancer is high in China, and the effects of related treatments and preventive measures need to be improved.MethodsThis study uses GIS spatial analysis methods and a scanning statistical analysis to study the major gynecological cancers in northern Jiangxi Province from 2016 to 2018.ResultsThe incidence and spatial pattern of cervical cancer, ovarian cancer, and uterine cancer had agglomeration characteristics and changes during the study period. The gynecological cancer had a spatial autocorrelation and agglomeration in its spatial pattern. The Moran’s Index of the overall gynecological cancer incidence rate was 0.289 (p = 0.005). Ripley’s L(d) function showed that the agglomeration radius was between 51.40 and 52.82 km. The results of the kernel density estimation showed that the cases of gynecological cancer were concentrated in the central and northeastern areas of the study area. The overall county-level incidence of gynecological cancer varied from 0.26 to 11.14 per 100,000. The results of the gravity center analysis showed that the spatial distribution of the gravity center point of gynecological cancer had moved toward the east during the past three years. The results of a hotspot analysis showed that there were five hotspot areas that had gynecological cancers. The most likely clusters of gynecological cancer at the county level in northern Jiangxi Province were distributed in the adjacent areas of Jiujiang, Yichun, and Nanchang, with a relative risk of 1.85.ConclusionThe research shows that GIS can display the distribution of cancer cases and can use spatial analysis methods and scanning statistical techniques to obtain key areas of cancer incidence. These results can provide data and key areas for the formulation of regional public health policies and provide recommendations for cancer screening and the rational allocation of health resources.

Primary health institutions preference by hypertensive patients: effect of distance, trust and quality of management in the rural Heilongjiang province of China

BackgroundTraditional “inverted triangle” healthcare resources allocation model in China has wasted a lot of health resources. The Chinese health reform began to strengthens the role of the primary health institutions in delivering primary health care especially in rural areas in the background of large development gap between urban-rural health and rapid growth in the incidence of chronic diseases in rural. We take hypertensive patients as an example, to verify the effect of policy implementation through distribution characteristics of rural primary health institutions preference of hypertensive patients and explore the influencing factor that promoting rationalized use of medical care for patients with chronic disease as well as rational allocation of health resources in rural areas.MethodsA cross-sectional survey was conducted in Heilongjiang, a province in northeastern China by using a self-designed questionnaire. Stratified cluster sampling was used to choose 484 hypertensive patients from two villages in Heilongjiang province in 2010.ResultsAbout 88.4% of respondents reported preferred primary health institutions (83.5% preferred village clinics and 4.9% preferred township hospitals), 49.4% of respondents knew hypertension management administered by primary health institutions, 53.5% received hypertension education from primary care physicians, more than half of respondents reported that they didn’t receive telephone interviews and family visits from primary care physicians over the past 6 months. Residence closer to the primary health institutions (OR = 10.360), trust in village doctors (OR = 7.323), elders (OR = 3.001), and asked for return visits by primary health physicians (OR = 2.073) promote preferences for primary health institutions.Conclusions: Accessibility to primary healthcare and doctor-patient trust stimulate patients to choose the primary health institutions. Primary health institutions should improve general approach to hypertension management and enhance the ability of providing basic public health services.

Forecasting the seasonality and trend of pulmonary tuberculosis in Jiangsu Province of China using advanced statistical time-series analyses.

ObjectiveForecasting the seasonality and trend of pulmonary tuberculosis is important for the rational allocation of health resources; however, this foresting is often hampered by inappropriate prediction methods. In this study, we performed validation research by comparing the accuracy of the autoregressive integrated moving average (ARIMA) model and the back-propagation neural network (BPNN) model in a southeastern province of China.MethodsWe applied the data from 462,214 notified pulmonary tuberculosis cases registered from January 2005 to December 2015 in Jiangsu Province to modulate and construct the ARIMA and BPNN models. Cases registered in 2016 were used to assess the prediction accuracy of the models. The root mean square error (RMSE), mean absolute percentage error (MAPE), mean absolute error (MAE) and mean error rate (MER) were used to evaluate the model fitting and forecasting effect.ResultsDuring 2005–2015, the annual pulmonary tuberculosis notification rate in Jiangsu Province was 56.35/100,000, ranging from 40.85/100,000 to 79.36/100,000. Through screening and comparison, the ARIMA (0, 1, 2) (0, 1, 1)12 and BPNN (3-9-1) were defined as the optimal fitting models. In the fitting dataset, the RMSE, MAPE, MAE and MER were 0.3901, 6.0498, 0.2740 and 0.0608, respectively, for the ARIMA (0, 1, 2) (0, 1, 1)12 model, 0.3236, 6.0113, 0.2508 and 0.0587, respectively, for the BPNN model. In the forecasting dataset, the RMSE, MAPE, MAE and MER were 0.1758, 4.6041, 0.1368 and 0.0444, respectively, for the ARIMA (0, 1, 2) (0, 1, 1)12 model, and 0.1382, 3.2172, 0.1018 and 0.0330, respectively, for the BPNN model.ConclusionBoth the ARIMA and BPNN models can be used to predict the seasonality and trend of pulmonary tuberculosis in the Chinese population, but the BPNN model shows better performance. Applying statistical techniques by considering local characteristics may enable more accurate mathematical modeling.

[Study of the prevalence and disease burden of chronic disease in the elderly in China].

Objective: To understand the prevalence and disease burden of major chronic diseases in the elderly in China and provide scientific basis for the prevention and control of chronic diseases and for the rational allocation of health resources. Methods: We analyzed the prevalence of chronic diseases in residents aged ≥60 years in China by using national and provincial surveillance data of chronic diseases and related risk factors in China. We conducted the analysis on the burden of chronic diseases in the elderly in China by using the data of global burden of disease. Results: The prevalence rates of hypertension, diabetes and hypercholesterolemia were 58.3%, 19.4% and 10.5% respectively in residents aged ≥60 years in China. Up to 75.8% of the residents aged ≥60 years had at least one chronic disease. The prevalence rate was higher in women than in men, higher in urban area than in rural area. With the increase of age, the prevalence rate of chronic diseases also increased. The top three chronic diseases with heavy disease burden in residents aged ≥70 years were stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease. Conclusion: The prevalence of major chronic diseases in the elderly is high with three quarters of the elderly suffering from at least one chronic disease, and the burden of chronic diseases is increasing.

Disease Profile and Outcome of Patients Admitted to A Pediatric Intensive Care Unit

Background: Pediatric Intensive Care Unit (PICU) has very important role in the management of critically ill children who require advanced airway, respiratory, and hemodynamic supports with the aim of achieving a better outcome. To describe the clinical spectrum and outcome patterns of diseases managed at PICU in Chittagong Medical College Hospital (CMCH) in order to provide data, which will assist in improving the management of diseases and the rational allocation of health resources. Materials and methods: It was a retrospective crosssectional study in which records of admissions of children from 29 days to 12 years of age were obtained from the PICU records. Results: A total of 851 patients were analyzed during the period of October 2015 to December 2016, of which 533 (62.6%) were males and 318 (37.3%) were females. The mean duration of hospital stay was 5.2 ±2.1 days (Range 0- 20 days). Among admission cases, Central Nervous System (CNS) was the most common system affected in our study 356 (41%) followed by respiratory system 263(31%) sepsis 89(10.45%) and cardiovascular diseases 55(%). We observed overall mortality rate 46.1%and Leave Against Medical Advice (LAMA) 4.11%. Highest mortality occurred in age group of 29 days to 1 year. Children with encephalitis and sepsis had higher mortality 25% and 21% respectively. Conclusion: The leading cause of admission was CNS infection followed by respiratory diseases and sepsis. The overall mortality rate in our PICU was high. A wellequipped intensive care unit with modern and innovative facilities along with the availability of fulltime trained pediatric intensivists made a significant impact on the outcome of critically ill children in our PICU.&#x0D; JCMCTA 2018 ; 29 (1) : 11-16

Risk factors for death in children with severe hand, foot, and mouth disease in rural area in Sichuan, China

Background: Hand, foot, and mouth disease (HFMD) causes substantial disease burden in the Western Pacific region particularly in young children below 5 years of age. In recent years, outbreaks of hand, foot, and mouth disease (HFMD) have increased throughout the mainland of China, especially in rural areas. Methods & Materials: A case–control study was designed to examine risk factors associated with death from severe HFMD. A total of 221 severe HFMD cases from 2012 to 2016 in rural area were collected from the National Surveillance System. Results: Multifactorial logistic regression was used to analyse independent associations between potential influence factors and death from severe HFMD in rural area in Sichuan. We found that the children whose parents went out to work were more likely to die from severe HFMD than the children lived with parents (OR = 2.18, 95%CI: 1.02–6.35). Additionally, the children whose first visit was to a village-level clinic had a high risk of death from severe HFMD. Patients with EV71 infection or persistent fever, symptoms of convulsion, coolness of extremities, and vomiting had an increased risk of death from severe HFMD (all p < 0.05). While breastfeeding children and having a confirmed diagnosis at the first visit to the hospital were identified as protective factors for death from severe HFMD (OR = 3.77 and 1.91, 95%CI: 2.01-8.33 and 1.01-2.69). Conclusion: To reduce the mortality from severe HFMD in rural area, parents and health care providers need to pay attention to the patients with EV71 infection or with high-risk symptoms. Health administration departments should pay more attention to the rational allocation of health resources and increase financial support and manpower in village-level health institutions.

Risk factors for death in children with severe hand, foot, and mouth disease in Hunan, China

Background: In recent years, outbreaks of hand, foot, and mouth disease (HFMD) have increased throughout East and Southeast Asia, especially in mainland China. The disease now presents as an increasingly serious public health threat in China.Methods: A case–control study was designed to examine risk factors associated with death from severe HFMD. A total of 553 severe HFMD cases were collected from the National Surveillance System.Results: Multifactorial logistic regression was used to analyse independent associations between potential influence factors and death from severe HFMD. We found that the migrants were more likely to die from severe HFMD than the resident population (OR = 3.07, 95%CI: 1.39–8.32). Additionally, the children whose first visit was to a village-level clinic had a high risk of death from severe HFMD. Patients with EV71 infection or symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting had an increased risk of death from severe HFMD. While breastfeeding children, having a confirmed diagnosis at the first visit to the hospital and with symptom of hyperarousal were identified as protective factors for death from severe HFMD.Conclusions: To reduce the mortality from severe HFMD, doctors and health care providers need to pay attention to the patients with EV71 infection or with symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting. Health administration departments should pay more attention to the rational allocation of health resources. Furthermore, they should increase financial support and manpower in village-level health institutions.

Delisting Policy Reform in South Korea: Failed or Policy Change?

ObjectivesThe sustainability of national health insurance in South Korea has been under threat because of the relative and absolute high expenditure on drugs and its fast rate of increase. According to this need, a Drug Expenditure Rationalization Plan (DERP) was enacted in late 2006, and a reevaluation project to delist drugs started in 2007 as one part of the DERP. MethodThis article follows the process of the delisting policy in Korea. It addresses the history of the policy implementation and its changes, content, and impact and suggests a more reasonable policy direction, thereby setting a helpful example for other countries. ResultsAfter a pilot reevaluation and the subsequent evaluation of a hypertension drug, the DERP fell into arrears as regards its original time line mainly because of the difficulties in developing methodologies and the government's inexperience in managing a megascale reevaluation project. The confusion and conflicts during the evaluation became a major burden on the government and society. Finally, the government changed the framework of the delisting policy from reevaluation based on cost-effectiveness to across-the-board price reductions aiming at the quick attainment of financial savings and minimizing conflict between the government and stakeholders. ConclusionsThe government should lead the project with a more consistent and sustainable assessment framework of cost-effectiveness as the tool for the rational allocation of health resources, providing strong leadership and political will and a far-sighted view rather than focusing on compromise with special interest groups. In addition, development of more practical and multidimensional evaluation methodology is needed.

The Global Burden of Disease Study: a useful projection of future global health?

One major conclusion of the Global Burden of Disease Study (GBDS) is that the global burden of disease will not change significantly from 1990 to 2020, in developed regions, developing regions or as a whole. Using the disability-adjusted life year (DALY), the Study estimates the burden as a result of 107 diseases, accidents and their disabling sequelae, disaggregated with respect to cause, sex, age and geographical region. The basic data used to construct estimates are sparse, and the DALY as a tool has received many criticisms. It obscures the distribution of disease and its impact in terms of handicap, and includes several social and economic value judgements. This weakens its power as a guide for the rational allocation of health resources at any point in time. Does it have use in guiding future planning and preventive action? At a global level, exceeding ecological capacity primarily through relative overpopulation is likely to be the greatest threat to overall health, yet overpopulation is not considered as a risk factor in itself. This reflects the understanding of health as an issue of the individual rather than the community. Together with the productivity-orientated weighting of DALYs, the Study appears to be more concerned with cost-effectiveness of health interventions rather than their equity. This underlies the reservations of the World Health Organization regarding the Study's use as a rational tool in health policy.

Admission patterns and outcomes in a paediatric intensive care unit in South Africa over a 25-year period (1971-1995).

To describe admission and outcome patterns of diseases managed at a paediatric intensive care unit (PICU) in a developing country between 1971 and 1995, in order to provide data which will assist in improving the management of diseases and the rational allocation of health resources. This study is based on data collated from annual audits conducted by the head of the PICU, King Edward VIII Hospital, Durban, South Africa. This unit serves a childhood population of about 3-4 million aged from 0-12 years. The proportion of children admitted to the ICU as a percentage of the general paediatric admission has increased from 1.5% in 1971 to 7% in 1995. During this period, 7580 children were admitted to the unit, an average of 303 cases per annum. The overall mortality rate was 35.44% (range 29.9 to 45.4%); over 90% of the children admitted were intubated and 80% required intermittent positive pressure ventilation. Common childhood vaccine preventable infections have declined substantially and have been replaced by HIV related syndromes, lower respiratory tract infections, metabolic disorders, septicaemia and hyaline membrane disease. The mean duration of ICU stay per survivor over the study period 1991-1995 was 13.891 days. Tetanus, septicaemia and HIV related diseases required the longest ICU stay per survivor (>20 days), while accidental injuries, neonatal apnoea and asthma required the shortest duration of ICU stay per survivor (<6 days); 23.9% of all deaths occurred in the first 24 h. The profile of diseases in children admitted to this PICU has changed considerably over 25 years. Some of these changes can be attributed to the shift in emphasis to primary health care, especially higher vaccination coverage rates. Profitable utilisation of limited ICU facilities would probably be enhanced by the use of outcome measures such as mortality and mean number of ICU days of stay per survivor.

The QALY: A guide for the public health physician

This paper considers the background to the rational allocation of health resources at DHA level within the context of the new purchaser/provider regime. A popular approach to this problem has been that of cost utility analysis, using quality adjusted life years (QALYs) as the measure of the benefit derived from a health intervention. This paper seeks to offer the practising public health physician an appraisal of the practical value and pitfalls of a QALY-based approach. To this end, the theoretical background to QALYs and their practical use are described and some of the practical and ethical problems and pitfalls are discussed. It is concluded that the QALY concept provides a useful tool in aiding decision making in the allocation of health care resources, but that it is too early for a universal application of the approach.