简介：AbstractBackground:We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.Methods:We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.Results:A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r= 0.946, P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.Conclusions:More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.

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简介：ThehugewinterstormofDecember23–29,2015deliveredheavyrainfallinabroadswathacrosstheUSA,delugingEast-CentralMissouri.Recordhighriverlevelsweresetatmanysites,butdamagesweremostpronouncedindevelopedfloodplainareas,particularlywherehighleveeswerebuiltorriverchannelsgreatlynarrowed.Anaverageof20cmofrainthatmostlyfellinthreedaysimpactedtheentire10300km2MeramecBasin.Comparedtothepriorrecordfloodof1982,thehighestrelativestage(+1.3m)onMeramecRiveroccurredatValleyParkproximalto(1)anewlevee,(2)alandfillinthefloodway,(3)largefloodplainconstructionfills,and(4)tributarycreekbasinsimpactedbysuburbansprawl.Eventhoughonlyasmallfractionofthe1.8millionkm2MississippiRiverwatershedaboveSt.Louisreceivedextraordinaryrainfallduringthisevent,thehugechannelizedrivernearandbelowSt.Louisrapidlyrosetosetthe3rd-highesttothehigheststagesever,exhibitingtheflashyresponsetypicalofamuchsmallerriver.

简介：AbstractPurpose:Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods:During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results:In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion:There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

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简介：AbstractPurpose:It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.Methods:This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.Results:Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).Conclusion:Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

简介：AbstractBackground:Despite the availability of free tuberculosis (TB) diagnosis and treatment, TB care still generates substantial costs that push people into poverty. We investigated out-of-pocket (OOP) payments for TB care and assessed the resulting economic burden and economic consequences for those with varying levels of household income in eastern China.Methods:A cross-sectional study was conducted among TB patients in the national TB programme networks in eastern China. TB-related direct OOP costs, time loss, and coping strategies were investigated across households in different economic strata. Analysis of Variance was used to examine the differences in various costs, and Kruskal-Wallis tests were used to compare the difference in total costs as a percentage of annual household income.Results:Among 435 patients, the mean OOP total costs of TB care were USD 2389.5. In the lower-income quartile, OOP payments were lower, but costs as a percentage of reported annual household income were higher. Medical costs and costs prior to treatment accounted for 66.4 and 48.9% of the total costs, respectively. The lower the household income was, the higher the proportion of medical costs to total costs before TB treatment, but the lower the proportion of medical costs patients spent in the intensive phase. TB care caused 25.8% of TB-affected households to fall below the poverty line and caused the poverty gap (PG) to increase by United States Dollar (USD) 145.6. Patients in the poorest households had the highest poverty headcount ratio (70.2%) and PG (USD 236.1), but those in moderately poor households had the largest increase in the poverty headcount ratio (36.2%) and PG (USD 177.8) due to TB care. Patients from poor households were more likely to borrow money to cope with the costs of TB care; however, there were fewer social consequences, except for food insecurity, in poor households.Conclusions:Medical and pretreatment costs lead to high costs of TB care, especially among patients from the poorest households. It is necessary to train health system staff in general hospitals to promptly identify and refer TB patients. Pro-poor programmes are also needed to protect TB patients from the medical poverty trap.

简介：TherapidpopulationgrowthhasbeenamajorproblemofBeijing.Itaffectedontransportation,schoolingandhousing.On26thSeptember2011,BeijingPopulationandFamilyPlanningCommissionannouncedthattheywoulddraftpopulationassessmentprovisions.Governmentpolicieswouldbeissuedaccordingtopopulationplansforassessingtheireffectsonpopulationcontrol.

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简介：Agoodorbaddesign,equipmentdispositionandmanagementofIntensiveCareUnit(ICU)isoneoftheimportantstandardswhichjudgethemedicallevel.AstheinvestmentofequipmentsinICUissocostly,theproblemsofhowtodesignICUcorrectly,howtodisposetheequipmentsinitandhowtomanageICUmustbesolvedeffectively.WehaveworkedoutasetofmethodsfortheaboveproblemsthroughinvestigatingICUinseveralhospitals.

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简介：TibetantownsandvillagesaretheremotestareasinChinaregionalsociety.Theremotenessisevidentintwoaspects:(1)thenaturalenvironment;locatedinthesouthwesternfrontierofChina,asthecoreofthe'theThirdExtreme',Tibetclaimstobethefarthest

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简介：这期是2016年的最后一期杂志,一年再次结束,一年又将开始。这一年,儿子继续长大。四个伙伴相约滑雪。初生牛犊不怕虎,孩子们趁家长找教练时,上了高级道的缆车到达山顶,一个小伙伴摔了两跤后明智地等待救援,被巡逻的救援车带下山;一个小伙伴被救援教练带着,摔了五跤后总算滑到了山脚;儿子和另一个好朋友虽然也摔了跤,但是没有依靠外力,自己滑下了高级道,小脸儿神采飞扬,顾盼间自信爆棚,揉揉摔疼的屁股,俩个人结伴又上了高级道的缆车。

简介：本刊立足于我国教育经济发展与改革的实际,密切关注国内外教育经济学学科发展的动态,坚持以创建有中国特色的教育经济理论、为我国教育改革和发展服务、为教育经济学学科建设服务为宗旨,在广泛征求意见后,拟定2017年重要选题,供国内外学者及学界同仁参考。1.教育经济学学科建设2.教育供给侧结构性改革3.教育发展与新型城镇化建设的关系研究4.民族地区教育与民族地区经济社会发展的关系