农村医疗机构产权制度改革有关问题的思考

随着社会主义市场经济体制的逐步建立和完善 ,随着卫生改革的不断推进和深化 ,农村医疗机构为了在市场竞争中求生存、求发展 ,开始探索产权制度改革 ,转换经营机制 ,增添新的活力 ,并取得了一定成效。但是农村医疗机构产权制度改革有其特殊性 ,特别是随着国家医药卫生体制改革意见的出台 ,营利性、非营利性医疗机构的划分 ,医疗机构产权制度改革已成为人们关注的重要内容 ,是社会各界尤其是卫生界研究的一项重要课题。为了推动医疗机构产权制度改革的逐步深入 ,本文结合漯河市农村医疗机构产权制度改革的主要做法和经验 ,就有关问题与大家探…     

医疗机构实行股份制改革的探讨

从合理配置卫生资源、提高资源利用效率角度来看,进行医疗机构产权制度改革是卫生改革的必然趋势,也是卫生改革的难点。笔者就医疗机构改革的益处、存在的问题、应注意的几个问题进行剖析和阐述。     

区域卫生经济研究的盛会--华东卫生经济研究协作会第十七次学术年会圆满落幕

2001年10月16～18日,华东卫生经济研究协作会第17次学术年会在山东省青岛市召开。参加会议的有华东7省(市)卫生经济学会的负责人、卫生厅(局)规财处处长及论文作者60余人。年会交流论文35篇。复旦大学公共卫生学院胡善联教授作了题为《卫生经济的研究进展——第三届国际卫生经济学术会议情况介绍》的报告。在讨论中与会代表就卫生改革与发展的热点问题各抒己见,畅所欲言。一些同志还提出了很好的意见和建议。年会的时间虽短,大家的共同感觉是收获颇丰。 关于医疗机构产权制度改革问题。与会代表认为,结合医疗卫生特点,探索各种经营方式,建设适应市场经济体制要求、权责明确的现代产权制度,是公立医疗机构实现体制创新的现实选择;产权制度改革的核心是保障国家所有权,落实医疗机构经营权。随着改革的不断深入,医疗机构产权制度改革将呈现多样化格局。关于医疗机构分类管理。代表们认为,从     

卫生医疗机构转换经营机制初探

《中共中央、国务院关于卫生改革与发展的决定》指明了卫生改革发展的方向,形成适应社会主义市场经济体制和人们健康需求的、比较完善的卫生体系,在卫生事业改革中,医疗机构如何转换经营机制成了需研究解决的新课题,为此,作如下粗浅的探讨。一、加快医疗机构产权制度改革,确立医疗机构市场的主体地位     

关于医疗机构产权制度改革的思考

医疗机构产权制度改革,是深化卫生改革绕不开的现实问题。在中国、建立适应市场经济的医疗机构产权制度：首先应产权主体明确,产权关系清晰;其次应用合理、具体的产权配置、形成医疗机构内部产权结构多元化;再次要建立一整套规范的保护和实现产权关系的法律制度,以期更好地发挥新的产权制度的功能和作用。     

对医疗机构改革深层次问题的思考

随着卫生改革的不断深化，医疗机构一些深层次的矛盾日益暴露出来，卫生资源利用不足已成为制约卫生事业发展的重要因素，因此各地都在研究医疗机构改革问题，大胆模索改革的实践，对此引发了几点思考。１医疗机构产权制度改革问题《中共中央、国务院关于卫生改革与发展的...     

对医疗机构产权制度改革的若干认识

1 医疗机构产权制度改革的必然性 医疗机构产权制度改革己经在若干省市付诸实施,有的省市领导对此非常重视,并在比较大的范围内展开。这究竟是企业改制风潮掀起的小浪花,还是卫生改革巨浪初露端倪? 从根本上讲,我国现阶段的国情是:我国正处于社会主义初级阶段;我国经济体制改革的目标模式是建立社会主义市场经济体制,而且已经初步建立框架。正是这两点决定了我国医疗机构产权制度改革不是偶然的,而是一种必然的发展趋势。1.1 我国卫生资源总量不足 我国正处于社会主义初级阶段,国家财力有限、国家卫     

医疗机构产权制度改革的调查研究

《中共中央、国务院关于卫生改革与发展的决定》指出：卫生改革“要适应社会主义市场经济的发展，遵循卫生事业在内在规律。”这为卫生发展与改革指明了方向，要求改革当前的卫生管理体制，增强医疗机构的生机与活力，更好地满足人民群众对医疗隆重的多层次需求，不断提高医疗服务水平，而产权制度改革则是我们改革的一种探索，产权制度改革的效果、国家、单位、职工等各方对改革的满意度和接受度、产权制度改革前后各方的观念转变程度如何、单位经营观念、经营效果、社会效果是否因产权改制而发生显著变化等等。这些都与卫生体制改革的顺利开展密切相关，研究产权制度改革的效果，可以使有关部门及单位清醒地认识到医疗机构当前面临的机遇和挑战，体制改革在社会主义市场经济条件下的必要性，吸取试点单位改革当中取得的经验，发现其中的问题，以便在以后的系列改革中，有的放矢，保证改革的顺利进行。     

医疗机构产权转制运行操作的理论探讨

为深入贯彻党的十五届四中、五中全会和《国务院办公厅转发体改办等部门关于农村卫生改革与发展指导意见的通知》精神 ,加快医疗机构产权制度改革步伐 ,促进医疗卫生事业的健康快速发展 ,积极探索医疗机构产权制度改革的稳妥、有效途径 ,从而实现医疗机构产权人格化、资本社会化、筹资多元化、经营市场化、管理科学化 ,达到优化卫生资源配置 ,调动一切积极因素 ,不断提高卫生服务质量和效率 ,增强卫生事业生机与活力的目的。医疗机构产权在转制过程中 ,必须坚持实事求是、因地制宜 ,因院施策 ,多种形式 ,稳中求进 ,成熟一个转制一个的原则。…     

医疗机构产权制度改革探讨

探讨医疗机构产权制度的形成;医疗机构产权制度改革的动因;医疗机构产权制度改革的主要形式,以及医疗机构产权制度改革的评价,认为医院改制既有积极效应,又有待解决的问题.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.