我国省际卫生经济投入产出的动态效率测度研究

我国省际卫生经济投入产出的Malmqust生产率指数在绝大多数地区呈现平均上升趋势.我国卫生经济投入产出效率增长较快的省份,其生产率增长源泉几乎都来自于技术进步的变化,与此同时,相对于技术的不断进步,中国省际卫生经济的资源配置效率并未获得相应改善.相对于中西部地区,东部地区各省区的相对技术效率呈下降趋势;而从技术进步变化趋势看,除了西部几个省份以外,2002～2007年间全国各省区卫生经济投入产出的技术进步效应都非常显著.相对技术效率的进一步分解结果表明,西部各省区的卫生经济投入产出并未出现拥挤状态,此时的规模无效应该是卫生资源投入不足所导致.     

2012-2021年全国中医医院卫生资源配置效率分析

[目的]分析2012-2021年我国中医医院卫生资源配置效率,为优化资源配置提供参考。[方法]利用数据包络分析与Malmquist指数评价我国中医医院卫生资源配置效率。[结果]2021年全国仅6个省份中医医院综合效率相对有效发展。2012-2021年全国中医医院卫生资源总量呈上升趋势,卫生资源配置的全要素生产率(TFP)呈不规则变化,年均下降1.5%,综合效率年均下降1.0%,技术变动效率年均下降0.5%。[结论]我国中医医院效率总体偏低,应优化卫生资源配置;中医医院资源配置存在省际间差异,应平衡省域间的服务提供水平;我国中医医院机构冗余现象明显,应合理调整投入;中医医院技术与组织管理水平总体下降,应提高技术进步率、探索更高效的组织管理模式。     

我国省域卫生资源利用效率的实证研究

目的 了解我国31个省的卫生资源利用率的动态变化及影响因素,为更好地促进我国卫生资源的有效利用提供科学的基础资料和参考.方法 采用基于数据包络分析(DEA)的Malmquist指数分解对我国2007—2012年卫生资源面板数据(3项投入指标,4项产出指标)进行分析.结果 5年间我国卫生资源生产率的年平均增长率为3.4%,再一步分解发现效率变化年平均增长率小于1%,而技术变化年平均增长率为2.8%;纯技术效率年平均增长0.5%,规模效率年平均减退9.9%.结论 我国卫生资源生产率增长较缓慢,并且主要得益于技术进步,存在技术衰退的现象,应合理调配卫生资源的管理和配置,激发纯技术效率和规模效率.     

四川省民族地区卫生资源配置及需求预测研究

目的 评价“十三五”以来四川省民族地区卫生资源配置公平性和利用效率,并预测其卫生资源需求,为民族地区进一步优化卫生资源配置提供参考。方法 基于人口、地理维度,利用集聚度评价四川省民族地区卫生资源配置公平性,借助数据包络分析评价卫生资源利用效率,并采用卫生资源密度指数进行需求预测。结果 每千人口卫生资源拥有量和每平方公里卫生资源拥有量均呈增长趋势; 基于人口配置的卫生资源公平性优于地理维度; 甘孜、阿坝的卫生资源集聚度最低; 2020年四川省民族地区卫生资源综合效率、纯技术效率、规模效率均值分别为0.815、0.905、0.898; 民族地区执业(助理)医师(271.27%)、注册护士(190.23%)、卫技人员(172.68%)的缺乏比例高。结论 四川省民族地区卫生资源地理公平性差,区域内差异显著; 甘孜、阿坝的卫生资源配置公平性亟需改善; 卫生资源利用效率有待提升,规模收益差异明显。     

应用数据包络分析评价我国卫生资源的省际效率研究

目的探讨我国各省区医疗资源投入产出效率,了解我国医疗资源规划情况,为我国进一步合理规划医疗资源提供科学依据。方法使用数据包络分析对我国不同省份医疗资源的利用效率进行研究与比较。研究从《2012年中国卫生统计年鉴》中提取31个省,自治区,直辖市医疗卫生资源的6项指标及其数据,利用DEAP软件测算我国省份之间卫生资源的利用效率。结果 DEA总体有效共有11个省份,占全国比例35.5%,综合效率,技术效率与规模效率由高到低均呈现"东部—西部—中部"的格局,而规模报酬则"中部—东部—西部"逐渐递减。结论本研究表明中部地区医疗资源利用效率不足,有待改善的现状。省际之间医疗资源利用效率有待提高。     

我国省域医疗服务的全要素生产率

目的测算我国各省域医疗服务的全要素生产率,为持续提高我国医疗服务的全要素生产率提供科学参考和政策建议。方法基于2009—2016年我国31个省域(不含港澳台地区)医疗服务投入和产出的面板数据,采用Bootstrap-Malmquist数据包络分析,测算医疗服务的全要素生产率。结果 2009—2016年,东、中、西部和全国的年均全要素生产率分别增长了1.8%、2.2%、0.8%和1.5%。分解各省域的Malmquist全要素生产率变化指数后,技术效率变化指数增幅为中部东部西部;技术进步指数增幅为东部中部西部。结论 2009—2016年我国省域全要素生产率略有增长,但东、中、西部增长不均衡。建议:国家鼓励符合条件的省域引入区域医疗绩效评价,作为优化区域卫生资源配置的治理工具;东、中、西部均需大力推进医药产业的技术创新;西部地区应大力提升信息化水平,探索远程医疗,完善人才建设,以吸引人才、留住人才、培养人才。     

基于DEA模型的新疆哈密地区卫生资源运行效率评价

目的研究分析2009—2015年新疆哈密地区整体卫生资源投入和产出的具体情况,针对不同投入和产出多重组合的交叉作用效果,试探索影响该地区卫生资源利用效率的因素,为能够提高该地区卫生服务运行效率提供参考依据、指明方向。方法依据投入、产出指标的类型,此研究采用数据包络分析法的BBC模型进行分析研究,以业务、经济和服务3个角度作为切入点,分析评价其卫生资源运行效率状况。结果业务效率模型,该地区卫生资源以2012年(整体效率为1)为界,此前年度处于规模报酬递增状态,此后年度处于规模报酬递减状态;经济效率模型,首尾年度整体效率为1,呈现固定规模状态,但大部分年度处于规模报酬递减状态;服务效率模型,卫生资源效率整体呈波动状态。2009—2015年该地区卫生资源规模报酬持续波动,资源利用率还有一定提升空间。业务效率和经济效率在2015年基本达到有效,服务效率有待提高。结论哈密地区医疗业当前效率低下的主要掣肘来源于经营规模,医疗改革的重点方向在于发挥好规模效率部分。医疗部门应该综合权衡各方面的目标,制定出合理的规模发展方向,对医疗资源进行优化配置,实现公益性与收益性的统一。     

基于DEA的陕西省卫生资源配置效率评价

目的:对陕西省卫生资源配置效率进行研究,探索优化资源配置的措施和途径,为新一轮卫生资源配置研究提供政策建议。方法:采用数据包络分析(DEA)理论及方法,对陕西省卫生资源配置的横向及纵向效率进行相对有效性评价及分析。结果:DEA横向评估中,卫生资源配置效率存在地区差异,5个市卫生资源配置效率呈相对无效状态;DEA纵向评估中,2000-2009年卫生资源配置综合效率不断提高,规模效率递增,2007-2009三年规模效率不变。结论:加大政府投入,加强区域卫生规划实施力度;以存量调整、结构优化、管理水平改进为主要手段,促进资源优化配置。     

基于DEA和Malmquist指数的我国省域卫生资源配置效率评价

目的通过对2008-2012年我国31个省、自治区、直辖市的面板数据和横截面数据的收集,对我国省域卫生资源配置效率进行静态和动态两方面的评价并提出相关建议。方法采用文献研究法和数据包络分析法中的CCRBCC模型和M almquist指数模型。结果 2012年31个省市中的平均综合效率值为0.980,总体有效省市20个,非总体有效省市11个,分别占被评价省市的64.5%和35.5%。2008-2012年我国各省区医疗资源配置效率的全要素生产率年均提高了10.0%,总体处于上升趋势。结论非总体有效的11个省市为提高卫生资源配置效率需要加大政府投入力度,优化卫生投入规模,改善医疗管理水平。而进一步提升我国各省、市卫生资源配置的全要素生产率,应在重视技术进步与创新的同时,也应高度重视组织管理水平的提升。     

我国西部地区乡镇卫生院资源配置状况分析

[目的]分析和评价我国西部地区乡镇卫生院资源配置的利用效率与公平性,为西部地区基层卫生资源规划提供参考和依据。[方法]收集2012-2017年西部地区乡镇卫生院的相关数据,运用数据包络分析法评价资源配置的效率,并使用集聚度分析探讨乡镇卫生院资源配置的公平性。[结果] 2017年西部地区中,云南、宁夏、广西3省乡镇卫生院资源配置有效,其综合效率、技术效率、规模效率均为1;西部地区纯技术效率和规模效率的均值分别为0. 869和0. 791; 2012-2017年西部地区乡镇卫生院的各项资源集聚度均远小于1,而其与人口集聚度的比值数大致接近于1。[结论]西部地区乡镇卫生总体的院资源配置效率不高,按人口数量配置的公平性优于按地理面积配置的公平性。但省际配置公平性的差距较大,部分经济落后省份在乡镇卫生人员的配置上存在不公平。西南地区乡镇卫生院资源的可及性优于西北地区,而其按人口分布的均衡性较西北差。     

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.     

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.     

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.     

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.