我国家庭医生签约服务政策执行的制约因素与优化路径：基于史密斯政策执行过程模型

深化家庭医生签约服务是深化医药卫生体制改革、强化基层医疗卫生服务、实现"健康中国"战略目标的重要选择，也是当前更好维护人民群众健康的重要途径。为有效推进签约服务工作，国家陆续推出各项政策，全国各地也在积极进行实践探索，成效明显。但是，签约服务仍面临诸多问题，其中"执行难"是签约服务深度推进的一大困境。通过史密斯政策执行过程模型，结合签约服务政策执行过程，发现签约服务仍存在法治性不足、政策执行人员水平不高、激励不足、政策环境影响等诸多制约因素。因此，需要从法律和制度方面进行顶层设计、提升执行人员素质和职业认同、建立医患互信、优化政策执行环境等角度进行政策创新，探索家庭医生签约服务可持续发展的路径。     

The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

美国中东政策评析

美国在中东遇到大麻烦,主要战略目标未能实现。伊拉克安全形势持续严峻,巴以和谈停滞不前,伊朗核问题难以解决,压叙利亚屈服迄未奏效,恐怖活动越反越多,大中东改造计划受挫。美遇到的困难未超出其承受能力,美国在中东仍居主导地位,美中东政策在手法和策略上有所调整,实质上并无变化。     

五所医院特需医疗服务状况调查

通过对上海医科大学附属华山医院、协和医院、北京同仁医院、中山医科大学附属第一医院、浙江医科大学附属第二医院开展的特需医疗服务情况的调查，论述了五所医院的具体做法，在对调查结果进行分析的基础上，就特需医疗服务的管理提出了建议。     

21 d-6°头低位卧床期间运动训练对动态姿态平衡的影响

目的探讨21 d-6°头低位卧床和卧床运动训练对动态姿态平衡和控制功能的影响. 方法 10名健康男性青年被试者分为卧床对照组和卧床训练组,每组5人,卧床期间训练组每天进行2次、每次30 min逐级增加负荷的头低位功率自行车训练;分别于卧床前和卧床后21 d进行了动态姿态平衡和双膝等速肌力的测试. 结果与卧床前相比,对照组动态本体感觉得分和运动控制适应能力明显降低,双膝相对峰力矩明显降低,同时伴有腘绳肌与股四头肌峰力矩屈/伸比值的明显增加;训练组动态本体感觉得分和运动控制适应能力明显高于对照组,而腘绳肌与股四头肌峰力矩屈/伸比值无明显改变. 结论 21 d-6°头低位卧床运动训练能够明显改善卧床后动态姿态平衡及其动态运动适应功能.     

Economic appraisal of laser applications in health care. Report of a project

This article reports on the results of a project evaluating effectiveness and cost-effectiveness of laser applications in health care. The literature was collected, emphasizing well-designed clinical trials and cost-effectiveness analyses. Few randomized clinical trials (RCTs) have been done outside the specialty of ophthalmology. Even fewer cost-effectiveness studies have been done, despite the frequent claims of cost-effectiveness in the medical literature. Review papers were commissioned, and a group of laser experts, economists, and policy-analysts met for 2 days to discuss the policy implications of lasers. The main conclusion from the conference is that inappropriate and unskilled use of lasers is presently the greatest problem with their application in health care.     

Pharmaceutical Policy and the Lay Public*

Almost every national and supranational health policy document accords high importance to the need to listen to and ‘empower’ patients. The relationship between pharmaceutical policy and the lay public is not direct but mediated by several actors, including health care workers, patient organisations, industry and, most recently, the media. Although the overall aim of health and pharmaceutical policy is to address the needs of all citizens, there are only a few, well organised groups who are actually consulted and involved in the policymaking process, often with the support of the industry. The reasons for this lack of citizen involvement in health and pharmaceutical policymaking are many, for example: there is no consensus about what public involvement means; there is a predominance of special interest groups with narrow, specific agendas; not all decision makers welcome lay participation; patients and professionals have different rationalities with regard to their views on medicine. Because the lay public and medicine users are not one entity, one of the many challenges facing policy makers today is to identify, incorporate and prioritise the many diverse needs. The authors recommend research which includes studies that look at: lay attitudes towards pharmaceutical policy; lay experiences of drug therapy and how it affects their daily lives; the problem of identifying lay representatives; the relationship between industry and the consumers; the effect of the media on medicine users and on pharmaceutical policy itself. The authors acknowledge that although lay involvement in policy is still in its infancy, some patient organisations have been successful and there are developments towards increased lay involvement in pharmaceutical policymaking. This article is the fourth in a series of articles on this topic that will appear in Pharmacy World & Science during 2005.     

聚醋酸乙烯酯与铜（Ⅱ）离子的配位反应及其催化作用

以ＥＳＲ、ＵＶ和ＩＲ表征Ｃｕ（２＋）离子与ＰＶＡＣ的配位反应。根据ＣＵＣｌ２·２Ｈ２Ｏ乙醇溶液与ＰＶＡｃ－ＣｕＣｌ２·２Ｈ２Ｏ乙醇溶液的电导率差值随Ｃｕ（２＋）离子摩尔浓度变化的明显转析点得知，１个Ｃｕ（２＋）离子大约能与ＰＶＡｃ４个链节单元配位。证实ＭＭＡ在Ｃｕ（Ⅱ）－ＰＶＡｃ配合物／Ｎａ２ＳＯ３体系的聚合体是无规ＰＭＭＡ，得率为７０％。讨论了ＭＭＡ在Ｃｕ（Ⅱ）－ＰＶＡｃ配合物／Ｎａ２ＳＯ３体系络合催化引发下的游离基反应历程。