从循证研究看卫生改革中的十大政策问题

本文从循证研究的角度对我国卫生改革中的10个重大政策问题进行了剖析,内容涉及基本医疗卫生制度的模式选择、基本药物制度、竞争、垄断、医疗价格、医疗保险基金管理和公立医院改革等,希望对调整和完善医药卫生体制改革政策有所借鉴.     

“三基”技能竞赛的实践和作用探析

"三基"是指基础理论、基本技能、基本知识,是医务人员要求掌握的最基本技能,它是继续医学教育的重要内容之一。实践证明,三基技能竞赛是继续医学教育的一种有效形式和有益补充,能有效促进院内继续医学教育的开展。     

Functional significance of men’s testosterone reactivity to social stimuli

Rapid testosterone fluctuations in response to social stimuli are observed across a wide range of species, and the highly conserved nature of these fluctuations suggests an adaptive function. This paper reviews the current literature on testosterone reactivity, primarily in human males, and illustrates how life-history theory provides an adequate theoretical framework to interpret findings. The review is structured around supporting evidence suggesting that situations implicated in mating effort either directly (e.g., interactions with a mate) or indirectly (e.g., intrasexual competition) are generally associated with a brief elevation of testosterone, while situations implicated in parenting effort (e.g., nurturant interactions with offspring) are generally associated with a decline in testosterone. Further, we discuss how these fluctuations in testosterone have been linked to future behaviors, and how situational, motivational, and physiological variables moderate the interplay between social stimuli, testosterone reactivity, and behavior. Supporting the notion that testosterone can play a causal role in modulating behavior in response to social stimuli, we also summarize recent single administration studies examining the effects of testosterone on physiology, neurobiology, and behavior. A conceptual model provides links between supported findings, and hypothesized pathways requiring future testing.     

The price of alcohol: a consideration of contextual factors

BACKGROUND: The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska. Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale. METHODS: The core data for these analyses came from a telephone survey of Alaskan retail establishments licensed to serve alcohol. This survey utilized computer-assisted telephone interviewing (CATI) techniques to collect alcohol-pricing information from on-premise (i.e., establishments where alcohol is consumed at the point of purchase such as bars and restaurants) and off-premise (i.e., establishments such as grocery stores and convenience markets where consumption occurs in other locations) alcohol retailers throughout the state of Alaska. Price estimates were developed for each beverage-type based on alcohol content. Separate regression analyses were used to model each of the 8 price indices (on-premise and off-premise measures for beer, spirits, wine, and the average price across beverage types). All regressions also controlled for a set of zip-code level indicators of community economic and demographic characteristics based on census data. RESULTS: Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices. CONCLUSIONS: More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.     

射击射箭运动员竞赛状态焦虑状况及影响因素分析

目的了解射击射箭运动员赛前竞赛状态焦虑状况及其影响因素。方法以全国射击比赛作为应激源,采用竞赛状态焦虑量表(CSA I-2)、特质焦虑问卷(TA I)、艾森克人格问卷(EPQ)、运动员临场应激应付方式量表(CS I-A)对30名射击射箭运动员进行调查。结果竞赛状态焦虑水平存在项目差异(F=5.431,P=0.005),射箭队员的竞赛状态焦虑水平较其他项目的队员高(P0.01);不同神经质运动员的认知、躯体状态焦虑水平存在显著性差异(F=7.832,P=0.002;F=3.527,P=0.044),高神经质运动员赛前认知、躯体状态焦虑水平高于非高神经质运动员(P0.05);不同特质焦虑运动员认知、躯体状态焦虑水平存在显著性差异(F=4.830,P=0.016;F=4.459,P=0.021),高特质焦虑运动员赛前认知、躯体状态焦虑水平高于低特质焦虑运动员(P0.05);采用不同应对方式的运动员在认知、躯体状态焦虑和状态自信心上均存在显著性差异(F=3.561,P=0.028;F=4.332,P=0.013;F=3.775,P=0.023),采用进攻-情感应对策略的运动员认知和躯体状态焦虑水平高于采用进攻-任务应对策略的运动员(P0.01),采用回避-任务应对策略的运动员状态自信心得分高于采用进攻-情感应对策略的运动员(P0.05)。结论运动项目、特质焦虑和神经质水平及应对方式选择上的差异均可对竞赛状态焦虑产生一定影响,高特质焦虑、高神经质和射箭项目的运动员应成为赛前焦虑管理的重点人群。     

针灸推拿技能比赛对学生动手能力的影响

本文介绍了在高等中医院校举办针灸推拿技能比赛的实施方法 及所收到的效益,通过定期组织该类技能比赛,不仅有效激发中医药大学生的学习热情、拓展学校教学思路,也是提高学生动手能力的有效途径.     

Cellular competition modulates survival and selection of CD8+ T cells

In this investigation we compare the repopulation of the CD8⁺ T cell compartments of bone marrow (BM) chimeras by either normal nontransgenic or T cell receptor (TcR) αβ-transgenic (TG) CD8⁺ T cells, the fate of TG and non-TG CD8⁺ T cells in different parabionts and the survival of TG and non-TG peripheral CD8⁺ T cells after transfer into athymic hosts. We found that cellular competition among CD8 T cells occurs at several steps of T cell differentiation including (a) during the DN to DP transition, (b) positive selection in the thymus, (c) export from the thymus and (d) in the periphery. Comparison of the results obtained in the BM chimeras and in the parabionts shows that an important step of T cell selection occurs during seeding of peripheral lymphoid tissues. Once established, peripheral T cells resist replacement by recent thymus migrants, i.e. in the periphery, selection of T cell repertoires follows the rule “first come, first served”. Peripheral dominance correlates with T cell activation and division. Cell cycling and CD44 expression are more frequent among non-TG CD8 T cells than TG CD8 T cells and within the latter, more frequent among P14 TG CD8 T cells than anti-HYTG CD8 T cells. Thus, in the absence of intentional immunization, the frequencies of CD8⁺ T cells follow a hierarchy of selection in which non-TG ⩾ P14 TG > anti-HY TG. We also show that the equilibrium size and the fate of one CD8 T cell population differs according to the presence or absence of other CD8 T cell populations. Under these circumstances, selection of T cell repertoires and T cell survival and memory rely not only on the interactions of each T cell with their respective ligands, but also on the nature and number of other competing cells.     

Social functioning in major depressive disorder

Depression is associated with social risk factors, social impairments and poor social functioning. This paper gives an overview of these social aspects using the NIMH Research and Domain Criteria ‘Systems for Social Processes’ as a framework. In particular, it describes the bio-psycho-social interplay regarding impaired affiliation and attachment (social anhedonia, hyper-sensitivity to social rejection, competition avoidance, increased altruistic punishment), impaired social communication (impaired emotion recognition, diminished cooperativeness), impaired social perception (reduced empathy, theory-of-mind deficits) and their impact on social networks and the use of social media. It describes these dysfunctional social processes at the behavioural, neuroanatomical, neurochemical and genetic levels, and with respect to animal models of social stress. We discuss the diagnostic specificity of these social deficit constructs for depression and in relation to depression severity. Since social factors are importantly involved in the pathogenesis and the consequences of depression, such research will likely contribute to better diagnostic assessments and concepts, treatments and preventative strategies both at the diagnostic and transdiagnostic level.     

Policies towards hospital and GP competition in five European countries

This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway and Portugal. Drawing on the policies and empirical evidence described in five case studies, we find both similarities and differences in the approaches adopted. Constraints on patients’ choices of provider have been relaxed but countries differ in the amount and type of information that is provided in the public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them to compete on quality but prices are set in different ways across countries. They can be collectively negotiated, determined by the political process, negotiated between insurers and providers or centrally determined by provider costs. Competition amongst GPs varies across countries and is limited in some cases by shortages of providers or restrictions on entry. There are varied and innovative examples of selective contracting for patients with chronic conditions aimed at reducing fragmentation of care. Competition authorities do generally have jurisdiction over mergers of private hospitals but assessing the potential impact of mergers on quality remains a key challenge. Overall, this study highlights a rich diversity of approaches towards competition policy in healthcare.     

Urinary epinephrine and norepinephrine levels in women athletes during training and competition

Training and competitive epinephrine and norepinephrine levels and proportions were compared in two groups of women athletes to determine whether changes in catecholamine excretion reflect the added mental stress of athletic competition on physical effort. An intercollegiate basketball team and a group of track and field athletes volunteered as subjects. Competitive epinephrine urinary levels were significantly (P<0.01) higher than training levels. A concomitant rise in the norepinephrine with an increase in physical effort was observed in both groups of athletes following training sessions as well as after athletic competition. Track and field athletes trying to qualify for an international team exhibited significantly (P<0.01) higher epinephrine levels than the team members; thus suggesting that anticipation of competiton imposes a mental stress on an athlete. Constant changes in the catecholamine pattern as against a normal work load have yet to be established.