Laryngeal Cancer in Kazakhstan - Ethnic,Age and Gender Differences over Time

The purpose of the present study was to provide an assessment of the incidence of cancer of the larynx inKazakhstan with especial attention to ethnicity and gender, as well as age. The retrospective design covered allnew cases of laryngeal cancer in 11 years (1999-2009). The total number was 4,967 cases, 4,535 (91.3%) in malesand 432 (8.7%) in women, with a gender ratio of 10.5:1. Patients of Kazakh (31.2%) and Russian (51.4%) ethnicityaccounted for the vast majority (82.6%), with Russians predominating in both sexes, but particularly in females.Age peak in Kazakhs was 70 years and older (14.6±0.70/0000), and in Russians was 60-69 years (21.6±1.30/0000).In the dynamics, the rates had the tendency to decrease more markedly in Russian than Kazakh men, especiallyin the younger groups, while increase was noted in the youngest females of both ethnicities, but again greater inRussians, presumably reflecting change in underlying lifestyle factors.     

Strengthening vaccination policies in Latin America: An evidence-based approach

Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public–private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the long term. These reforms are now crucial, particularly as vaccines for previously neglected, developing-world diseases become available. In summary, a regionally-coordinated health policy will reduce vaccination inequality in Latin America.     

腰椎间盘突出症手术患者DRGs支付方式探讨

目的：探讨苏北某三甲医院骨科腰椎间盘突出症手术患者住院费用的影响因素,为有效控制腰椎间盘突出症手术患者住院费用提供参考。方法选取2011—2015年腰椎间盘突出症手术患者2090例,根据疾病诊断相关组（DRGs）方法,按伴发症数目将患者分为5组,按年龄将患者分为2组,探讨不同分组住院费用的差异。结果腰椎间盘突出症手术患者按不同伴发症分组,各组间住院费用有统计学意义,F=2.958,P=0.045;腰椎间盘突出症手术患者按年龄分组,两组间住院费用没有统计学意义,t=-0.908,P=0.39。结论以伴发症为截点对腰椎间盘突出症手术患者住院费用进行分类具有可行性,有利于腰椎间盘突出症手术患者住院费用的控制和诊疗规范的监控。     

我校民族班学生临床护理课程的成绩分析与对策

目的探讨民族班（简称民班）学生对临床护理课程的掌握程度,及时发现教学中存在的问题,以期提高临床护理教学质量。方法对新疆医科大学护理学院高职2005-1、2005-3民班学生4门临床护理课程的平均成绩、及格率等进行统计学分析。结果2个民班学生临床护理课程成绩差异明显,与学生来源、家庭经济状况及学习自主性等相关。结论建议采取合理配置,随机分班,增加学生学习兴趣,提高学生自主学习能力,营造良好校园氛围等,以促进高校少数民族人才的培养。     

Epidemiology of Esophagus,Lung and Breast Cancer in Mountainous Regions of Kyrgyz Republic

Relative incidences of esophagus, lung and breast cancers differ in the various populations in Kyrgyzstan.Esophagus cancer is the most commonly observed among the Turkic groups, especially in Kazakhs, while lung andbreast cancer are frequently encountered among the European representatives of the population – Russians inparticular. Fluctuation in rates for these cancer forms in the Kyrgyzstan mountain regions is highly dependable onthe height above sea level. One potential major factor, which may account for the low cancer frequency in generaland influence esophagus, lung and breast cancer forms in particular – is mountain hypoxia. Since, among the nativecitizens (Kyrgyzes), which are adapted to mountain hypoxia conditions (population adaptation), the indicated cancerforms are not so often than the same forms appearance among the other ethnical groups (long adaptation), especiallynewcoming ones.Thus, the incidence rates of esophageal cancer in the Kazakh population is about 32,3 (per 100,000), the samesickness in Kyrgyz is about 11,3, the figure for lung cancer among the Russian population is 34,8, while amongKyrgyzes it is 11,2, breast cancer incidence in Russian citizens is 34,8 but only15,1 among Kyrgyz residents.It could be established that the studied forms of cancer are less common in high mountain regions than in theregions with low mountains. To a certain extent, mountain hypoxia may function like a brake for the development ofcancer tumors. HGowever, the situation is complex, because of , the presence of the other factors entailed by thedemographic, social-economic and other variation.     

DRG评价方法在肿瘤专科医院应用及问题探讨

目的 本研究基于浙江省绩效评价的数据,分析讨论DRG评价方法在肿瘤专科医院的应用及问题,为肿瘤专科医院的评估与发展提供建议.方法 利用CMI、RW、DRG组数、时间和费用消耗指数等DRG考核指标,对肿瘤专科医院评价结果进行分析探讨.结果 肿瘤专科医院的CMI值排在全省三甲医院最后一位,仅有0.65,DRG覆盖组数最少,...     

S-DRG分组器的构建与改进方法

S-DRG借鉴了澳大利亚AR-DRG的构建方法，历经了5年的本土化。根据国家临床重点专科建设项目评分标准，重新诠释ADRG。利用上海市的病案首页数据，结合我国诊断和手术编码的特点，构建主要诊断排除库和CCL，并在实践中和临床专家一起不断完善。手术组（S组）和重要的操作组（O组）采用轮询法，解决一次住院、实施多次手术或操作的病例入组叠加问题。在住院病案首页增加转归情况，杜绝未治疗的疾病被误判为有效的CC。建议国家尽快推进ICD11，淘汰ICD-9-CM-3体系，选择可结构化的手术和操作代码，并尽快统一全国的基于DRG的成本核算办法。     

COVID-19 en migrantes y minorías étnicas

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.     

Strengthening vaccination frameworks: Findings of a study on the legal foundations of National Immunization Technical Advisory Groups (NITAGs)

In 2017, the Strategic Advisory Group of Experts on Immunization’s Assessment Report of the Global Vaccine Action Plan noted the need to “better document the ways in which legislation and regulations have been used to promote or undermine immunization at the national level”. Despite National Immunization Technical Advisory Groups (NITAGs) now existing in over 134 countries worldwide, there has been very little academic consideration of their legal underpinnings. In this paper, we compare the legal foundations and authority of 28 NITAGs from the six WHO Regions. All are members of the Global NITAG Network. We categorize the NITAGs based on their legal foundation and on the authority granted to them by their government, organizing them into a taxonomy of models. We then propose legal considerations for governments contemplating establishing or reforming a NITAG.     

基于数据包络分析的医院绩效管理优化策略探讨

目的探究数据包络分析方法在医院临床科室效率评价中的应用,提出绩效管理优化策略。方法以北京市某三级综合医院39个临床科室为样本,用DRGs对住院服务产出进行风险调整,用径向模型对科室2018年-2019年技术效率进行静态测度,用全局参比Malmquist指数模型对科室两年中各月的全要素生产率及其分解构成变化进行动态测度。结果2018年-2019年仅有3个科室总体有效,全要素生产率总体呈上升趋势,主要由技术进步效应推动,结构效应贡献有限。结论数据包络分析在临床科室年度和月度效率评价中显示出技术优势和实用价值。据此提出绩效管理优化策略:基于DRGs进行风险调整;提高绩效管理的灵活性与适应性;提供客观、公正的效率评估视角;效率驱动绩效改进;正确运用测量方法。