基于分级诊疗的广西卫生人力资源配置分析

目的:从推进实施分级诊疗的视角,对比分析广西的医院和基层医疗卫生机构卫生人力资源配置状况与存在问题,并有针对性地提出政策建议。方法:对广西相关年份的医院及基层医疗卫生机构的卫生人力资源配置状况进行分析和讨论。结果:广西医院及基层医疗卫生机构卫生人力资源均呈增长趋势,但医院与基层医疗机构之间在人员数量、学历及职称构成等人员质量方面仍有较大差距,优势资源仍有向医院汇集的态势。结论:广西的卫生人力资源配置与分级诊疗的需要仍不相适应,建议政府加大基层卫生人力供给、改革基层医务人员薪酬制度、加快推进医联体改革,引导卫生人力资源向基层流动。     

A class of Covariate-Adjusted Response-Adaptive Allocation Designs for Multitreatment Binary Response Trials

A class of covariate-adjusted response-adaptive randomization procedures is developed for binary treatment outcomes in a phase III clinical trial set up involving multiple treatments. The target allocation is developed by combining the ethical aspects with statistical precision under the existence of treatment covariate interaction. Relevant measures of the performance for the proposed allocation designs are studied and compared.     

我国妇幼保健资源配置现状及公平性分析

目的了解我国妇幼保健资源配置现状,评价其公平性,为促进我国妇幼保健资源的整体优化提供基本参考。方法以2005-2014年《中国卫生和计划生育年鉴》和《中国统计年鉴》中妇幼保健资源配置的相关指标为原始资料,对我国及各省市的资源配置现状进行描述和分析;同时运用泰尔指数对资源配置的公平性进行评价。结果我国拥有的妇幼保健机构数、医师数、床位数、护士数逐年增加;2005-2014年我国妇幼保健机构、医师数泰尔指数变动较小,床位数、护士数的泰尔指数在0.019 5~0.047 6、0.021 9~0.044 5之间变化,呈增长趋势,且东部地区相对偏高;区域内差异对泰尔指数的贡献率大于区域间,对妇幼保健资源配置的公平性影响较大。结论我国妇幼保健资源总量虽上升,但资源配置不公平,且呈下降趋势,尤其是区域内公平性问题严重,相关部门应重点关注,统筹兼顾,改善妇幼保健资源配置不公平的现状。     

吸引和稳定农村基层卫生人员的影响因素及其干预策略研究进展*

目的总结国内外有关农村基层卫生人员吸引和稳定的影响因素及其主要干预策略的研究进展,为改善我国农村基层卫生人员的招募和留用提供参考。方法对国内外基层卫生人力资源现状、离职意愿和工作意愿、工作选择的影响因素、主要干预策略和效果以及离散选择实验方法的应用等进行文献复习和研究。结果农村基层卫生人员尤其是骨干人员招募难、留用难,且存在较高的离职意愿,个人、工作和生活等相关因素是选择或留在农村基层的主要考虑因素。国内外采取了多种有效的干预措施,但缺乏对干预效果的评价。结论农村基层卫生人员招募难、留用难限制了我国农村基层卫生人力资源整体素质的提升,必须采取具有成本效果的干预策略加以改善。     

Sample allocation balancing overall representativeness and stratum precision

Purpose

In large-scale surveys, it is often necessary to distribute a preset sample size among a number of strata. Researchers must make a decision between prioritizing overall representativeness or precision of stratum estimates. Hence, I evaluated different sample allocation strategies based on stratum size.

Combining multiple biomarkers linearly to maximize the partial area under the ROC curve

It is now common in clinical practice to make clinical decisions based on combinations of multiple biomarkers. In this paper, we propose new approaches for combining multiple biomarkers linearly to maximize the partial area under the receiver operating characteristic curve (pAUC). The parametric and nonparametric methods that have been developed for this purpose have limitations. When the biomarker values for populations with and without a given disease follow a multivariate normal distribution, it is easy to implement our proposed parametric approach, which adopts an alternative analytic expression of the pAUC. When normality assumptions are violated, a kernel‐based approach is presented, which handles multiple biomarkers simultaneously. We evaluated the proposed as well as existing methods through simulations and discovered that when the covariance matrices for the disease and nondisease samples are disproportional, traditional methods (such as the logistic regression) are more likely to fail to maximize the pAUC while the proposed methods are more robust. The proposed approaches are illustrated through application to a prostate cancer data set, and a rank‐based leave‐one‐out cross‐validation procedure is proposed to obtain a realistic estimate of the pAUC when there is no independent validation set available.     

Response‐adaptive treatment allocation for survival trials with clustered right‐censored data

A comparison of 2 treatments with survival outcomes in a clinical study may require treatment randomization on clusters of multiple units with correlated responses. For example, for patients with otitis media in both ears, a specific treatment is normally given to a single patient, and hence, the 2 ears constitute a cluster. Statistical procedures are available for comparison of treatment efficacies. The conventional approach for treatment allocation is the adoption of a balanced design, in which half of the patients are assigned to each treatment arm. However, considering the increasing acceptability of responsive‐adaptive designs in recent years because of their desirable features, we have developed a response‐adaptive treatment allocation scheme for survival trials with clustered data. The proposed treatment allocation scheme is superior to the balanced design in that it allows more patients to receive the better treatment. At the same time, the test power for comparing treatment efficacies using our treatment allocation scheme remains highly competitive. The advantage of the proposed randomization procedure is supported by a simulation study and the redesign of a clinical study.     

西安市乡镇街道卫生院疫情报告专用计算机的配置和使用情况调查

目的 了解西安市乡镇(街道)卫生院计算机的配置和使用现状.方法 对县区疾控中心的疫情信息管理人员和各卫生院承担疫情直报工作的防保人员进行问卷调查.结果 西安市180个建制卫生院的计算机装备率已达到84.44%,上网直报率提高到85.00%以上,95.00%的卫生院直报用户是以宽带接入方式实现疫情信息网络直报的.被调查的137个卫生院共拥有计算机310台,但专门用于疫情信息报告的计算机仅占24.84%.57.66%的卫生院只有1台计算机.结论 因计算机分布不均衡,一些卫生院计算机的拥有量和放置、使用情况还不能满足疫情信息直报工作的需要.     

基于转录组数据分析药用大黄的密码子使用偏好性

目的研究药用大黄Rheum officinale转录组编码序列的密码子使用特点及其影响因素,为蒽醌类化合物异源合成的载体选择及药用大黄分子进化研究提供理论基础。方法利用perl程序及Codon W软件分析4733条药用大黄转录组编码序列的密码子使用偏好性。结果药用大黄转录组编码序列的GC、GC3平均含量分别为45.6%、44.73%,GC12与GC3存在显著正相关(r=0.215,P0.001);ENc-GC3中性图及偏倚性分析结果显示,大部分基因分布于远离期望曲线和平面中心点,大部分基因分布偏离期望曲线和中心点。通过基因高表达筛选密码子方法确定了29个药用大黄的最优密码子,大多数的最优密码子以U和A结尾。结论突变压力在药用大黄转录组编码序列的密码子使用偏好性形成过程这起到主要作用。     

一种大豆秸秆蜜环菌培养基及其生产条件的优化

目的 为了解决天麻栽培中对木材的大量使用造成的森林资源破坏及栽培成本增加问题,该研究对农作物余料替代木材（或木屑）培养蜜环菌的可行性进行了探讨,以期降低天麻的栽培成本,同时使农作物余料得到有效利用,进而保护林木资源。方法 观察蜜环菌的生长情况,划线法测量蜜环菌生长速度;苯酚浓硫酸法测定不同培养基中蜜环菌的总多糖含量;为了进一步优化大豆秸秆培养基配比,对主料配比、蔗糖含量、无机盐含量及含水量进行四因素三水平L₉（3⁴）正交优化试验。结果 通过比较不同培养基培养中蜜环菌的生长情况,发现大豆秸秆培养基培养的蜜环菌从接种第4天就开始生长,菌丝长势好,生长速度为0.352 cm·d^-1,是桦木屑培养基生长速度0.283 cm·d^-1的1.48倍;大豆秸秆培养基培养的蜜环菌总多糖含量最高,为39.260 mg·g^-1,远远高于桦木屑培养的蜜环菌总多糖含量17.028 mg·g^-1,大豆秸秆培养基优势明显;主料（大豆秸秆与麦麸）配比为8∶2,蔗糖含量为主料的1%,无机盐含量为主料含量的0.5%,含水量50%时,蜜环菌生长速度稳定为0.392 cm·d^-1。结论 该研究结果为天麻栽培中使用大豆秸秆培养基替代木材（或木屑）培养基培养的蜜环菌提供了依据,为天麻在栽培中减少林木资源浪费、保护自然环境提供了参考。