The treatment gap in epilepsy: the current situation and ways forward

This article is a summary of a workshop held by the ILAE concerning the issue of the epilepsy treatment gap in developing countries. The gap is defined in terms of those people with epilepsy who are not being appropriately treated and is the result of an array of medical, political, social, economic, and cultural factors. The situation regarding the treatment gap for various countries is reviewed, along with some of its causes. Although the overall gap is estimated to be large, a number of recent projects and interventions have been effective in delivering appropriate treatment to people with epilepsy in underresourced countries of the developing world. It is hoped that these may be transferable elsewhere and that, combined with the ILAE/IBE/WHO Global Campaign against Epilepsy and increased support from the worldwide epilepsy community, the treatment gap will begin to be bridged.     

冬凌草甲素抗肿瘤作用机制研究进展

冬凌草甲素是中草药冬凌草抗肿瘤的主要活性成分。近几年的研究发现,冬凌草甲素体外抗肿瘤的分子机制可能包括:阻遏细胞周期、下调端粒酶活性、抑制细胞膜钠泵活性、诱导肿瘤细胞凋亡、逆转多药耐药等,其中诱导肿瘤细胞凋亡信号转导途径方面的研究较多,但是冬凌草甲素新剂型、体内抗肿瘤药理机制及药物动力学等方面的研究仍较少。     

Predictors for treatment outcomes among patients with drug-susceptible tuberculosis in the Netherlands: a retrospective cohort study

ObjectivesWe evaluated treatment outcomes and predictors for poor treatment outcomes for tuberculosis (TB) among native- and foreign-born patients with drug-susceptible TB (DSTB) in the Netherlands.MethodsThis retrospective cohort study included adult patients with DSTB treated from 2005 to 2015 from a nationwide exhaustive registry. Predictors for unsuccessful treatment outcomes (default and failure) and TB-associated mortality were analysed using multivariate logistic regression.ResultsAmong 5674 identified cases, the cumulative incidence of unsuccessful treatment and mortality were 2.6% (n/N = 146/5674) and 2.0% (112/5674), respectively. Although most patients were foreign-born (71%; 4042/5674), no significant differences in these outcomes were observed between native- and foreign-born patients (p > 0.05). Significant predictors for unsuccessful treatment were aged 18–24 years (odds ratio (OR), 2.04; 95% CI 1.34–3.10), homelessness (OR, 2.56; 95% CI 1.16–5.63), prisoner status (OR, 5.39; 95% CI 2.90–10.05) and diabetes (OR, 2.02; 95% CI 1.03–3.97). Furthermore, predictors for mortality were aged 74–84 years (OR, 5.58; 95% CI 3.10–10.03) or ≥85 years (OR, 9.35, 95% CI 4.31–20.30), combined pulmonary and extra-pulmonary TB (OR, 4.97; 95% CI 1.42–17.41), central nervous system (OR, 120, 95% CI 34.43–418.54) or miliary TB (OR, 10.73, 95% CI 2.50–46.02), drug addiction (OR, 3.56; 95% CI 1.34–9.47) and renal insufficiency/dialysis (OR, 3.23; 95% CI 1.17–8.96).ConclusionsNative- and foreign-born patients exhibited similar TB treatment outcomes. To further reduce disease transmission and inhibit drug resistance, special attention should be given to high-risk patients.     

Finding the moral heart of treatment: mental health care in a French prison

Morality is one of the most important elements of social actions, specifically in medical settings. Unfortunately, in social science, morality is often undertheorized and can lead to moralism. The aim of the paper is to test the "moral economy theory" which highlights the link between some local moral evaluations and a political context. We focus on "treatment" as therapeutic tool and as moral regulation of patients in a French remand centre. On the basis of an ethnography of forms of care for prisoners (2009-2010), and semi-directed interviews with working mental health professionals (n = 10), we analyse their engagement and their moral expectations of the prisoners under their care. Firstly, we show how prisoners are selected and then converted into patients deserving of attention (expectations of honesty, sincerity and compliance). Secondly, we show how these patients are divided into three main intervention categories, in which the treatment is both therapeutic and moral (expectations of responsibility, recognition of guilt, and self-esteem). Finally, we discuss these moral criteria within a new moral economy of vulnerability.     

Building institutions for an effective health system: lessons from China's experience with rural health reform

This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded. It presents the case of China, which is implementing an ambitious health reform, drawing on a series of visits to rural counties by the author over a 10-year period. It illustrates how the development of reform strategies has been a response both to the challenges arising from the transition to a market economy and the result of actions by different actors, which have led to the gradual creation of increasingly complex institutions. The overall direction of change has been strongly influenced by the efforts made by the political leadership to manage a transition to a modern economy which provides at least some basic benefits to all. The paper concludes that the key lessons for other countries from China's experience with health system reform are less about the detailed design of specific interventions than about its approach to the management of institution-building in a context of complexity and rapid change.     

军队医院规模经济研究的宏观思考

本研究从分析军队医院规模经济研究的重要性人手,紧紧围绕医院卫生经济政策、卫生资源配置、经济筹资补偿、经济核算、收益分配、经济管理信息化及规模经济评价等方面进行系统思考,并提出需要研究的具体内容.     

基于效率的医院规模经济实证分析

目的了解医院是否存在规模经济及适宜床位规模大小。方法利用浙江省500张床及以上综合性医院数据,用主、客观结合的方式和效率回归调整模型筛选评价指标,用数据包络分析方法和Tobit回归模型进行实证分析。结果所有决策单元的总体效率和纯技术效率、规模效率平均得分均大于0.93;36%的单元为总体有效,65%的单元为纯技术有效,43%的单元为规模有效;43%的单元处于规模报酬不变区间,42%的单元处于报酬递增区间,15%的单元处于报酬递减区间;全要素生产率平均呈下降;效率的影响因素主要有床位、药品收入比重、设备数量、医院等级、诊次床位比、业务收支比、每床卫技数、每床固定资产、所在地区千人医生数和经济水平等。结论多数医院存在规模经济。医院床位数在800～1 300张较为合适。提高医院经营效率可采取以下措施：合理控制床位;控制药品收入比重,注重医疗技术的提高;提高管理水平,控制固定资产过度投入;提高地区卫生资源水平和经济发展水平。     

浙江省公立医院规模经济实证分析

目的 分析浙江省公立医院的规模经济情况.方法 选取浙江省125所二级乙等以上公立医院为样本,运用道格拉斯生产函数,分别以医院服务量和医院业务收入作为因变量建立两种生产模型,分析2004--2006年样本医院投入与不同产出变量的关系.结果 2004-m2006年,样本医院的服务量与业务收入两大产出均处于规模经济阶段.产出增长率高于投入增长率;三级医院的服务量、业务收入、总资产和职工总数均明显高于二级医院(P=0.000).结论 规模经济是当前医院不断扩张的根本动因.为防止医院过度扩张所导致的医疗服务供给问题,医院应理性控制其规模的发展.     

转型期我国公立医院规模经济特征的实证研究

为研究转型期我国公立医院规模经济特征．为有效控制医院规模持续扩张提供依据,应用短期超越对数成本函数模型,以广东省305家公立医院的数据为基础,进行了规模经济实证研究。结论表明：（1）各级公立医院均呈现出规模经济,规模经济呈长“L”型特征,即理论上,我国公立医院可以在无限规模扩张中获得规模经济。（2）各级公立医院均表现为固定资产投入过度转型期我国公立医院规模扩张是以高精尖医疗设备的投入为主要特征。（3）控制城市大医院规模持续扩张的短期措施可以从改变医疗服务项目收费价格着手。长期策略的关键还在于建立一个迫使医院追求成本最小化的制度环境。