上海市长宁区2011年民营医疗机构医疗事故原因分析

目的探讨民营医疗机构医疗事故的原因,分析其医疗安全质量管理中存在的问题,提高医疗安全性。方法收集2011年上海市长宁区民营医疗机构发生的医疗事故案例资料,分析诊治经过、争议要点、鉴定意见及处理情况。结果2011年上海市长宁区民营医疗机构共发生医疗事故4起,其中由法院委托鉴定1起;我医疗事故处理办公室委托鉴定3起,主要原因为诊断失误、诊疗技术应用失当和用药不当。结论我国民营医疗机构医疗质量管理亟待改进,需要落实医疗机构考核培训制度,加强医疗技术临床应用规范化及临床合理用药等质量控制,以保障患者安全。     

Improvement of the nutritional quality of foods as a public health tool

Objectives

To assess the potential contribution of improving the nutritional quality of processed foods on individuals’ nutritional intake and food supply. This paper also discusses the means to encourage firms to implement these reformulations, particularly in public/private partnerships.

Study design

The French Observatory of Food Quality was created by the Government for the quantification and follow-up of food reformulation by the food industry. This nutritional composition database on branded products was matched with two consumption databases: TNS Kantar Worldpanel, which provides details on quantities bought and food expenditures; and INCA 2, an individuals’ food consumption survey completed by the French Food Safety Agency. Three food groups were considered: breakfast cereals (355 items in 2008), biscuits and pastries (1805 items in 2008), and bread-based products (620 items in 2009).

Methods

First, the variability in nutrient composition within food categories was determined, which made it possible to consider several food composition modification scenarios within each category. The formulation of the food items with the lowest nutritional quality was modified to three different levels to improve the overall level of quality in a given category. Second, the quantities of sugars, fat, fibre and sodium delivered to the French market through breakfast cereals, biscuits, pastries and bread-based products were calculated for each scenario. Finally, the distribution of individuals’ nutrient consumption from the three food groups among the French population was assessed.

Results

These scenarios generated important improvements of 1–22% (increase in the amount of fibre or decrease in the amounts of sugars, fat and sodium delivered to the market), depending on the scenario, the food group and the nutrient considered. Improvement of the products with the lowest nutritional quality would also lead to significant variation in individuals’ nutrient consumption for the average adult and child consumers of the three groups (range 4.2–18.8%, depending on the scenario, the food group and the nutrient considered).

Conclusion

Encouraging the reformulation of foods, especially for products with the lowest nutritional quality in each category of processed foods, is a worthy target for health policy makers. The methodology presented in this paper provides information for negotiations between policy makers and firms to quantify commitments in terms of their potential impacts on individuals’ nutrient intake, and to check that the firms’ commitments are actually met.     

上海市某区民办医疗机构执业人员现状分析与干预研究

目的为提高民办医疗卫生机构执业人员依法执业意识和知识,从而起到加强对民办医疗卫生机构业务指导。规范医疗执业行为,提高医疗服务质量。方法对某区辖区内36户民办医疗机构执业人员学历、职称、执业注册现状、依法执业等情况进行分析。开展个性化培训、问卷调查、监督检查、互动参与等卫生综合干预,并通过问卷调查、违法违规行为处理情况对比进行干预服务效果评价。结果民办医疗机构执业人员存在学历结构低、高级职称的人员缺乏的现象。培训前后问卷调查结果比较,干预前后的差异具有统计学意义。采用综合干预措施后医疗机构和医务人员违法违规行为明显减少。     

Utilization of HIV-related services from the private health sector: A multi-country analysis

Increasing the participation of the private health sector in the AIDS response could help to achieve universal access to comprehensive HIV prevention, treatment, care and support. Yet little is known about the extent to which the private health sector is delivering HIV-related services. This study uses data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) from 12 countries in Africa, Asia and Latin America and the Caribbean to explore use of HIV testing and STI care from the private for-profit sector, and its association with household wealth status. The analysis indicates that the private for-profit health sector is active in HIV-related service delivery, although the level of participation varies by region and country. From 3 to 45 percent of women and 6 to 42 percent of men reported the private for-profit sector as their source of the most recent HIV testing. While in some countries, use of the private for-profit health sector for HIV testing and STI care increases with wealth, in others the relationship is not clear, as there are no significant differences in using private for-profit HIV-related services between the rich and the poor. We conclude that as the global AIDS response evolves from emergency relief to sustained country programs, broader consideration of the role of the private for-profit health sector may be warranted.     

Isoniazid resistance in patients with Extrapulmonary Tuberculosis using line probe assay in a private multispecialty hospital in Bangalore,India

We aimed to study the rate of isoniazid (INH) resistance in Extrapulmonary Tuberculosis samples from a private care setting.A Line probe assay was performed on 74 culture isolates of Mycobacterium tuberculosis or directly on extrapulmonary samples received in our laboratory from 2018 to 2021.The INH mono-resistance among these extrapulmonary samples was 6.7%. (5 among 74) (95% CI: 1.04%–12.48%) Resistance to rifampicin was not detected.Increasing the availability and leveraging public private partnerships in hospitals for universal testing for INH resistance may increase detection of INH monoresistance in EP-TB and improve the strategy for TB elimination.     

Once covered,forever covered: The actuarial challenges of the Belgian private health insurance system

The Belgian Law of 20 July 2007 has drastically changed the Belgian private health insurance sector by making individual contracts lifelong with the technical basis (i.e. actuarial assumptions) fixed at policy issue. The goal of the Law is to ensure the accessibility to supplementary health coverage in order to protect policyholders from discrimination and exclusion, essentially when these operate on the basis of age. Due to the unpredictable nature of medical inflation risk and the difficulty to model future increases of health claims, the legislator introduced medical indices together with a specific updating mechanism, which aim at establishing standardized and fair premium adjustments across the sector. This paper considers two major issues of the current Belgian system. The first one is related to the transferability of the reserves, whereas the second one is related to age-discrimination. We discuss these issues and their interplay, and we address the conflict between the goal of the Law and the practical problems arising in the light of the actuarial techniques.     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

民办高校青年教师的婚姻质量研究

目的:了解民办高校青年教师的婚姻质量现状,为提高其婚姻生活满意度探索有效的途径提供现实依据。方法:随机抽取民办高校青年教师,用婚姻质量量表和生活满意度量表进行测试,SPSS17.0进行数据统计分析。结果:男青年教师和女青年教师在婚姻质量各维度上不存在显著性差异;有子女的青年教师与无子女的青年教师的婚姻质量在"性格相容"与"化解冲突"上有显著性差异,无子女的青年教师婚姻中的性格包容性和化解冲突的能力要强于有子女的青年教师;民办高校青年教师对生活的满意度与婚姻质量的总体和各维度存在着非常显著的正相关。结论:民办高校青年教师的婚姻质量在性别上没有显著性差异;无子女的婚姻质量高于有子女的青年教师;其生活满意度与婚姻质量有显著相关性。     

Thank you for letting me be your physician

I believe this article emphasizes how emotionally valuable receiving patients' trust is to the practicing physician. It also gives new insight into understanding the emotional loss a physician may experience when leaving private practice, even if they remain active in medicine. Finally, for those entering medicine, it explains the profound personal satisfaction they can experience from long term trusting relationships with patients.     

A two-tiered public-private health system: Who stays in (private) hospitals in Ireland?

Despite efforts to create a universal, single-tiered Irish health system, an unequal "two-tiered" system persists. The future blueprint for Irish health care, Sláintecare, recommends a separation of public and private hospital treatment. This study examines patterns of overall and private hospital utilisation in Ireland that could help identify some of the impacts of the proposed separation of public and private hospital treatment. Using data from EU-SILC (2016) (n = 10,131) the factors associated with inpatient hospitalisation and private inpatient hospitalisation are estimated using probit models.Unsurprisingly, those who are economically inactive are more likely to have had an inpatient stay. Furthermore, those aged over 65, with a chronic illness, with a medical/ GP visit card and private health insurance and those with only private health insurance are also more likely to have had an inpatient stay. Those with only primary education are less likely to report an inpatient stay in private hospital. Those aged over 25 and less than 65, those with a medical/ GP visit card and private health insurance and those with only private health insurance are significantly more likely to opt for a private hospital. Understanding overall and private hospital utilisation patterns is imperative for implementing universal health care and associated resource planning and fulfilling policy recommendations.