肝癌介入治疗患者家属对健康教育需求的调查

目的调查分析肝癌介入治疗患者家属对健康教育的需求。方法选择某院2010年6月～2011年11月的肝癌介入治疗患者家属113位,采用自设问卷对家属就健康教育的需求进行调查。结果家属对患者现状及预后需求性占首位,占100%,其次是病因,占87.61%,占第3位的是介入治疗后注意事项,占94.69%,其后依次是介入治疗方法、饮食与营养、用药知识和复查及随访指导,6种需求具有代表性,P﹤0.05。家属除对患者出血的预防措施和方法、患者感染的预防措施和方法、最佳饮食组合、术后绝对卧床时间的知晓率较高外,对其他护理方法的知晓率较低。要求通过医护人员的宣传的82人,占72.57%,健康教育宣传录像的24人,占21.24%,通过书刊的仅7人,占6.19%,通过医护人员的宣传的方法具有代表性,差异有统计学意义,P﹤0.05。结论通过调查,可全面掌握肝癌介入治疗患者家属的健康教育需求,从而采取多种形式对肝癌介入治疗患者家属进行全面的健康教育,减轻患者及家属的心理压力,提高肝癌介入治疗患者的家庭支持,改善患者的生存质量。     

Building world democracy through the UN

The evolution of autonomous units of organized human society from tribes to sovereign nation‐states has been paralleled by a belief in a need for global unification under a religious or secular authority.

A modern alternative to the subordination of nation‐state sovereignty to a higher authority is to restrain the excesses of the established world system by institutionalizing in the United Nations a democratic voice for the world public's opinions. This could be done by means of: (1) a UN Second ('we the peoples') Assembly or related proposal; (2) a UN Parliamentary Assembly to represent national parliaments; (3) an assembly representative of non‐governmental organizations affiliated with the UN or its Agencies and other bodies; (4) a UN‐grassroots system for information‐sharing and dispute‐solving.

The paper summarizes the principles of these approaches, and outlines in more detail the multidisciplinary basis of the concept of a UN Second Assembly, the Penrose method for equitable voting power or distribution of seats in a world assembly, and the work of the International Network for a UN Second Assembly (INFUSA) including the initiative for a series of international Conferences on A More Democratic United Nations (CAMDUN).     

Adaptation of the health literacy universal precautions toolkit for rheumatology and cardiology – Applications for pharmacy professionals to improve self-management and outcomes in patients with chronic disease

Over a decade of research in health literacy has provided evidence of strong links between literacy skills of patients and health outcomes. At the same time, numerous studies have yielded insight into efficacious action that health providers can take to mitigate the negative effects of limited literacy. This small study focuses on the adaptation, review and use of two new health literacy toolkits for health professionals who work with patients with two of the most prevalent chronic conditions, arthritis and cardiovascular disease. Pharmacists have a key role in communicating with patients and caregivers about various aspects of disease self-management, which frequently includes appropriate use of medications. Participating pharmacists and staff offered suggestions that helped shape revisions and reported positive experiences with brown bag events, suggestions for approaches with patients managing chronic diseases, and with concrete examples related to several medicines [such as Warfarin^©] as well as to common problems [such as inability to afford needed medicine]. Although not yet tested in community pharmacy sites, these publically available toolkits can inform professionals and staff and offer insights for communication improvement.     

Plan responses to diagnosis-based payment: Evidence from Germany’s morbidity-based risk adjustment

Many competitive health insurance markets adjust payments to participating health plans according to their enrollees’ risk − including based on diagnostic information. We investigate responses of German health plans to the introduction of morbidity-based risk adjustment in the Statutory Health Insurance in 2009, which triggers payments based on “validated” diagnoses by providers. Using the regulator’s data from office-based physicians, we estimate a difference-in-difference analysis of the change in the share and number of validated diagnoses for ICD codes that are inside or outside the risk adjustment but are otherwise similar. We find a differential increase in the share of validated diagnoses of 2.6 and 3.6 percentage points (3–4%) between 2008 and 2013. This increase appears to originate from both a shift from not-validated toward validated diagnoses and an increase in the number of such diagnoses. Overall, our results indicate that plans were successful in influencing physicians’ coding practices in a way that could lead to higher payments.     

Safety assessment of food and feed from biotechnology-derived crops employing RNA-mediated gene regulation to achieve desired traits: A scientific review

Gene expression can be modulated in plants to produce desired traits through agricultural biotechnology. Currently, biotechnology-derived crops are compared to their conventional counterparts, with safety assessments conducted on the genetic modification and the intended and unintended differences. This review proposes that this comparative safety assessment paradigm is appropriate for plants modified to express mediators of RNA-mediated gene regulation, including RNA interference (RNAi), a gene suppression mechanism that naturally occurs in plants and animals. The molecular mediators of RNAi, including long double-stranded RNAs (dsRNA), small interfering RNAs (siRNA), and microRNAs (miRNA), occur naturally in foods; therefore, there is an extensive history of safe consumption. Systemic exposure following consumption of plants containing dsRNAs that mediate RNAi is limited in higher organisms by extensive degradation of ingested nucleic acids and by biological barriers to uptake and efficacy of exogenous nucleic acids. A number of mammalian RNAi studies support the concept that a large margin of safety will exist for any small fraction of RNAs that might be absorbed following consumption of foods from biotechnology-derived plants that employ RNA-mediated gene regulation. Food and feed derived from these crops utilizing RNA-based mechanisms is therefore expected to be as safe as food and feed derived through conventional plant breeding.     

The Application of Non-Default Uncertainty Factors in the U.S. EPA's Integrated Risk Information System (IRIS). Part I: UF L,UF S,and “Other Uncertainty Factors”

The United States Environmental Protection Agency's Integrated Risk Information System (IRIS) includes hazard identification and dose-response assessment values developed by Agency scientists. Uncertainty factors (UFs) are used in the development of IRIS values to address the lack of information in five main areas. The standard UFs account for interspecies uncertainty (UF_A) and intraspecies variability (UF_H). The UF_A addresses uncertainty related to the extrapolation of data from animals to humans, whereas the UF_H addresses variability amongst individuals (i.e., intrahuman). Additional UFs have been employed to account for database incompleteness, extrapolations from a lowest-observed-adverse-effect level in the absence of a no-observed-adverse-effect level (UF_L), and subchronic-to-chronic extrapolation (UF_S). A sixth UF designated as “other uncertainty factors” (UF_O) has also been applied in place of the UF_L to account for uncertainty with the adversity of points of departure obtained using benchmark dose modeling. This review will discuss how UF_L, UF_S, and UF_O have been applied in IRIS assessments, along with the rationale used to describe the choice of UF values that deviate from the standard default of 10.     

The Right Kind of Evidence—Integrating, Measuring, and Making It Count in Health Equity Research

As health equity researchers, we need to produce research that is useful, policy-relevant, able to be understood and applied, and uses integrated knowledge translation (KT) approaches. The Manitoba Centre for Health Policy and its history of working with provincial government as well as regional health authorities is used as a case study of integrated KT. Whether or not health equity research “takes the day” around the decision-making table may be out of our realm, but as scientists, we need to ensure that it is around the table, and that it is understood and told in a narrative way. However, our conventional research metrics can sometimes get in the way of practicality and clear understanding. The use of relative rates, relative risks, or odds ratios can actually be detrimental to furthering political action. In the policy realm, showing the rates by socioeconomic group and trends in those rates, as well as incorporating information on absolute differences, may be better understood intuitively when discussing inequity. Health equity research matters, and it particularly matters to policy-makers and planners at the top levels of decision-making. We need to ensure that our messages are based on strong evidence, presented in ways that do not undermine the message itself, and incorporating integrated KT models to ensure rapid uptake and application in the real world.     

关于医疗卫生体制改革的认知差异性

卫生改革的顺利实施依赖于卫生系统内不同群体的合作,但是现有的文献表明,不同群体对于医疗卫生体制改革的认知存在较为明显的差异,影响卫生政策的实践效果.通过对文献的分析,对差异的程度进行定性分析;对认知差异的定量研究是未来研究需关注的领域.     

两种健康教育平面材料的效果评价

目的调查并评价健康教育平面材料的宣传效果,为今后改进设计制作提供依据。方法根据健康教育专家田本淳教授提供的健康教育媒体评价方法,对平面材料的8个指标进行调查,数据经统计分析后,得到对平面材料的评价依据。结果《母子平安》小折页和《母子健康合家幸福》宣传画的最后得分分别是67.20分和54.87分。结论两种健康宣传材料在信息传递和材料制作方面尚存在不足。今后在设计制作平面材料过程中,要注意信息的通俗性、简明性、生动性以及材质质量。