推进妇幼公共卫生均等化服务的思考

通过对近几年常州市实施妇幼公共卫生均等化服务的实践探索,认为有效实现妇幼公共卫生均等化服务必须加强组织领导、强化体系建设、依法监督管理、实施公卫项目、推进均等服务、有效科学决策。     

基本医疗卫生服务均等化研究进展与路径选择

加快推进基本医疗卫生服务均等化,已成为实现新医改提出的建立健全覆盖城乡居民基本医疗卫生制度的重要内容和热点问题。本文从国内外基本医疗卫生服务均等化理论基础、发展内涵、实施策略、筹资与供给机制、测量评价等方面系统阐述其研究进展,并在综合述评的基础上,提出了进一步明确基本医疗卫生服务均等化内涵界定、探索基本医疗卫生服务均等化筹资机制、构建基本医疗卫生服务均等化评价体系以及完善城乡基层基本医疗卫生服务及政策体系等方面的路径选择和思考建议。     

神木“医改”模式的推广价值及需完善之处

从让民众共享改革开放成果,实现基本医疗卫生服务均等化等方面分析了神木县实施“全民免费医疗”医改模式的价值取向和推广价值,并从预防为主,发挥中医药对保障人民健康作用和加大对基层医疗服务机构的投入等方面提出进一步完善“神木医改模式”的建议。     

Development of a Danish speech intelligibility test

A Danish speech intelligibility test for assessing the speech recognition threshold in noise (SRT_N) has been developed. The test consists of 180 sentences distributed in 18 phonetically balanced lists. The sentences are based on an open word-set and represent everyday language. The sentences were equalized with respect to intelligibility to ensure uniform SRT_N assessments with all lists. In contrast to several previously developed tests such as the hearing in noise test (HINT) where the equalization is based on scored (objective) measures of word intelligibility, the present test used an equalization method based on subjective assessments of the sentences. The new equalization method is shown to create lists with less variance between the SRT_Ns than the traditional method. The number of sentence levels included in the SRT_N calculation was also evaluated and differs from previous tests. The test was verified with 14 normal-hearing listeners; the overall SRT_N lies at a signal-to-noise ratio of ?3.15 dB with a standard deviation of 1.0 dB. The list-SRT_Ns deviate less than 0.5 dB from the overall mean.     

A New Breast Border Extraction and Contrast Enhancement Technique with Digital Mammogram Images for Improved Detection of Breast Cancer

Purpose: Breast cancer can be cured if diagnosed early, with digital mammography which is one of the mosteffective imaging modalities for early detection. However mammogram images often come with low contrast, highbackground noises and artifacts, making diagnosis difficult. The purpose of this research is to preprocess mammogramimages to improve results with a computer aided diagnosis system. The focus is on three preprocessing methods: a breastborder segmentation method; a contrast enhancement method; and a pectoral muscle removal method. Methods: Theproposed breast border extraction method employs a threshold based segmentation technique along with a combinationof morphological operations. The contrast enhancement method presented here is divided into two phages. In phaseI, a bi-level histogram modification technique is applied to enhance the image globally and in phase II a non-linearfilter based on local mean and local standard deviation for each pixel is applied to the histogram modified image. Thepectoral muscle removal method discussed here is implemented by applying a region growing algorithm. Results:The proposed techniques are tested with the Mini MIAS dataset. The breast border extraction method is applied to322 images and achieved 98.7% segmentation accuracy. The contrast enhancement method is evaluated based onquantitative measures like measure of enhancement, absolute mean brightness error, combined enhancement measureand discrete entropy. The proposed contrast enhancement method when applied to 14 images with different types ofmasses, the quantitative measures showed an optimum level of contrast enhancement compared to other enhancementmethods with preservation of local detail. Removal of the pectoral muscle from MLO mammogram images reducedthe search region while identifying abnormalities like masses and calcification. Conclusions: The preprocessing stepsproposed here show promising results in terms of both qualitative and quantitative analysis.     

对医保与医改的一些探讨意见

从基本公共服务均等化的角度提出了我国医改和医保的一些探讨性意见,认为核心是要科学处理好政府主导与发挥好市场机制之间的关系,重点需在创新体制机制、优化监管、提高绩效上努力。肯定了政府把基本医疗卫生制度作为公共产品向全民提供,并且强调即使在需要政府介入的基层医疗服务领域,也不能忽视市场的作用。此外,政府在加大医疗卫生投入的同时,要强化监督,提高投资绩效。     

广东省顺德区和云安县基本公共卫生服务均等化现况调查

目的通过比较不同经济地区基本公共卫生服务现状,找出广东省基本公共卫生服务不均等的原因和问题。方法2010年8月,采用典型抽样问卷调查方法,对顺德区和云安县社区卫生服务中心（站）和乡镇卫生院进行普查,问卷内容包括人力资源现状、基本公共卫生服务经费来源、基本公共卫生服务项目的提供情况等;采用系统抽样方法按20％的比例随机抽取上述两地区的住户,进行面对面的访谈式问卷调查,调查内容包括对基本公共卫生服务的知晓和接受情况。结果顺德区共有11家社区卫生服务中心,每千人拥有街道医院卫生技术人员平均为4．55人,拥有预防保健卫生技术人员为0．12人;云安县共有9家乡镇卫生院,每千人拥有乡镇卫生院卫生技术人员、预防保健人员分剐为O．70和O．06人。顺德区卫生技术人员学历以大专最多,占48．9％（2703／5524）,职称构成以初级为主,占65．2％（3606／5524）;云安县卫生技术人员学历以中专最多,占67．5％（172／255）,职称构成以初级为主,占60．0％（153／255）。9项基本公共卫生服务,5项及以上服务知晓率,顺德区居民为50．2％（287／572）,云安县为19．5％（48／246）（P〈0．01）。其中两地区居民知晓率最低的项目均为建立居民健康档案、重性精神疾病管理和老年人保健,分别为24．5％、31．6％、36．4％和14．2％、10．2％、20．7％。居民得到的较少的公共卫生服务项目有建立居民健康档案、老年人保健和糖尿病人管理,顺德区接受率分别为19．8％、25．4％和25．5％,云安县分别为4．9％、7．5％和O,顺德区高于云安县（P〈0．01）。2009年,顺德区婴儿死亡率为2．1‰,云安县为4．2％o;期望寿命顺德区为77．6岁,云安县为74．0岁。结论不同经济状况地区的公共卫生资源分布、服务能力、服务结果不均等,按照均等化原则,应加大对欠发达地区的支持力度。     

上海市长宁区外来流动孕产妇保健管理现状与对策

目的了解外来流动人口孕产妇保健管理、服务利用的现状,完善公共卫生管理职能提出合理化建议,为进一步发展社区卫生服务技能,创造健康支持环境,提供公平、安全、有效的全程管理和服务,提高孕产妇保健意识和水平提供依据。方法对上海市长宁区新泾镇户籍孕产妇与外来流动孕产妇保健现况和服务利用度进行社会公平性分析和客观评价,分析现行管理体制的运作难点,就如何完善公共卫生管理职能提出合理化建议。结果外来流动孕产妇早孕(妊娠<12周)建册率为22.5%,远低于本市户籍的92.7%,差异有统计学意义(P<0.001);产后访视率为93.5%,低于户籍产妇的99.8%,差异有统计学意义(P<0.01)。接受产前检查平均次数为4.4次,有22.0%的孕产妇未进行产前检查,其中53.5%不知道产前检查的意义,38.1%认为费用贵,8.4%觉得交通不方便;产前检查平均费用1 085.31元,平均分娩费用2 524.49元,最高7 000.00元。妊娠期间孕产妇期望的平均产前检查费用为459.00元,期望的平均分娩费用1 563.00元。结论建议进一步完善公共卫生管理,建立公共服务型政府,构建社区卫生服务网络,增加政府投入,从立足社会公平正义...     

精益生产方式在病案管理中的应用

结合病案管理工作的实际,介绍＂精益生产方式＂中的＂日事日清＂和＂均衡化＂在病案管理工作中的应用实例,对解决病案统计工作＂月初月末忙＂的问题提供了有效的方法。     

论基本公共卫生服务均等化

社会的总体经济增长不会自动、公平地惠及每个社会成员。在建立社会主义市场经济的过程中,政府提供包括基本公共卫生服务在内的社会公共产品的任务更加突出。实行基本公共卫生服务均等化,不仅是政府在市场经济体制下的职责,也是为了实现社会公平这一政治目标。