江苏省公立医院管办分开的探索和启示

随着医药卫生体制改革的进一步深化,探索管办分开的实现形式已成为当前公立医院改革的难点之一。文章在指出当前我国公立医院管理体制存在问题的基础上,分析评价张家港乡镇医院的"镇办镇管"模式、无锡市属医院的"医管中心"模式和镇江的"医疗集团"模式,总结江苏省公立医院管办分开的成功经验,希冀为更好推进公立医院的改革提供借鉴。     

浅谈以公共所有制实现医院改革

公共所有制是混合所有制的一种特殊形式。文章提出,在医药卫生体制改革中,要打破姓社、姓资和公立、民营的传统思维,积极探索从公共所有制入手推进医院改革。通过引进社会资本举办医院,增加医院数量;通过对公立医院进行股权改革,盘活医院存量,有效弥补国家医疗卫生投入不足;通过引入竞争机制,增加和激活医疗卫生资源,解决人民群众“看病难、看病贵”问题。     

宠物犬的社会支持作用机制

目的:考察饲养宠物犬、依恋宠物犬的社会支持作用机制.方法:本文为横断面研究,使用问卷法,采取阶段随机抽样,对在北京城八区中随机抽取的4个区中的321名饲养宠物犬和418名不饲养任何宠物的40岁及以上的受试进行调查.结果:(1)饲养宠物犬对身体健康、生活满意感具有显著影响,相对于不饲养宠物的受试,饲养宠物犬的受试身体更健康(β=0.074;P<0.05)、生活满意感更高(β=0.110;P<0.01).(2)饲养宠物犬会改变最近生活事件对身体健康的影响,但不会改变最近生活事件对生活满意感的影响(Z=2.59;P<0.01).(3)依恋宠物犬对生活满意感具有显著影响(β=-0.198;P<0.01),对宠物犬越依恋的受试,生活满意感越高.结论:饲养宠物犬的社会支持主效应及社会支持缓冲作用显著,表现为其对最近生活事件和身体健康的调节效应显著;依恋宠物犬的社会支持主效应显著,但缓冲作用不显著.     

Dealing with moral dilemma raised by adaptive preferences in health technology assessment: The example of growth hormones and bilateral cochlear implants

The aim of this article is to assess dilemma raised by adaptive preferences in the economic evaluation of growth hormone (GH) treatment for non-GH-deficient short children, and of bilateral cochlear implants for deaf children. Early implementation of both technologies and their irreversible consequences increase the potential conflicts faced by the assessors of health-related quality of life (HRQoL) states (on behalf of patients) who could be interviewed (parents, individuals with an experience of the same disability, or representative samples of the general public). Indeed, assessors' preferences may be influenced by their own situation and they are likely to vary according to age and the experience of disability. Three options are put forward which aim to resolve these moral dilemma and help economists make methodological choices that cannot be avoided in order to carry out this assessment. They are grounded on three specific egalitarian theories of social justice. The main contribution of this article is to show that a dialogue between ethics and economics, prior to an assessment, makes it possible to redefine the choice of effectiveness criteria (subjective well-being, capabilities or social outcomes), the choice of perspective (patients or the able-bodied), as well as the scope of assessment (medical and non-medical care).     

Factors Associated with Furry Pet Ownership Among Patients with Asthma

Background. Exposure to indoor allergens is an established risk factor for poor asthma control. Current guidelines recommend removing pets from the home of patients with asthma. Objectives. This cross-sectional study was conducted to determine the prevalence of furry pet ownership in asthmatics compared to nonasthmatics and to identify factors associated with furry pet ownership among those with asthma. Secondary analysis assessed characteristics among asthmatics that might be associated with allowing a furry pet into the bedroom. Methods. Using data from The National Asthma Survey collected from 2003 to 2004, we carried out univariate and multiple regression analyses, in 2009, to identify independent predictors of furry pet ownership in asthma sufferers after controlling for potential confounders. Results. Overall, asthmatics were more likely to own a furry pet than nonasthmatic individuals in the general population (49.9% versus 44.8%, p < .001). Multivariate analysis showed that female sex, older age, white race, and high income were independent predictors of furry pet ownership among asthmatics. Additionally, 68.7% of patients with asthma who own a furry pet allowed them into their bedroom. Higher income and carrying out ≤2 environmental control practices in the home were associated with increased likelihood of allowing a furry pet into the bedroom. Conclusions. Furry pet ownership is equally or more common among asthmatics compared to those without asthma. The majority of asthmatics with furry pets allow them into the bedroom. Recognizing and addressing these problems may help decrease asthma morbidity.     

A synthesis of welfare reform policy and its impact on substance users

Objectives: The purpose of this study was to provide an overview of welfare reform and its impact on the substance-abusing recipient. Methods: The data for this paper were derived from sources including the US Department of Health and Human Services and the National Institute on Drug Abuse. Results: The number of individuals on public assistance has decreased in the years following implementation of welfare reform legislation. Factors relevant to transitioning welfare recipients into the workplace, such as transportation and childcare, have special ramifications for the drug-using population. Additionally, these individuals require treatment for their addictions in order to become employable. The issue of concern is that recipients may be deterred from seeking benefits by various provisions of welfare reform legislation and turn instead to other sources (including illicit activities) for sustenance. Conclusions: Welfare caseloads have been dropping over the past two years. However, the number of substance abusers continues to rise. It is not known in what ways welfare reform will affect substance abusers who are welfare recipients. Important policy issues arise from this nexus; it is argued that these issues will require careful investigation.     

温州市社会福利院老年人生存状况研究

目的：了解福利院老年人的生存状况,便于今后更有效地开展扶老助老活动。方法通过发放问卷对社会福利院中的120位老年人进行调查。结果①福利院老年人平均年龄为83.8岁,37.5%老年人处于半自理和完全不能自理状况,心血管疾病是影响老年人身体健康的最大因素,大多数老年人存在2种或2种以上的疾病。②有孤独感的老年人占46.7%,每天以发呆为主的老年人高达69.2%,从事有益身心活动的老年人较少。③老年人对福利院院内环境和护理服务比较满意,但对居住条件和饮食满意度相对较低。④老年人最大的愿望是被人关怀。结论社会福利院的老年人生理、心理和交往能力方面存在较大问题,建议个人、家属、院方和社会力量共同有效介入。