Avoiding problems in clinical practice after the pill scare

The publications of 1995 and 1996 on the risk of venous thrombosis associated with the use of the combined oral contraceptive pill (COC) suggested that the risks were lower than previous estimates. The debate, which ensued, ensured that the safety of the COC with regard to arterial and venous disease was reassessed. This review details the importance of contraception for public health. It reassesses critically current prescribing practice in the light of the new publications on Factor V Leiden, arterial and venous disease. Methods of communicating information about the COC are assessed, and the difficulties of transmitting complex scientific data to health care professionals and the general public are debated. The importance of attempting to quantify the benefits and risks of the COC and explaining them in the context of other life events is emphasized.     

重庆市2004—2007年突发公共卫生事件分析

目的对重庆市2004—2007年报告的突发公共卫生事件进行分析，以加强对突发公共卫生事件的预防和应急处理。方法应用描述流行病学方法，分析事件特征。结果全市4年报告突发公共卫生事件478起，发病19884例，死亡56例；渝东南地区多发，时间分布基本呈双高峰：传染病事件占80．98％．学校事件占78．87％；事件平均报告时间3．44d，平均处理时间46．72d。结论突发公共卫生事件的发生与地区经济文化水平密切相关；应提高对乙、丙类传染病和非法定传染病事件的重视程度；学校卫生工作有待进一步加强：突发公共卫生事件报告管理体系有待进一步理顺。     

Determinants of private clinics' productivity: a comparison of city and county clinics in Korea

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9,212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants'incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100,000 and income of the administrative unit were found to be significant determinants, but only in city environments.     

社会融合对流动老人基本公共卫生服务利用的影响研究

目的 了解流动老人基本公共卫生服务利用情况,以及社会融合对基本公共卫生服务利用的影响。方法 于2021年7—12月,采用方便抽样的方法,抽取广州市、深圳市、江门市452名流动老人进行问卷调查。采用二元logistic回归模型分析流动老人社会融合对建立健康档案、接受健康教育和老年人健康管理之间的影响。结果 在452名流动老人中,60.8%建立了居民健康档案,接受过健康教育和老年人健康管理的分别有64.4%和60.0%。Logistic分析结果显示,流动老人的居民健康档案行为受到月消费水平（B = 0.368,P＜0.05）、社区文体活动参与程度（B = 0.362,P＜0.01）、居留意愿（B = 0.408,P＜0.001）、年龄（B = - 0. 513,P＜0.01）、户籍类型（B = 0.742,P＜0.01）、流动类型（B = - 0.539,P＜0.05）等变量的影响;健康教育服务利用行为受到社区文体活动参与程度（B = 0.354,P＜0.01）、年龄（B = - 0.411,P＜0.05）、户籍类型（B = 0.561,P＜0.05）的影响;老年人健康管理服务利用行为受到社区文体活动参与程度（B = 0.291,P＜0.01）、居留意愿（B = 0.239,P＜0.05）、年龄（B = - 0.474,P＜0.05）、流动类型（B = - 0.471,P＜0.05）、流动时间（B = 0.225,P＜0.05）、流动目的（B = 0.328,P＜0.01）的影响。结论 流动老人基本公共卫生服务利用率较低,社会融合会对流动老人的基本公共卫生服务利用产生积极影响。可以通过提高流动老人获得基本公共卫生服务的能力和社会融合水平来促进流动老人的基本公共卫生服务利用,从而实现基本公共服务均等化。     

基于内部控制视角的医院合同全生命周期管理

本文归纳了医院合同管理面临的主要问题,梳理了国家政策对医院合同管理的要求。基于内部控制视角,介绍了某医院加强合同全生命周期管理的实践:改变以往纸质管理模式,研发合同管理系统,推进智慧财务建设;贯穿事前、事中、事后阶段,建立合同闭环管理体系;对接相关系统,促进合同与全面预算、收支、采购管理有机结合;按照不同经济业务对运营风险防控的要求,实施合同分类管理。     

新政府会计制度下公立医院会计核算的难点及对策

2019年1月1日公立医院正式开始实施新政府会计制度,通过研究公立医院在新制度下会计核算的衔接问题以及适应问题,找出公立医院会计核算将面临的难点,如固定资产及其累计折旧核算方式、应付职工薪酬、科教项目核算等,并给出相应的解决对策,如利用信息化手段对应付职工薪酬进行资金分配、利用成本配比处理医院科教项目核算难点等,帮助公立医院能够在改革中进步,提升公立医院会计核算管理水平。     

我国农村居民健康感知影响因素分析*

摘 要：2019年8月,重庆市荣昌区作为全国567个紧密型县域医共体建设试点县之一,以“人通、医通、财通”为抓 手,加快整合医疗卫生资源,促进医疗卫生工作重心下移和资源下沉,积极推动分级诊疗制度建设,为辖区内居民提供全方 位的健康服务。     

Associations of park features with park use and park-based physical activity in an urban environment in Asia: A cross-sectional study

Park use is associated with health, yet our understanding of park features related to their use is limited. Singapore's parks were audited for 30 micro-features, then geospatial analysis characterized micro-features scores for parks nearest to participants' homes. Adults (3,435) reported their park use and park-based physical activity. Using linear regression models, we found living near a park with higher micro-features scores was associated with more time in parks and park-based physical activity. Specific micro-features were associated with more park time (wildlife areas, water features, forested areas, unpaved trails (2–2.6 h/month, p < 0.05)) and with physical activity in parks (water features, forested areas, large playground, open green spaces (1.8–2.2 h/month, p < 0.05)). These findings could inform parks planning to support population-health.     

Ghrelin as a Biomarker of Stress: A Systematic Review and Meta-Analysis

Introduction: Ghrelin is an orexigenic hormone which favors food-seeking behavior and has been postulated to be a biomarker of stress. We conducted a systematic review and meta-analysis on the evolution of ghrelin levels following acute stress. Methods: The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched for studies reporting ghrelin levels before and after acute stress in humans. Results: We included ten studies for a total of 348 patients. Acute stress (intervention) was always in a laboratory. Acute stress was psychological (Trier Social Stress Test), physical, or mixed (cold pressure test). The overall meta-analysis demonstrated an increase in ghrelin after the stress intervention (ES = 0.21, 95CI 0.09 to 0.34) compared with baseline levels. Stratification by time demonstrated an acute increase in ghrelin levels in the five minutes immediately following the initiation of stress (0.29, 0.10 to 0.48) but without any difference after. Obese individuals had a more significant (ES = 0.51, 95CI 0.18 to 0.84) and prolonged increase in ghrelin levels for up to 45 min compared with non-obese individuals who had a significant increase only five minutes after stress. Moreover, the ghrelin levels increased in response to stress with BMI (coefficient 0.028, 0.01 to 0.49; p = 0.013) and decreased with the time after the stress intervention (coefficient -0.007, −0.014 to −0.001; p = 0.025). Conclusion: Ghrelin is a biomarker of stress, with a short-term increase following acute stress. Obese individuals have both a higher and prolonged response, emphasizing the link between obesity and stress.     

The IHAT-GUT Iron Supplementation Trial in Rural Gambia: Barriers,Facilitators, and Benefits

Introduction: In most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical trial (termed IHAT-GUT), conducted at the Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM) (abbreviated as MRCG hereof). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in the Gambia. Methods: Individual interviews (n = 17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis. Results: Potential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff, and the local partnership. Conclusions: While facilitators and barriers were identified to conducting this clinical trial in a rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand.