我国婚前保健服务筹资机制研究

本文从婚前保健服务的属性入手,探讨其筹资机制,为完善我国婚检制度提供科学依据。采用文献调研和现场调研相结合的方法,梳理国内外婚检筹资现状,收集福建、广西、江苏等8个调研地区婚检筹资相关数据,并对政府有关部门、婚检机构相关人员进行访谈。婚前保健服务属于准公共产品的范畴,本文从筹资水平、资金渠道、资金分配、资金支付和资金监管等方面对其筹资机制进行探讨,提出应明确婚检服务性质、建立财政专项投入机制,进行科学论证、统一婚检服务基本筹资标准,及时足额拨付婚检专项经费、加强经费监管等政策建议。     

长期护理保险第一批试点城市保险筹资方案比较分析

目前我国已全面开展长期护理保险制度试点。通过对第一批四个试点城市的长期护理保险筹资方案进行梳理,比较分析各城市保险的筹资性质、筹资来源、筹资水平、筹资公平性,发现长期护理保险筹资来源较单一、缺乏激励措施、筹资总体水平不高、筹资公平性有待改善等问题。为完善长期护理保险筹资方案制度设计,本文提出需要特别注意的几个问题:完善筹资来源,应逐步形成合理稳定的筹资来源,拓宽筹资渠道,提高筹资水平;改善筹资公平性,从完善参保制度、加强宣传等方面提高筹资公平性;理顺保险筹资管理体系。     

X-ray studies on crystalline complexes involving amino acids and peptides

L-Arginine acetate crystallizes in the monoclinic space group P2¹ with a = 9.229(2), b = 5.178(3), c = 13.271(4) Å and β= 111.4(1)d?. The crystal structure was solved by direct methods and refined to an R value of 0.058 for 1333 observed reflections. The conformation of the arginine molecules in the crystal is different from those observed in the crystals of L-arginine, its salts and complexes. The crystal structure indicates that complexation with a small carboxylic acid like acetic acid is sufficient to align arginine molecules in a head-to-tail fashion. The structure contains a specific ion-pair interaction, involving electrostatic attraction as well as two nearly parallel, N-H. O hydrogen bonds, between the guanidyl group and the acetate ion.     

Qualitative differences among sweeteners

Seventeen sweeteners varying widely in chemical structure were arranged in a three-dimensional space by two multidimensional scaling procedures, INDSCAL and ALSCAL. Fructose, glucose, sorbose, xylitol and xylose tended to fall near one another. Two sweeteners with a syrupy component, maltose and sorbitol, fell further away. Ca cyclamate and the dipeptide aspartame were the two artificial sweeteners which fell closest to and thus tasted most like the sugars. The proteins monellin and thaumatin, as well as the chalcone glycoside, neohesperidin dihydrochalcone, all have long aftertastes and thus tended to fall proximate to one another. Stimuli with the highest metallic and bitter ratings (acetosulfan, sodium saccharin, rebaudioside and stevioside) tended to fall near one another with the amino acid d-tryptophan located a little farther away. Adjective scales were related to the spatial arrangement. Wide variability in the patterns of intensity ratings over subjects suggests that the sweet taste may be mediated by several peripheral receptor mechanisms.     

Clinicopathological studies of anomalous arrangement of the pancreaticobiliary ductal system with pancreas divisum

We examined the morphological aspects of the pancreaticobiliary ductal system in 13 patients with both anomalous arrangement of the pancreaticobiliary ductal system (AAPB) and associated pancreas divisum (PD), and compared their clinicopathological findings with those of patients with either AAPB or PD alone. PD is classified into three types, i.e., separate pancreas, nonfusion of the ventral and dorsal pancreatic ducts, and partial fusion of the ventral and dorsal pancreatic ducts. Of the 13 patients with AAPB and associated PD, 5 were male and 8 female; their mean age was 57 years. Nine of the 13 had clinical symptoms. Five of the 13 had gallbladder cancer, 3 had cholecystolithiasis, and 2 choledochal cyst. One patient showed nonfusion of both pancreatic ducts and the others showed partial fusion of the ducts. The length of the common duct from the orifice of the papilla of Vater to the junction of the common bile duct with the ventral pancreatic duct and the location of the union varied. The presence of both AAPB and PD made the arrangement of the pancreaticobiliary ducts very complicated. Clinical aspects were similar to those of AAPB and the patients were likely to be treated for a condition other than PD. However, since relapsing acute pancreatitis and intermittent epigastric pain are typical symptoms in patients with AAPB as well as in those with PD, we should carefully follow up those patients with both AAPB and PD.     

Surgical management of the coronary artery to pulmonary artery fistulas; a case of a large ruptured aneurysm

Three patients were treated for coronary artery-pulmonary artery fistula. Each was asymptomatic due to a coronary artery fistula. There was one instance each of myocardial infarction, mitral stenosis and a large closed ruptured aneurysm including a thrombus. All the fistulas were comprised of several small plexiform arranged vessels. The left to right shunt ratio was approximately 8 per cent or less. A surgical operation was performed to close the drainage orifice of the fistulas through pulmonary arteriotomy under cardiopulmonary bypass in two patients while one patient underwent a ligation of a large abnormal vessel to the aneurysm followed by a resection of the aneurysm without cardiopulmonary bypass. A large saccular aneurysm of such fistulas is rare and a rupture of such an aneurysm is even more rare. The surgical management of coronary artery fistulas is also discussed herein.     

贫困地区政府和集体在合作医疗筹资中的作用

在农村贫困地区，政府财政大多呈现赤字，集体经济薄弱，因此，在贫困地区合作医疗筹资过程中充分发挥政府和集体经济的作用是贫困地区合作医疗举办过程中应加以考虑的问题。本文通过对１０个贫困地区合作医疗试点县的研究认为，目前在１０个试点县中，各级财政和集体经济对合作医疗尚缺乏一定的支持，但有一定的筹资潜力，另外，民委、民政和扶贫经费也是潜在的筹资渠道。在资金的使用方向上应考虑为特困人群代缴合作医疗基金，以发挥资金的最大利用效率，同时也促进贫困地区合作医疗筹资的公平性     

贫困地区农民合作医疗支付能力研究

贫困地区合作医疗筹资的可行性,在很大程度上受到农民对合作医疗的支付能力和意愿支付水平的影响。但目前国内对农民支付能力的研究较少,本文利用扩展线性支出系统来研究农民的客观支付能力。研究结果表明:在农村贫困地区,一般人群的合作医疗筹资应以个人投入为主,而特困和贫困人群的合作医疗筹资应以政府和集体支持为主。     

Septum formation of the common hepatic duct associated with an anomalous junction of the pancreaticobiliary ductal system and gallbladder cancer: Report of a case

We herein describe a 48-year-old woman who developed a septum formation of the bile duct combined with an anomalous arrangement of the pancreaticobiliary ductal system in conjunction with gallbladder cancer. A preoperative endoscopic retrograde cholangiogram demonstrated a filling defect in the common hepatic duct which was misdiagnosed to be an elevated lesion. Further exploration revealed a septum formation of the bile duct along with gallbladder cancer. A resection of the dilated bile duct and gallbladder along with a dissection of the regional lymph nodes was performed. A histological evaluation showed the septum to consist of a normal bile duct wall while the tumor in the gallbladder was poorly differentiated adenocarcinoma. The patient made an uneventful recovery. The septum formation was presumed to be congenital in origin.     

国际卫生保健体制中筹资方式的比较与思考

本文通过对美国、英国、新加坡、澳大利亚几种典型筹资方式的分析，结合中国历史、现状及存在问题，描述中国城市的公费、劳保医疗及农村的合作医疗的筹资方式及变迁。分析存在问题和挑战，提出设置卫生税、采用具有储蓄制的合作医疗制度，建立医疗救助基金。为探讨今后的筹资办法作一些有益的思考。