Incidence and Characteristics of Childhood Hodgkin’s Lymphoma in Greece: A Nationwide Study (Greece)

Objectives To estimate the incidence and epidemiological profile of childhood (0–14 years) Hodgkin’s lymphoma in Greece derived by the network of childhood Hematology–Oncology departments on the basis of all 95 newly diagnosed cases during a seven-year period. Methods Seventy-one of these cases were individually age and gender matched to an equal number of controls. Results The incidence of childhood Hodgkin Lymphoma reached a relatively high figure of 7.8 per million children-years, with an age distribution (2.2 for children 0–4; 6.3 for those 5–9 and 13.9 for those 10–14-years-old) and male to female ratio (1.7:1) similar to that reported from other cancer registries. Childhood Hodgkin’s lymphoma was more common among children living in less crowded quarters (odds ratio (OR): 6.5 and 95% confidence intervals (95% CI): 1.4–30.7), among those who have changed residence 60 to 18 months before the onset of the index disease (OR: 4.4, and 95% CI = 1.4–14.0), among those whose families owned a cat (OR: 5.5, 95% CI = 1.2–25.6) but not among those whose families owned a dog and marginally more common, among those with a history of infectious mononucleosis (OR: 5.0, 95% CI = 0.6–42.8). Conclusions Our results point to infectious agent(s) as playing an etiological role but do not allow discrimination among the delayed establishment of the herd immunity hypothesis, the population mixing hypothesis or that invoking transmission of the agent(s) from the non-human reservoir. The Childhood Hematology–Oncology Group. Maria Moschovi, Hematology–Oncology Unit, First Department of Pediatrics, Athens University Medical School, ‘Aghia Sophia’ General Children’s Hospital, Athens, Greece Fani Athanassiadou- Piperopoulou, 2nd Department of Pediatrics, Aristotle University of Thessaloniki, AHEPA General Hospital, Greece Sophia Polychronopoulou, Department of Pediatric Hematology–Oncology, ‘Aghia Sophia’ General Children’s Hospital Athens, Greece Apostolos Pourtsidis, Department of Pediatric Hematology–Oncology, ‘Pan.&Agl. Kyriakou’ Children’s Hospital Athens, Greece Maria Kalmanti, Department of Pediatric Hematology–Oncology, University Hospital of Heraklion, Heraklion, Greece     

马克思关于人类社会阶段“跨越”发展的辩证法

马克思曾设想俄国农村公社有可能跨越资本主义制度“卡夫丁峡谷”而直接进入共产主义社会。本文运用马克思主义理论辩证地阐述了人类社会实现跨越发展所必备的条件内在因素、外在条件、动力以及跨越的内容。     

Solidarity and the Role of the State in Italian Health Care

The article deals with the issue of solidarity in health care,with particular reference to the Italian context. It presents thedifficulties of the Italian NHS and assesses the current proposalto counter the crisis of the Welfare State by giving upinstitutional arrangements, in order to favour the so-called`social private'. Moreover, it addresses the question ofprioritisation and targeting in the context of health care,arguing for the insufficiency of the standard approach of neutralliberalism, and showing how the concept of solidarity might helpto develop a different account. Lastly, it discusses the case oforgan transplantion in Italy, as an example ofsolidarity-inspired health care policy.     

Pay equity and nursing in Ontario: ten years later

Abstract
'Nurses have never been compensated in accordance with their central role in health care' ( Schreiber 1994 ), reflecting the generalized and well-documented under-valuing of the work of women ( Schreiber 1993 ). Pay equity legislation, passed in Ontario, Canada in 1987, designed to correct gender wage discrimination, created great optimism that the under-valuing of nurses' work might be ending. Nonetheless, this has not been the case, as the social, political, and economic climate has not kept pace with the speed and enormity of social change necessary to enact the intent of the legislation. Indeed, gains in nurses' wages have been directly offset by significant lay-offs. In this paper, we examine the issues surrounding the implementation of pay equity legislation in Ontario, Canada, along with analysis and implications of these issues, drawn from 10 years of experience. In addition, we highlight lessons that can be learned from the Ontario experience.     

医疗卫生机构改制上市的策略

随着我国加入WTO在即,医疗市场将全面放开,我国的医疗卫生机构的管理者应当认清形势,采取相应策略,作者认为,有些医疗卫生构应当更新观念,逐步向医疗卫生服务产业化,集团化、多元化的远行机制转变,采用与资本市场有机结合,把高投入,规范化的融资手段引入,使医疗卫生机构获得超长发展,为此,医疗卫生机构产权应多元化,如医院集团、股份制、委托经营等,随后阐述了资本运营对医疗卫生机构机构股份制改制的促进作用,并就资本运营与医疗卫生机构改制和医疗卫生股票上市的程序进行了论述。     

Effects of Compensation Methods and Physician Group Structure on Physicians' Perceived Incentives to Alter Services to Patients

Objective. To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients.
Data Source. Nationally representative data on physicians are from the 2000–2001 Community Tracking Study Physician Survey ( N =12,406).
Study Design. Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither.
Principal Findings. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services.
Conclusions. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.     

不同举办主体社区卫生服务机构护士满意度比较研究

目的了解不同举办主体社区卫生服务机构护士满意度情况。方法随机选取郑州市不同举办主体社区卫生服务机构的135名护士,采用自行设计调查问卷的方法,调查护士的满意度。结果医院、政府、民办社区卫生服务机构护士总体满意度分别为25.0%、62.5%、83.3%。医院办社区卫生服务机构护士自感工作时间最少;医院举办的社区卫生服务机构护士参与培训的次数最多;民办社区卫生服务机构护士自感工作量最适当。结论政府办和医院办社区卫生服务机构应增加对社区卫生服务机构护士的投入与支持,增加护士的满意度。     

Evaluating a service-learning assignment in a doctor of chiropractic program public health course

ObjectiveDespite the use of service learning in other health care education programs, little is published about its use in doctor of chiropractic programs. Since 2017, the public health course at our institution has included a service-learning assignment in which students volunteer for nonprofit organizations and write an essay about their experience. The objective of this study was to assess the effects of the assignment on students'' self-reported public health knowledge and attitudes.MethodsBetween April 2017 and June 2018, 56 essays were collected from students who volunteered at a nonprofit organization focused on 3 categories: youth, the environment, or poverty. Each essay was deidentified and assigned random 4-digit-number file names. Ten files were randomly selected from each of the 3 categories for qualitative thematic analysis using deductive and inductive coding.ResultsStudent essays demonstrated competency in public health concepts, including organizational systems, levels of prevention, and the social ecological model. In addition, a majority of the students went beyond discussing knowledge gained from this assignment and described the impact of their experience on their personal growth.ConclusionThis study demonstrates that students respond favorably to a service-learning assignment that addresses public health competencies and may foster personal and professional development.     

Safety evaluation of Lactobacillus pentosus strain b240

Lactobacillus pentosus has a long history of use in cooked and uncooked fermented foods. Viable and heat-killed nonviable preparations of L. pentosus strain b240 were evaluated for short term and subchronic toxicity and genotoxic potential. Dose levels were determined through acute oral toxicity tests with viable (LD₅₀ > 2500 mg/kg) and nonviable (LD₅₀ > 2000 mg/kg) b240. In the short term study, rats received 2500 mg/kg/day (∼1.7 × 10¹¹ cfu/kg/day) viable b240 for 28 days. In the subchronic study, rats received 500, 1000 or 2000 mg/kg/day (up to ∼3.0 × 10¹² cfu equivalents/kg/day) nonviable b240 for 91 days followed by a 28-day recovery. No mortalities occurred. No treatment-related effects were identified for general condition, body weight, food-water consumption, ophthalmology, urinalysis, hematology, blood chemistry, organ weights, histopathology and gross pathology. Although statistically significant effects were noted for several endpoints in the short term and subchronic studies, none were related to the test materials. The NOAEL for nonviable b240 was 2000 mg/kg/day, the highest dose tested. Additionally, nonviable b240 (?5000 μg/plate) was not mutagenic in Salmonella typhimurium or Escherichia coli tester strains nor did nonviable b240 orally administered to rats at levels ? 2000 mg/kg/day for two days, induce a clastogenic response.     

对新型医疗改革的伦理再思考

我国医疗卫生领域各方面的改革日益成为社会关注的焦点。对新型医疗改革的一些关键问题进行了分析,从确定“政府主导”的医改思路,明确“公立医院公益性”的医改方向,推动公共卫生机构实行全额预算的医改要求,实行人人享有基本医疗服务的医改目标这四个方面,进行了深入的思考,提出一些有益的见解。