上海市社区卫生服务收支两条线管理的调查与分析

对上海市19个区县的社区卫生服务“收支两条线”管理情况进行调查,从管理框架、制度设计等方面进行了利弊分析,建议在区卫生局层面,设立社区卫生专管机构;对社区卫生服务中心主任和社区卫生服务中心财务会计实行委派制。     

新疆牧民增收问题的思考与建议

改革开放以来,我区的牧民收入有较大提高,但一直低于农民的收入水平,这与新疆发展现代化畜牧业的战略目标不相协调,牧民增收缓慢有客观原因,也有思想认识上的误区.根本原因在于生产方式极其落后,牧区的整体发展跟不上时代前进的步伐.实现牧区城镇化,强化牧民定居工程,在未来的十年内,使牧民定居点实现“两个百分之百”.积极拓展移民扶贫空间、加速人工草地建设、制定优惠政策、实现牧区生产经营多元化;高度关注制约牧民增收的不利因素、着力提高牧民的文化和科学技术素质、使牧民与全社会同步进入小康。     

Multilevel analysis of geographic variation among correlates of child undernutrition in India

Prior research has identified a number of risk factors ranging from inadequate household sanitation to maternal characteristics as important determinants of child malnutrition and health in India. What is less known is the extent to which these individual‐level risk factors are geographically distributed. Assessing the geographic distribution, especially at multiple levels, matters as it can inform where, and at what level, interventions should be targeted. The three levels of significance in the Indian context are villages, districts, and states. Thus, the purpose of this paper was to (a) examine what proportion of the variation in 21 risk factors is attributable to villages, districts, and states in India and (b) elucidate the specific states where these risk factors are clustered within India. Using the fourth National Family Health Survey dataset, from 2015 to 2016, we found that the proportion of variation attributable to villages ranged from 14% to 63%, 10% to 29% for districts and 17% to 62% for states. Furthermore, we found that Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh were in the highest risk quintile for more than 10 of the risk factors included in our study. This is an indication of geographic clustering of risk factors. The risk factors that are clustered in states such as Bihar, Jharkhand, Madhya Pradesh and Uttar Pradesh underscore the need for policies and interventions that address a broader set of child malnutrition determinants beyond those that are nutrition specific.     

医院药品费用占比的分析与调控

药品费用占患者总医疗费用的比例可以反映医疗卫生资源消耗的内在结构,常作为医院药品费用控制的评价指标,控制药品费用占比可以优化用药结构,促进医药费用合理发展,但药品费用占比评价指标也有其内在的局限性,需要积极探索结构优化的方法,以促进我国医药卫生事业的健康发展。     

Discussion Based on Analysis of the Suicide Rate and the Average Disposable Income per Household in Japan

Objective:

Suicide is one of the major social issues in Japan. According to a report of the National Policy Agency, there were approximately 22 000 to 24 000 annual suicides between 1994 and 1997 and there have been over 30 000 annual suicides in Japan since 1998. For these reasons, we think it is important to discuss the economic factor related to suicides in recent years.

Method:

In this study, we examined suicide rates and the average disposable income per household in Japan in the last 15 years (ie 1994–2008) and discussed the statistical analysis of the average disposable income per household and the associated suicide rates.

Results and Discussion:

During the research period, annual suicide rates per 100 000 population in Japan ranged from 16.9 to 25.5 among the total population, from 23.1 to 38.0 among men, and from 10.9 to 14.7 among women. The annual average disposable income per household (ten thousand yen) ranged from 424.0 to 549.9. The average disposable income per household was related to the suicide rate among the total population and among men. The average disposable income per household was not related to the suicide rate among women.

Conclusion:

We believe that this discussion will be useful in developing specific suicide preventive measures.     

Income Levels and Response to Contingency Management for Smoking Cessation

Background: Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. Objective: This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. Methods: A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Results: Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Conclusions: Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.