互联网医疗与跨境医疗结合的法律风险：以粤港澳大湾区为例

粤港澳大湾区的建立为三地医疗卫生事业的协同发展提供了新的契机。三地医疗协同发展面临跨径跨境医疗中的各种障碍。在“互联网+”背景下发展起来的互联网医疗作为远程医疗的形式之一,在优化医疗资源,方便社会公众就医及获取保健信息方面有着相当的优势。将互联网医疗与跨境医疗相结合发展尽管能够发挥两者优势,但面临一定的法律风险。本文基于我国立法现状,以粤港澳大湾区为对象,就跨境医疗与互联网医疗相结合的法律风险做出一定的探讨。提出可借鉴欧盟经验,签订具有统一适用效力的协议,以保障患者、医生、第三方医疗平台的合法权益。     

中低档女性性工作者行为特征、性传播疾病感染状况及其危险因素调查

目的:对我市中低档女性性工作者(female sex worker,FSWs)行为特征进行探究,然后统计艾滋病病毒/性传播感染(human immunodeficiency virus/sexually transmitted infections,HIV/STIs)的感染情况并探究相关危险因素。方法:对我市中低档场所工作的FSWs发放问卷调查500份,共收回421份。其中来自中档的FSWs278例,记为观察组;来自低档FSWs143例,记为对照组。对两组FSWs的行为特征、HIV/STIs进行统计,然后应用Logistics回归分析对HIV/STIs的危险因素进行分析。结果:观察组年龄30岁、汉族比例、接受初中及初中以上教育、处于已婚状态、拥有本地户籍、家住城市、首次商业性行为年龄20岁、一周工作时间≤5d、不吸烟、不饮酒以及坚持使用安全套的FSWs比例均显著高于对照组,差异有统计学意义(P0.05)。两组传染性疾病的感染中观察组感染HIV/STIs、梅毒以及HSV-2的比例均显著低于对照组,差异有统计学意义(P0.05)。对可能影响FSWs发生HIV/STIs感染的危险因素进行Logistic回归性分析筛选出4个危险因素,即:初中以下教育程度、未坚持使用安全套、不进行HIV检查以及接受HIV相关服务等。结论:不同档次FSWs行为特征存在一定差异,其中低档FSWs呈现年轻化、低文化程度、未婚等显著趋势。并且教育程度低、未坚持使用安全套以及缺乏HIV相关知识是感染HIV/STIs的危险因素,在HIV预防中应引起足够的重视。     

The missing cases of tuberculosis in Malawi: the contribution from cross-border registrations

Low case detection rates of new smear-positive pulmonary tuberculosis (PTB) patients globally are a cause for concern. The aim of this study was to determine for patients registered for TB in Malawi the number and percentage who lived in a neighbouring country and the registration, recording and reporting practices for these 'foreign' patients. All 44 non-private hospitals, which register and treat all TB patients in the public health sector in Malawi, were visited. Ten (23%) hospitals in 2001 and 14 (32%) in 2002 maintained a separate register for cross-border TB cases. Patients recorded in these registers were not formally reported to the Malawi National TB Programme (NTP), the neighbouring country's NTP, nor to WHO. They therefore constitute missing cases. In Malawi, the number of cross-border new smear-positive PTB cases was 77 in 2001 and 91 in 2002, constituting about 3% of missing smear-positive cases in those hospitals that maintain cross-border registers and about 1% of missing cases nationally.     

2011～2013年泉州市艾滋病哨点暗娼人群监测结果

目的评价暗娼人群艾滋病综合干预措施效果。方法对泉州市2011～2013年艾滋病哨点暗娼人群的监测资料进行分析。结果 2011～2013年合计调查暗娼2 576人,艾滋病防治知识知晓的1 996人,平均知晓率为77.48%（P〈0.01）。承认有吸毒行为的36人,占1.40%;最近1次与客人发生性行为时使用安全套的1 671人,占64.87%;患过性病的90例（淋病5例、梅毒20例、生殖道沙眼衣原体感染7例、尖锐湿疣23例、生殖器疱疹10例、其他性病14例）,占3.49%;最近1年接受过安全套宣传与发放或艾滋病咨询与检测的1 168人,占45.34%;接受同伴教育的115人,占4.46%。合计检测血液2 519份,HIV抗体均为阴性;梅毒抗体阳性的39份,阳性率为1.55%;HCV抗体阳性的11份,阳性率为0.44%。结论泉州市暗娼人群HIV感染率较低,但艾滋病知识知晓率和安全套使用率都不高。     

澜沧江-湄公河次区域HIV-1分子流行病学及跨境传播研究进展简

澜沧江-湄公河次区域是全球人类免疫缺陷病毒Ⅰ型（HIV-1）感染最为严重的地区之一,流行多种HIV-1病毒亚型,并且存在跨境传播的现象。该文总结了近年来澜沧江-湄公河次区域各个国家（省）的HIV-1感染情况和流行亚型。另外,对该区域流行的主要HIV-1亚型：B亚型、C亚型和CRF01_AE的跨境传播以及CRF07_BC和CRF08_BC在中国境内的跨省传播进行了介绍,希望能为该区域,特别是云南省和我国HIV-1的病毒起源、传播路线等研究提供一定的参考,也为该地区艾滋病（AIDS）疫情的预防控制提供科学依据。     

Moving health professionals as an alternative to moving patients: The contribution of overseas visiting medical specialists to the health system in Malta

Cross-border healthcare has become a major policy issue in the past years across the European Union. Professional mobility, as a means of providing specialised health services has not been given sufficient attention in both the research and policy agendas. This paper presents a case study of the contribution made by visiting overseas medical specialists to the health system in Malta. Twenty-five semi-structured interviews were conducted. A grounded theory approach was utilised in view of the limited amount of literature available on the subject. Qualitative content analysis revealed one superordinate theme, being the value of the service, and three further subthemes, which include the quality of the service provided, its longevity and durability, as well as the critical contributions of expatriates. The service is an integral component of the local health service. This study makes an important contribution to the literature on cross-border healthcare. Lessons learnt may be transferable to other small island states and territories. The European Reference Networks being developed at EU level may need to focus more on the benefits that can accrue through short term professional mobility than has been the case to date. The findings also serve to propose several important features that need to be in place to increase the chances of longevity, sustainability, quality and cost effectiveness in cross border health care services.     

Essential levels of health information in Europe: An action plan for a coherent and sustainable infrastructure

The European Union needs a common health information infrastructure to support policy and governance on a routine basis. A stream of initiatives conducted in Europe during the last decade resulted into several success stories, but did not specify a unified framework that could be broadly implemented on a continental level.The recent debate raised a potential controversy on the different roles and responsibilities of policy makers vs the public health community in the construction of such a pan-European health information system.While institutional bodies shall clarify the statutory conditions under which such an endeavour is to be carried out, researchers should define a common framework for optimal cross-border information exchange.This paper conceptualizes a general solution emerging from past experiences, introducing a governance structure and overarching framework that can be realized through four main action lines, underpinned by the key principle of “Essential Levels of Health Information” for Europe.The proposed information model is amenable to be applied in a consistent manner at both national and EU level. If realized, the four action lines outlined here will allow developing a EU health information infrastructure that would effectively integrate best practices emerging from EU public health initiatives, including projects and joint actions carried out during the last ten years.The proposed approach adds new content to the ongoing debate on the future activity of the European Commission in the area of health information.