Statin use and medically attended acute respiratory illness among influenza vaccine recipients

BackgroundPrevious studies have suggested that statins decrease influenza vaccine effectiveness and increase risk of medically attended acute respiratory illness (MAARI).ObjectivesTo examine the association of incident statin use and MAARI in a cohort of influenza vaccine recipients.MethodsThis retrospective cohort study evaluated influenza vaccine recipients within the Tricare population. The primary outcome compared MAARI incidence during the follow-up period in a propensity score-matched cohort of incident statin users and statin non-users. Secondary analysis included propensity score-adjusted comparisons between incident statin users and statin non-users in the entire cohort and prespecified sub-cohorts with and without comorbidities. The propensity score was derived from 72 variables encompassing demographics, medical history, comorbidities, medication use, and healthcare utilization.ResultsMAARI incidence in statin users was similar to non-users in the propensity score-matched cohort (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.84–1.01). In contrast, statin users with lower comorbidity had lower OR for MAARI compared to non-users (Charlson Score zero cohort: 0.85 [CI 0.74–0.98]; No Diabetes cohort: 0.88 [CI 0.80–0.96]).ConclusionIncident statin use was not associated with increased MAARI incidence and may be associated with lower incidence of MAARI in those with less comorbidity. This study thus offers reassurance regarding the effectiveness of the influenza vaccine in statin users.     

District‐level impacts of health system decentralization in Indonesia: A systematic review

The local‐level impacts of decentralizing national health systems are significant yet infrequently examined. This review aims to assess whether localized health services delivery in Indonesia, which commenced a health system decentralization process in 2001, achieved its objectives or could be enhanced. A systematic review was undertaken to collate published evidence regarding this topic and synthesize key findings holistically using the six building blocks framework of the World Health Organization (WHO) to categorize health system performance. Four research databases were searched in 2016 for relevant evidence published between 2001 and 2015. The inclusion criteria were relevance to the topic of decentralization impacts at the district level, original research, and published in English. Included articles were appraised for quality using a standardized tool, with key findings synthesized using the WHO building blocks. Twenty‐nine articles met the inclusion criteria and categorized under the WHO building blocks categories. The findings highlight problematic impacts of decentralization related to three building blocks: service delivery, health financing, and workforce. In the 15 years of post‐decentralization in Indonesia, the service delivery, health workforce, and health financing blocks should be prioritized for further research and policy evaluation to improve the overall health system performance at the district level.     

Longitudinal outcomes of using a fluoride performance measure for adults at high risk of experiencing caries

BackgroundStaff of the VA Office of Dentistry, the dental care arm of the U.S. Department of Veterans Affairs' Veterans Health Administration, developed a performance measure (PM) regarding appropriate fluoride use. The authors hypothesized that after the implementation of this PM, veterans at high risk of experiencing caries would require fewer new dental restorations than in the past.MethodsIn a retrospective longitudinal analysis, the authors evaluated the effectiveness of a PM in reducing restoration rates in veterans at high risk of experiencing caries. They evaluated changes in restoration rates for all eligible veterans, as well as the subpopulation at high risk of experiencing caries (defined as receiving two or more restorations in 12 months) both before and after the implementation of the PM.ResultsIn 2012, 81 percent of clinics provided fluoride for more than 90 percent of their patients at high risk of experiencing caries. After use of the PM for four years, there were 8.6 percent fewer patients needing two or more restorations, a 10.8 percent decrease in the mean number of restorations and a modest 3.4 percent fewer patients at high risk of experiencing caries who required new restorations after the initial 12-month period.ConclusionsFluoride use for patients at high risk of experiencing caries rose from 51.8 percent in 2008 to 93.6 percent in 2012. Restoration rates rose before implementation of the PM and fell consistently after its implementation.Practical ImplicationsFluoride use reduces the need for future restorations in adults at high risk of experiencing caries.     

政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

公立医院财政预算项目绩效管理制度设计、实施与研究进展

本文主要采取文献分析、专家咨询和调查研究等方法,了解公立医院财政预算项目绩效管理的研究进展、制度设计和实施情况,发现公立医院预算绩效管理仍处于起步阶段,管理制度体系不健全,指标体系、信息系统、人才队伍建设等相对滞后。建议学术界积极开展相关研究,政府特别是中央层面应组织对项目绩效评价试点情况开展基线调查,了解各试点医院工作进展、问题和需要改进的方向,设计分项目绩效评价指标,赋予各类评价指标科学合理权重、分值,明确评价标准,形成统一的预算绩效管理制度框架,指导各医院推进预算绩效管理。     

医疗领域中区块链的应用与数据安全问题研究

介绍当前医疗信息化面临的挑战及区块链技术特点,分析区块链技术在医疗领域的应用前景,探讨在医疗领域中应用区块链技术存在的安全问题和解决思路,以构建病患健康档案为例,阐述基于区块链技术的医疗信息系统构建过程。     

Generating better evidence to engage local food outlets in obesity prevention research

Participation from the business community is critical to effectively addressing the problem of obesity. This commentary builds on the recent Institute of Medicine report – Accelerating Progress in Obesity Prevention – which calls for participation from the business community, particularly food outlets, to effectively address the problem of obesity. This commentary specifically discusses the importance of collecting information on fiscal-related outcomes (e.g., revenue) in order to better engage local food outlets in obesity prevention activities in the community. The routine collection of fiscal indicators in obesity prevention studies is critical so that the argument for more involvement from local food outlets, particularly for those interventions which are revenue positive or revenue neutral, can be more persuasively made.     

对建立医院出资人制度的几点思考

为了国有资产的保值和增值，为了应对日益严峻的市场竞争，建立公立医院出资人制度的需要日显迫切；在法制尚不健全的当前，只有建立起分权制衡的出资人制度框架才有可能收到预期的效果。     

从SARS危机看我国健康与发展

围绕健康与发展探讨4个相关的问题。(1)结合SARS对中国经济影响的估计，得出SARS危机的启示，即健康与发展之间存在密切联系；(2)在中国改革开放以来20多年发展的背帚下，分析了发展与健康之间的相互作用，以及政府及其卫生部门在应对发展挑战中的缺陷；(3)分析了经济转型尤其是分权化对卫生部门的影响，指出卫生服务存在不公平、效率低、反应性差的问题；(4)上述发展和转型进程中，贫困弱势人群成为利益受损者，其健康改善进展缓慢。由此提出未来的发展思路是为改善贫困人口健康提供服务，实现公平协调发展。