Parental opinions towards the “No Jab,No Pay” policy in Australia

BackgroundIn 2016, Australia introduced the “No Jab, No Pay” legislation, which removed the option of non-medical exemptions from the vaccination requirements to receive certain family and child care tax benefits. We aimed to gauge parental support for “No Jab, No Pay” and explore how it has impacted parental attitudes towards vaccination, particularly among families that are reliant on the tax benefits linked to vaccination under “No Jab, No Pay”.MethodsAn online survey distributed to parents with children under 5 in Australia assessed parental knowledge and opinions towards childhood vaccination and the “No Jab, No Pay” policy.ResultsA total of 411 parents completed the survey. The majority of parents reported their child was either fully vaccinated or they intended to fully vaccinate. Eighty-two percent of parents were in favour of “No Jab, No Pay.” The belief that vaccine-preventable diseases are a significant risk to unvaccinated children was a predictor of supporting the “No Jab, No Pay” policy (AOR = 5.95, 95% CI = [3.60, 10.94], p < 0.001). Parents that depend on the financial benefits associated with “No Jab, No Pay” and parents that utilize child care services were significantly more likely to reconsider vaccination, if they previously hesitated or objected, because of the policy (AOR = 9.66, 95% CI = [4.98, 18.72], p < 0.001 and AOR = 2.09, 95% CI = [1.04, 4.17], p = 0.04).ConclusionWe found that there is widespread support for “No Jab, No Pay” among parents of young children, but parents that depend on the financial benefits or utilize child care services may be disproportionately affected by the policy. Childhood vaccination coverage in Australia could best be improved by increasing access to vaccination services and by imposing significant administrative barriers to obtaining non-medical exemptions.     

期刊评审人危机的化解机制:认证、认定与激励

【目的】 探索期刊评审人危机的化解方法。【方法】 分析引起评审人危机的原因,并对认证、认定和激励评审人的可行性进行分析,提出一些具体的执行方案。【结果】 科技期刊可从以下方面化解评审人危机:提高评审过程的开放性和透明性;将评审报告标注DOI号,使其变成可被引用的文献,并与评审人的ORCID关联;借鉴新的社交媒体平台的认证、认定和激励机制,构建期刊同行评审工作认证平台,对评审工作进行认证和记录关联;对评审人工作的量和质进行评价和奖惩激励。【结论】 结合上述认证、认定和激励措施,一方面可以解决传统同行评审的弊端,避免学术欺诈和虚假评审问题;另一方面将允许有更多合格的研究人员自愿参与学术期刊的同行评审;再者,通过激励可以使评审人更快、更高效、更富信誉和建设性地进行评审,从而促进期刊和科学的发展。     

Characterizing reward system neural trajectories from adolescence to young adulthood

Mixed findings exist in studies comparing brain responses to reward in adolescents and adults. Here we examined the trajectories of brain response, functional connectivity and task-modulated network properties during reward processing with a large-sample longitudinal design. Participants from the IMAGEN study performed a Monetary Incentive Delay task during fMRI at timepoint 1 (T1; n = 1304, mean age=14.44 years old) and timepoint 2 (T2; n = 1241, mean age=19.09 years). The Alcohol Use Disorders Identification Test (AUDIT) was administrated at both T1 and T2 to assess a participant’s alcohol use during the past year. Voxel-wise linear mixed effect models were used to compare whole brain response as well as functional connectivity of the ventral striatum (VS) during reward anticipation (large reward vs no-reward cue) between T1 and T2. In addition, task-modulated networks were constructed using generalized psychophysiological interaction analysis and summarized with graph theory metrics. To explore alcohol use in relation to development, participants with no/low alcohol use at T1 but increased alcohol use to hazardous use level at T2 (i.e., participants with AUDIT≤2 at T1 and ≥8 at T2) were compared against those with consistently low scores (i.e., participants with AUDIT≤2 at T1 and ≤7 at T2). Across the whole sample, lower brain response during reward anticipation was observed at T2 compared with T1 in bilateral caudate nucleus, VS, thalamus, midbrain, dorsal anterior cingulate as well as left precentral and postcentral gyrus. Conversely, greater response was observed bilaterally in the inferior and middle frontal gyrus and right precentral and postcentral gyrus at T2 (vs. T1). Increased functional connectivity with VS was found in frontal, temporal, parietal and occipital regions at T2. Graph theory metrics of the task-modulated network showed higher inter-regional connectivity and topological efficiency at T2. Interactive effects between time (T1 vs. T2) and alcohol use group (low vs. high) on the functional connectivity were observed between left middle temporal gyrus and right VS and the characteristic shortest path length of the task-modulated networks. Collectively, these results demonstrate the utility of the MID task as a probe of typical brain response and network properties during development and of differences in these features related to adolescent drinking, a reward-related behaviour associated with heightened risk for future negative health outcomes.     

Trends in U.S. Ambulatory Cardiovascular Care 2013 to 2017: JACC Review Topic of the Week

The National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry is the largest outpatient cardiovascular practice registry in the world. It tracks real-world management and quality of 4 common cardiovascular conditions: heart failure, coronary artery disease, atrial fibrillation, and hypertension. In 2013, the PINNACLE Registry contained information on 2,898,505 patients, cared for by 4,859 providers in 431 practices. By 2017, the registry contained information on 6,040,996 patients, cared for by 8,853 providers in 724 practices. During this time period, care processes for PINNACLE patients generally improved. Among patients with heart failure, combined beta-blocker and renin-angiotensin antagonist medication rates increased from 60.7% to 72.8%. Among patients with coronary artery disease, statin medication rates increased from 66% to 80.1%. Among patients with atrial fibrillation, oral anticoagulation rates increased from 52.7% to 65.2%. In contrast, blood pressure control rates among patients with hypertension were largely stable. PINNACLE data also fueled a variety of quality measurement programs and 51 peer-reviewed publications.     

乡村医生签约服务实践分析——以江苏省大丰市和浙江省嵊州市为例

目的:分析江苏省大丰市和浙江省嵊州市乡村医生签约服务实践及其初步成效。方法:采用典型抽样,对江苏省大丰市和浙江省嵊州市卫生局的局长或分管局长、乡镇卫生院的院长、乡村医生进行访谈,对访谈内容和政策文件进行归纳,对签约服务前后的服务量变化进行描述性分析。结果:大丰和嵊州乡村医生签约服务以村卫生室和乡镇卫生院为主体,面向全体居民并侧重重点人群,因地制宜地设计了不同的个性化服务包,并建立了相应的保障措施和激励机制。结论:通过签约服务,满足了群众的个性化需求;乡村医生收入增加,积极性提高,农村卫生服务网底得到巩固;基本公共卫生服务质量有所改善;基层医疗卫生机构基本医疗功能得到进一步强化;乡村医生签约服务助推了农村卫生改革,为地方制定和完善农村卫生改革政策提供了依据,但仍需进一步完善。建议:加强乡村医生队伍建设;完善乡村医生签约服务的激励机制;加强对乡村医生签约服务工作的总结评估,为进一步推广签约服务提供依据。     

陕西省基层医务人员激励机制的满意度调查研究

目的：通过对陕西省基层医疗机构医务人员激励机制满意度的现状调查,找到影响医务人员工作积极性的主要激励因子。方法选择陕西省陕南、关中、陕北地区医疗机构进行问卷调查,并对统计数据采用因子分析法和Krukal－Wallis检验。结果影响医务人员工作积极性的主要激励公因子有培训和发展、薪酬待遇与保障水平、管理方式和团队合作、工作条件与工作环境,并且不同属性的医务人员对激励满意度存在差异。结论要提高医务人员的工作积极性,就必须结合陕西各地区的具体情况,建立适合的激励机制。     

大学生学习动力分析

目的调查大学生学习动力现状,探讨其激励机制和方法、途径。方法通过自制问卷,调查某军医大学学员学习动力情况。结果大学生学习动力主要是自身前途(62.0%)、考试压力(47.2%)、兴趣爱好(38.0%)、父母要求(25.1%)、奖学金等荣誉(17.3%)、学校浓厚的学习氛围(11.2%);动力缺失的原因依次为对所学专业不感兴趣(48.4%)、学校学风不好(25.1%)、学习成绩好坏与就业前景无关(23.4%)、个人功底差,付出与成绩不成正比(23.1%),教师教学效果差(21.3%);大学生认为提升学习动力的方法依次为:提高教师授课水平(55.1%)、加强学术交流(49.4%)、营造良好校园文化氛围(49.0%)、改善学校软硬件设施(45.5%)、改革教学制度(44.0%)、组织课外科研竞赛及兴趣小组(41.0%)。结论针对学习动力缺失的原因,结合不同学生的具体情况,有针对性地建立激励机制,不断提升大学生的学习动力。     

Do family physicians need more payment for working better? Financial incentives in primary care

IntroductionFinancial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries.ObjectiveOur study aims to describe and compare recent existing primary care indicators and related financing in European countries.MethodsLiterature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network.ResultsTen countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income.ConclusionsThe implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well.