Parliament in action: Drug withdrawals and policy changes in the U.K.

Previous studies on changes in health policies theorize such changes either as crises responses, or as the outcome of longer-term stakeholder conflicts. In this paper, we propose that parliaments function as overlooked, intermediate actors that contribute to translating the interests of stakeholders into policy changes. We study the role of parliament connecting policy makers and stakeholders in the context of drug regulation. Based on three high-profile cases of drug withdrawals between 1991 and 2005 in the United Kingdom (triazolam, rofecoxib, and co-proxamol), we distinguish partisan-political, individual-idiosyncratic, and collective-institutional pathways of parliamentary action on drug withdrawals. Distinguishing direct and indirect actions, we argue that indirect courses of action, including advocacy and educational work, can be just as effective as regular legislative endeavours, under certain conditions.     

基于清晰集定性比较分析的地方政府县域医共体创新实践影响因素及其组合路径分析

背景地方政府创新的影响因素分析一直是地方治理创新研究的重要议题。目的探究影响地方政府县域医共体创新实践的因素，并分析其组合路径。方法于2021年3月，以中国医院协会医共体分会举办的第二届"寻找县域医共体实践价值案例"评选活动的初选结果为案例源，将"政策创新类型"作为结果变量（中央主导型创新/地方回应型创新=0，地方自发型创新=1），以经济发展水平、行政层级、地理区位、问题属性及平台作为条件变量，采用清晰集定性比较分析（csQCA）法，通过必要条件分析、充分条件组合分析，探究影响地方政府县域医共体创新实践的因素并构建地方政府县域医共体创新实践的影响路径模型。结果5个条件变量一致性均<0.9，即经济发展水平、行政层级、地理区位、问题属性及平台均不是地方自发型创新的必要条件。条件变量组合分析（基于中间解）结果显示，共得到5组前因条件组合，分别为：经济发展水平*~地理区位*平台，行政层级*~地理区位*平台，经济发展水平*问题属性*平台，~经济发展水平*地理区位*~问题属性*平台，经济发展水平*行政层级*地理区位*问题属性（*表示"且"，~表示"非"）。5组前因条件组合一致性指标均为1，原始覆盖率为0.14~0.43，净覆盖率为0.14~0.43，总体覆盖率为1。地方政府县域医共体创新实践主要呈现出两类模式，即平台型创新模式和动机型创新模式。结论若要实现高水平的医共体创新实践，应该关注政策与当地经济发展水平之间的强相关性，激活地方政府的主动创新意愿，以及加强对县域医共体的平台支持。本研究对于理解地方政府县域医共体创新实践的机理乃至地方政府创新都具有一定价值。     

Reduced or painful jaw movement after collision-related injuries: a population-based study

BACKGROUND: The authors report the incidence of and factors associated with reduced and/or painful jaw movement after motor vehicle collisions that resulted in whiplash-associated disorders (WADs). METHODS: All adults filing collision-related personal injury claims during an 18-month period in Saskatchewan, Canada, were evaluated via questionnaire to determine demographic characteristics, precollision health (including jaw pain), collision parameters and collision-related symptoms, including reduced and/or painful jaw movement and injury-related neck pain. The authors excluded patients who were hospitalized for more than two days and those who sustained injuries as a pedestrian, bicyclist or motorcyclist. In determining incidence rates, the authors also excluded those who had had jaw pain before the collision. RESULTS: The incidence of reduced and/or painful jaw movement was 14.9 percent (n = 1,158), and it was higher in subjects with WADs (15.8 percent) than in those without WADs (4.7 percent; relative risk = 3.36, 95 percent confidence interval, 2.36 to 4.78). Within the WAD injuries, multivariable logistic regression revealed that the onset of reduced and/or painful jaw movement was associated with female sex; age < 50 years; having hit one's head in the collision; and postinjury symptoms of difficulty swallowing, ringing in the ears, dizziness or unsteadiness, and more intense neck pain. Collision parameters, such as head position at the time of the crash and headrest use and type, were not associated with onset of jaw symptoms. CONCLUSIONS: Reduced or painful jaw movement was more common in people with WADs than in those with other collision-related injuries. Among those with WADs, reduced or painful jaw movement was more common in women and younger people. CLINICAL IMPLICATIONS: Reduced or painful jaw movement is an important aspect of WADs, and more studies are needed to determine how to best assess and treat this problem.     

Intestinal parasitic infections in suburban government schools,Lak Hok subdistrict,Muang Pathum Thani,Thailand

ObjectiveTo provide baseline information of parasitic infections in 3 suburban government schools, Lakhok subdistrict of Muang Pathum Thani, Thailand.MethodsThis study was conducted between May-June 2010 using simple direct smear and modified formalin ether and from a population of 1 253 in 3 suburban government schools.ResultsTotal samples of 202 registered and participated. The average of prevalence of infection from 3 schools was 13.9%, there were 13.7%, 14.3% and 13.9% in N, S and R school, respectively with no significant difference between schools (P>0.05). The infection rates did not show significant difference between genders (P>0.05). The highest rate of infection was 20.4% in Pathom 2 (8 years) students and the lowest was 4% in Pathom 1 (7 years) with statistically difference between age groups (P<0.05). The highest prevalence of pathogenic protozoa was Giardia lamblia (G. lamblia) which was found in 50% of infected cases, followed by 25% of Entamoeba histolytica (E. histolytica) and Blastocystis hominis (B. hominis). The highest prevalence of non-pathogenic protozoa was Endolimax nana (E. nana) which was found in 88.9%, followed by 11.1% of Entamoeba coli (E. coli). Mixed infections between Blastocystis hominis (B. hominis) and Endolimax nana (E. nana) were reported at 7.1%. The only helminthic infection found in this study area was hookworm, found in 1 student (3.8%). The formalin ether concentration technique showed a higher efficacy of detection (78%-100%) than the simple direct smear method (0%-50%).ConclusionsSurveillance of Protozoan infections may need to be focused on suburban areas.     

决策树在天津市某区公务员健康状况影响因素分析中的应用

目的了解天津市某区公务员健康状况的影响因素,为提高该人群的健康水平提供依据。方法于2008年9-12月,采用整群抽样的方法抽取天津市某区部分公务员,发放问卷740份,进行健康状况和相关影响因素的问卷调查。利用705份有效问卷,应用SAS8.2 Enterprise Miner模块建立决策树模型,对该区公务员人群的健康状况影响因素进行分析和预测。结果该区公务员总体患病率为47.0%,患病率较高的前4种疾病为高血压(17.87%),高血脂(17.73%),脂肪肝(15.89%),颈、腰椎疾病(12.77%)。决策树筛检出的健康状况影响危险因素(重要性)包括年龄大(1.0000)、吸烟(0.8359)、不按时吃饭(0.7972)、心理健康分值低(0.5860)、体质指数高(0.4748)、被动吸烟(0.3673)、教育系统公务员(0.2876)、文化程度高(0.2832)、饮酒(0.1365);保护性因素(重要性)包括充足的睡眠时间(0.3873)、充足的体育锻炼时间(0.2845)、女性(0.2636)、亚健康分值低(0.2364)。决策树模型ROC曲线下面积为0.8881(95%CI:0.8643～0.9119),预测的准确度为80%。结论公务员人群健康状况不容乐观,各种慢性病患病率较高,是今后开展健康管理的重点群体。     

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。     

农村公共卫生管理政府责任缺位的应对措施

目的：探讨农村公共卫生管理政府责任缺位的应对措施。方法针对我地区农村公共卫生管理政府责任缺位,提出建议民营资本进驻的建议,并提供具体方法,分析其实际效果。结果干预后农村医疗总床位数及初级以上执业人员均显著多于干预前（P＜0.05）,干预后患者总住院时间短于干预前（P＜0.05）,均次医疗费用少于干预前（P＜0.05）。结论提高政府对农村医疗资源的支持,能有效减低医疗费用,提高农村基层医务人员工作积极性。     

An Early Stage Evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital''s facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

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Relationship between regulatory barriers to entry and pharmacy technician wages

BackgroundPharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While these requirements may improve patient safety, there is a risk that laws and regulations which impose substantial education and training requirements on technicians could create barriers to entry which restrict the workforce and increase wages.ObjectiveThis study has two objectives: 1) Describe changes in barriers to entry and wages over time; and 2) Evaluate the correlation between changing barriers to entry and pharmacy technician wages.MethodsData come from Bureau of Labor Statistics Occupational Employment Statistics from 1997 to 2017 and National Association of Boards of Pharmacy Surveys of Pharmacy Law from 1997 to 2014. A barrier to entry was defined as adoption of registration, licensure, or certification. Wage data was adjusted to 2017 dollars using the Consumer Price Index. Ordinary least squares regression evaluated the correlation between the proportion of states which had at least one barrier to entry and wages. An interrupted time series model estimated the impact of adopting a barrier to entry on the trend in technician wages over time.ResultsTechnician wages increased between 1997 and 2007 but remained flat between 2008 and 2017. A strong correlation was observed between the proportion of states which had at least one barrier to entry and technician wages (R2 = 0.93, p < 0.0001). However, the interrupted time series models did not identify any relationship between adoption of a barrier to entry and the trend in technician wages (p = 0.363).ConclusionsThis research suggests adoption of legal/regulatory barriers to entry did not have a significant influence on the trend in technician wages over time. More research is needed to evaluate the impact of barriers to entry on non-wage practice variables, such as privileges and satisfaction.