Technology assessment and knowledge brokering: the case of assisted reproduction in The Netherlands

OBJECTIVES: Even when policy makers show interest and evidence-informed and convincing HTA studies are available, use of assessment products is not guaranteed. In this article, we report our experience with knowledge brokering to foster evidence-informed policy making on cost-effective treatment and reimbursement of assisted reproduction in The Netherlands. METHODS: From earlier work in the field of knowledge brokering, we foresaw the need for a deliberative strategy to manage the inherent tension between scientific rigor demanded by researchers and responsiveness to real-time needs demanded by policy makers. Therefore, we structured the process in three distinct steps: (i) agreement about the main messages from the research, (ii) analysis of the policy context and of the meaning of the main messages for the actors involved, and (iii) an invitational meeting to make recommendations for action. RESULTS: One of the recommendations that would require changes in ministerial policy was followed up instantly, whereas the other recommendation is still under debate. The Dutch Society of Obstetrics and Gynecology activated the revision of two guidelines. The patient organization uses the new scientific insights in informing members and the public. Closing the loop, The Netherlands Organisation for Health Research and Development (ZonMw) funded research to close knowledge gaps that became apparent in the process. CONCLUSIONS: Knowledge brokering is a promising approach to bring HTA into practice. We conclude that the methodologies to feed research results into the policy process are still in an incipient stage and need further development.     

Perceived health damages during a physicians'' strike in Israel.

This study analyzed the relationship between perceived need for health services and perceived damages to the health of the public due to curtailment of medical services during a physicians' strike. A model describing this relationship was hypothesized and tested in one city in Israel during the course of the strike. Results indicated that significant damage was perceived by the public as a result of the strike, a perception that persisted despite utilization of alternative care centers set up by the strikers. Furthermore, it was shown that financially weaker segments of the population were more likely to perceive damages to their health during a strike than were the more affluent segments of society.     

调动公立医院医务人员工作积极性国家层面政策分析

调动医务人员工作积极性对公立医院至关重要。本研究系统检索和梳理了2009-2018年国家层面颁布的调动医务人员积极性的相关政策,对颁布时间、颁布部门和政策内容进行分析。研究发现,不同时间政策关注重点有所变化,多部门联合发文成为趋势。但是部分政策推进仍然缺乏系统性,部分措施缺乏国家层面的专项政策文件,部分内容缺乏实施细则。需要继续加强多部门合作,不断完善顶层制度设计及相关实施细则。     

曲靖市某高校大学生结核病防治知识健康教育效果评估

目的 调查曲靖市某高校大学生结核病防治知识现状及评价健康教育效果,为有效开展高校结核病健康教育和结核病防控工作提供依据。方法 抽取曲靖市某高校在校学生,开展知识讲座、宣传栏、宣传册等结核病健康教育干预。用自制调查问卷,采用随机抽样方法,进行干预前后结核病知识调查,评估干预前后效果。结果 高校学生对结核病防治核心信息的总体知晓率由干预前的70.89%提高到干预后的85.49%。对于结核病人治疗后需经结核病防治机构确认其传染性消失后方可复学的由干预前的83.17%提高到干预后的97.76%,如果同学患了结核病,98.02%的学生选择劝他们到结核病防治机构接受诊疗。对于尽早发现和治愈结核病病人等4项措施,干预前后差异均有统计学意义。结论 健康教育对提高大学生结核病防治知识水平、建立积极正确的态度、形成健康的行为方式有显著作用,是高校预防控制结核病行之有效的方法。     

大学生艾滋病知识与健康教育效果评估

目的：了解大学生预防艾滋病知识、态度，并对健康教育效果进行评价。方法：采用整群随机抽样方法，运用自编问卷对川北教育学院大学生进行艾滋病防治健康教育前后效果调查。结果：健康教育后较教育前学生对艾滋病一般知识和传播途径的知晓率有明显的上升。结论：在大学生中开展艾滋病／性知识的健康教育十分必要。     

Public understanding of food risks in four European countries: a qualitative study

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor na?ve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.     

长沙市某高校大学生性知识、性态度、性行为调查

目的了解大学生性知识、性行为、性态度及性传播疾病等方面知识情况，为在大学生中开展性教育提供理论依据和指引方向。方法对长沙市某高校17—24岁间1020名1—4年级大学生的性知识、性态度、性行为、性传播疾病等知识进行问卷调查。结果大学生性知识来源主要为传媒机构。大学生性知识知晓率普遍低，约为35％，性知识掌握情况受年级高低、学生来源、父母文化程度及是否受过健康教育等因素的影响（P〈0．05）。80．3％性行为发生在低年级阶段，89．6％未采取避孕措施。大学生对性传播疾病知识了解不全面。结论高校仍是现阶段性教育的主要渠道，性教育要尽早开展，内容力求全面通俗易懂，形式多样，注重正确引导，培养大学生树立正确的恋爱观和性态度，掌握科学的性知识。     

大学生对公共场所实施控烟认知及校园控烟需求调查

目的了解大学生人群烟草暴露情况、对学校等公共场所控烟认知及需求,为高校控烟工作提供依据。方法采用多阶段分层及整群抽样方法,对保定市4所高校2 730名在校大学生进行问卷调查。结果在2 602名被调查大学生中,现在吸烟率是12.0%,2 267名非吸烟者的被动吸烟率为24.6%,大学生被动吸烟主要发生在网吧（70.6%）,宿舍（57.5%）,家中（49.9%）等场所;吸烟组和非吸烟组学生针对不同类型公共场所控烟的认识不同;73.5%的调查对象希望了解与吸烟相关的知识;83.0%认为有必要在大学生中开展拒绝吸烟或戒烟的技能指导。结论应大力开展针对大学生的烟草相关知识健康教育活动,提升其自我保健意识、能力和控烟态度,并且加强高校校园及其他公共场所的控烟工作。     

Public knowledge, attitudes, and behavior toward Kansas mandatory seatbelt use: implications for public health policy

State law and policies established by legislative bodies represent an important machinery for amplifying the effects of behavior change efforts in individuals and groups. This study shows the inter-relationships of public health policy, behavior, attitude, knowledge of the general public and how their outcomes can affect health and safety, policy formulation, enactment, implementation, policy evaluation and its revision or repeal. Observational and interview surveys of the driving public were conducted over an eighteen month period (1987-1989) in Kansas. Results showed major differences in the public's knowledge, attitudes, and behavior toward the new mandatory seatbelt law across different geographic locations of metropolitan, urban and suburban areas. The new law had the support of more than half of those interviewed. The public's knowledge and attitude on the seatbelt use and law were far from being ideal. Much work is needed to convince about 27% of the driving public who declared they never use their seatbelts and would ignore any law/policy that would force them to comply.     

Aberrant drug-taking behaviors and headache: patient versus physician report

OBJECTIVE: To explore prevalence of aberrant medication-taking behaviors (AMTB) among headache patients and treating physician's awareness of such behaviors. METHODS: Fifty patientphysician dyads were surveyed on patients' AMTB. RESULTS: The most frequently endorsed behaviors by patients and physicians, respectively, were going to the ER for pain medication (n = 19) and continuing to take pain medication despite minimal relief (n = 23). For the majority of AMTB, phi coefficients indicating level of patient-physician agreement were equal to chance. CONCLUSIONS: Headache patients perform a wide range of AMTB. Low rates of patient-physician agreement indicate that physicians possess limited knowledge of patients' AMTB.     

Parent education for kindergarten mothers: Needs assessment and predictor variables

This study investigated present methods of parent education in the kindergartens, mother's level of and need for knowledge about child development areas, and the variables that related to mothers' needs in these areas. The subjects of this study were 80 teachers and 67 mothers of 21 kindergartens in Seoul, Korea. The instruments were two questionnaires on a 4-point Likert scale. The questionnaire for mothers was composed of 117 items, and that for teachers was of 14 items. The results showed that (1) The most common type of parent education was teacher-parent conference and newsletter (2) Among the six general areas, mothers had most knowledge about modification of child behavior, but their most felt need was knowledge about child development (3) Need assessment based on item analysis revealed, in descending order, felt need for knowledge about creative development, observation techniques, social development, safety and first-aid, and ways to stimulate educational motivation, and (4) The variables that predicted mothers' felt needs were the birth order of the child, mother's experience in parent education, family cohesion, adaptability, and communication.     

医学院校大学生HIV/AIDS知识、态度调查

目的了解医学院校学生的艾滋病知识和态度,为开展艾滋病防治工作提供依据。方法以某医科大学大二学生为调查对象,随机抽取10个班级进行调查,共计341人进行横断面现场调查。结果医学生对艾滋病的传播途径问题回答的正确率较高,超过90%,对非传播途径、艾滋病的早期临床症状问题回答的正确率较低。生源地为城市的学生得分高于农村的学生,差异有统计学意义（P〈0.05）。学校课程教育、互联网、电视、报纸杂志是学生获得艾滋病相关知识的主要途径。在对待艾滋病患者的问题上,该人群的态度较好,生源地为城市的学生得分高于农村的学生,差异有统计学意义（P〈0.05）。艾滋病相关知识得分和态度得分之间无相关性（r=0.06,P〉0.05）。结论医学生的艾滋病知识、态度较好,但仍存在不足,需要进一步开展艾滋病健康教育,尤其是农村学生的艾滋病防治知识的健康教育需进一步加强。     

辽宁某医科大学学生艾滋病知识态度调查分析

目的了解医学院校大学生艾滋病相关知识、态度、信念情况，为制定大学生预防艾滋病健康教育方案提供依据。方法对大连医科大学216名在校学生的艾滋病相关知识、态度、安全性信念等进行问卷调查。结果大学生对AIDS的知识和态度得分为27，66±3．52分（满分46），安全性信念知识得分为3，71±1．38分（满分8）。能正确判断共用饮食器皿、共用坐厕、共用剃须刀和牙刷等途径能否传播艾滋病的比例分别为42，65％、37．91％和33．18％。正确的安全性观念的持有率较低。结论大学生艾滋病知识和安全性观念还很欠缺，对传播途径存在的认识误区，提示在医学院大学生中开展艾滋病健康教育是必要的。     

2007年某农业院校学生艾滋病知识与态度调查

[目的]了解大学生对艾滋病相关知识的水平与态度,为制定相应的政策、规划和措施提供依据。[方法]2007年,对山东农业大学部分在校学生进行调查。[结果]调查1227人,对艾滋病可通过性、血液、母婴途径传播的知晓率均在83．37％以上,对非有效传播途径的知晓率为12．80％～66．10％;获得艾滋病相关知识的途径主要为报刊（占89.49％）、广播电视（占85．49％）、教科书（占66．50％）;93．32％想了解更多艾滋病知识,50．94％愿意做艾滋病知识宣传员。[结论]农业院校学生艾滋病相关知识的知晓率较高,但不够全面。     

Implementing an EHR with ROI in mind

The factors that play into a physician's decision to implement an electronic health record (EHR) system are many and variable. But whether the primary motivation is improved quality of care, increased revenue, enhanced operational efficiency, or better compliance with reporting requirements, it is essential to plan the implementation in order to maximize the practice's return on investment.     

Physicians and medical innovation

Previous attempts to model some aspects of physician behaviour include those of Evans, Sloan and Feldman and Wolfson. It is suggested that the introduction of knowledge as a distinct element in a microeconomic model of physician behaviour is preferable to the inclusion of a variable called 'discretionary influence' or 'quality of care' in the physician's utility function. This is because the properties of functions containing either of these variables appear to be indeterminate. By comparison the properties of the knowledge constraints can be specified with some confidence. The factors affecting a physician's demand for treatment on behalf of patients are identified as (1) the physician's objective function, (2) his knowledge and (3) the availability of medical resources. Furthermore, the knowledge element can be sub-divided into two parts: the set of prior probabilities and the set of likelihood functions. The former may be identified with the physician's local knowledge, whereas the latter may be associated with the physician's medical training. A significant fraction of the growing demand for hospital care has been attributed to changes in medical technology. During the late fifties and afterwards 'more cases became treatable' and physicians, it is argued, cannot resist the 'technological imperative'. The paper shows that the model may be used to generate testable hypothesis regarding the adoption by physicians of both process and product innovations. The discussion of the physician's medical knowledge is fundamental to the inducement mechanism. The policy instruments available to achieve an optimal diffusion of innovations are reviewed.     

Korean public opinion on alcohol control policy: A cross-sectional International Alcohol Control study

ObjectiveTo examine Korean public opinions toward alcohol control measures on availability, advertisement, drink-driving and pricing policy, and how the views on alcohol control policy vary by demographics, drinking patterns and attitude to drinking environments.MethodsThe study used national-based, cross-sectional data collected in 2012 as part of the International Alcohol Control study. 2510 people (M: 1163, F: 1261) aged 15–65 and living in geographically diverse regions of Korea completed the questionnaire asking the support of 12 alcohol control measures.ResultsGenerally, targeted measures (purchase age of 20 and drink-driving) were more popular than universal (availability, advertisement and price) among Koreans. Gender, age, marital status, drinking patterns and attitude to drinking environments related to alcohol use of young and heavy drinkers were strong predictors of the opinions on most of the alcohol control measures. It was daily/weekly drinkers who opposed most restrictions on alcohol availability and price and the support from individuals who are more aware of problems with drinking in public place was outstanding in every control measure.ConclusionThese findings should be taken into account by Korean policy-makers as they formulate an alcohol policy for the country.     

在幼儿教育专业学生中开展口腔保健健康教育的效果评价

目的:了解健康教育对幼儿教育专业学生口腔保健相关知识、态度的影响。方法:以371名幼儿教育专业学生为研究对象,于健康教育前后,对学生进行口腔保健相关知识和态度方面的不记名问卷调查。结果:教育后学生口腔保健的基本知识平均得分由教育前的12.1分提高到17.8分(满分19分),两者相比差异有显著性。教育后对口腔保健及其相关问题的正向态度率均明显高于教育前。电化教育、文字教育和讲座是学生最希望获得口腔保健知识的方式。结论:在幼儿教育专业学生中开展有关口腔保健的健康教育,不仅必要而且可行和有效,对增加学生口腔保健的基本知识、树立与口腔保健有关的正确态度都有积极的影响,为他们今后在托幼机构的工作中,对学龄前儿童开展口腔健康教育奠定了一定的基础。     

Analysis of food irradiation education for elementary,middle, and high school students for three years in South Korea

BACKGROUND/OBJECTIVES

The current South Korean government policy on food irradiation technology should be reformed based on an in-depth investigation of the communications aspect, because the issue is no longer of a technological nature, given the proven safety and efficacy of the processes.

SUBJECTS/METHODS

The target population of the education program consisted of elementary, middle, and high school students attending 310 schools in South Korea (2013: 63 schools, 2014: 104 schools, 2015: 143 schools). Data subjected to analysis were 13,327 pre-education and 12,641 post-education questionnaires received from 7,582 elementary, 2,671 middle, and 3,249 high school students who participated in the education program from May 2012 to April 2015 (n = 12,831), after the exclusion of inadequately filled-in questionnaires.

RESULTS

Analysis of the three-year educational effect trend was conducted by comparing levels of variables before and after food radiation education. The analysis yielded the finding that the post-education levels were significantly higher for all variables. That is, for interest in education, perception (necessity, safety, subjective knowledge, and information acquisition), objective knowledge, and attitude, with the sole exception of objective knowledge in 2013.

CONCLUSIONS

Given that post-education levels of perception, knowledge, and attitude concerning irradiated foods increased considerably compared to pre-education levels, behavior change should be induced by providing continuous education to enhance, these primary variables.     

乡级计划生育服务人员计划生育政策及相关知识调查研究

目的了解乡级计划生育服务人员对计划生育政策的认知、态度及避孕知识知晓情况。方法采用封闭式问卷调查形式对119名乡级计划生育服务人员(简称乡级服务人员)进行研究。结果绝大多数乡级服务人员对现行计划生育"一孩政策"的可接受性较高,对国家实行避孕节育知情选择政策持赞同态度;并认为推行知情选择政策可提高群众参与计划生育的积极性,有利于促进妇女健康。调查显示,乡级服务机构中,初级职称人员和无职称人员所占比例较高,分别占63.87%和22.69%;乡级服务人员对计划生育避孕节育相关知识的掌握率普遍偏低,不同地区服务人员知识水平不同(P0.01)。结论甘肃省乡级服务人员素质偏低,对开展日常工作所需的避孕相关知识掌握不足。