Aspekte zur gesundheitsökonomischen Bewertung im Gesundheitssystem

Health economists use models to estimate comparative costs and usage of interventions in health care. However the concepts and methods used have inherent weaknesses, especially in the determination of relevant and exact effect sizes. Health economic methodologies do not replace sociopolitical decision making, but they can play an important role in rational decision making about necessary changes to our social and health system if the instruments themselves are neither over- nor underestimated.     

基于熵权法的健康城市发展水平实证分析——以中国54个城市为例

目的：为有效识别城市发展过程中的健康风险,提高居民健康福祉,制定相关公共卫生政策提供实证依据。方法：通过熵权法和聚类分析,对中国54个城市的健康发展水平进行比较研究。结果：(1)健康城市总体发展水平及态势良好,但健康发展不平衡问题比较突出,区域、城市及领域之间存在较大差距;(2)在健康城市六个子系统中,健康经济得分较高、发展较好,而健康社会、健康人群、健康环境、健康文化、健康服务得分较低,发展相对薄弱;(3)健康城市子系统指数与城市人口规模关系强弱不同,其中健康经济及健康人群关联较强;(4)健康城市综合指数得分与其子系统指数得分并不统一,有的城市综合得分较高但其子系统中某一单项得分靠后,有的城市综合指数得分不高但其某个单项得分靠前。结论：健康城市发展是一个动态过程,针对不同城市发展中存在的问题,“补短板、强弱项”,从而推动健康城市发展和健康中国战略实施。     

Smallpox models as policy tools

Mathematical models can help prepare for and respond to bioterrorism attacks, provided that their strengths and weaknesses are clearly understood. A series of initiatives within the Department of Health and Human Services brought modelers together with biologists and epidemiologists who specialize in smallpox and experts in bioterrorism response and health policy and has led to the parallel development of models with different technical approaches but standardized scenarios, parameter ranges, and outcome measures. Cross-disciplinary interactions throughout the process supported the development of models focused on systematically comparing alternate intervention strategies, determining the most important issues in decision-making, and identifying gaps in current knowledge.     

Testing the 2017 PHC reform through pilots: Strengthening prevention and chronic care coordination

Numerous official reports have highlighted insufficient provision of preventive services within primary health care (PHC) in Poland. Other identified weaknesses include inappropriate referrals to ambulatory care that contribute to long waiting times for specialist consultations. Since mid-2018, a new model of PHC organization has been piloted and can be seen as an attempt to address some of these weaknesses. It draws on the Primary Health Care Act of 2017 and puts much more emphasis on disease prevention and health promotion within PHC as well as shifts management of common chronic conditions to multidisciplinary PHC teams. The implementation of this model has been supported by a range of financial and non-financial measures, including a special grant that helps PHC practices to adapt their IT systems to the requirements of the pilot. Yet, the overall requirements were prohibitive to most PHC practices and only 42 were eventually included in the pilot. In this paper, we describe the content of this model, the difficulties in its implementation and how they were addressed and discuss its possible effects on PHC and the health system more broadly.     

Local health departments in Washington State use APEX to assess capacity.

THE ASSESSMENT PROTOCOL for EXCELLENCE in PUBLIC HEALTH process was carried out in the state of Washington to assess local health department capacity and to identify their self-perceived strengths and weaknesses. Staff from 24 of the 32 local health departments in Washington completed organizational capacity assessments. Fifty percent or more of the health departments identified the following eight indicators as strengths: legal authority, public policy and implementation, budget development, financial reporting and administration, audit, financial documentation, organization and structure of program management, and policy board procedures. Seven indicators were identified as weaknesses by 50% or more of the respondents: legal counsel, mission and role, data collection and analysis, planning and development, evaluation and assurance of community health assessment, community health assessment and planning, and community health policy. The results of the assessment highlight the traditional organizational and service delivery strengths of the local health departments and point out weaknesses in their ability to assess community health and to develop communitywide health policy.     

Re-thinking the relationship between long-term condition self-management education and the utilisation of health services

Encouraging self-management has been viewed as one means of reducing health service utilisation and contributing to improved demand management. However, the processes and imputed relationship between self-management education skills and health service contact are poorly understood. This paper reports on data from an embedded qualitative study which ran alongside a randomised controlled trial in England designed to test the clinical and cost effectiveness of a self-care support policy which found no statistically significant reductions in health service utilisation. Drawing on concepts from the sociology of chronic illness, analyses suggest that the biographical and social context relevant to individuals' experience of living with a long-term condition, history of health service utilisation, and relationships with health professionals are relevant to understanding the impact of self-management education and related policies aimed at bringing about changes in service use. Our study suggests that future health policy assumptions about utilisation in the context of chronic disease management and self-care support polices may benefit by acknowledging the complex, contextual and recursive nature of health service utilisation operating in the life worlds of patients' experience of living with a long-term condition.     

金砖五国卫生技术评估应用比较研究

卫生技术评估(HTA)能够为医疗卫生服务提供可靠决策依据。结合文献及国内外卫生技术评估网站的相关资料,从HTA的机构设置、职责范围、资金来源、流程等方面,对金砖五国HTA情况进行梳理和比较分析发现,金砖五国HTA发展水平不一,各国处于HTA发展的不同阶段。其中,巴西和中国的HTA体系发展较为完善,南非发展较为缓慢。金砖五国的HTA发展面临着缺乏专业知识、医疗卫生体系不健全等挑战,需加快发展步伐;巴西、中国仍需进一步加大政府投入,完善HTA体系建设评估指南,提升HTA研究能力;印度应扩大HTA评估网络,提高评估流程的透明度和客观性;南非需加快建立HTA机构。     

Religious advance directives: the convergence of law, religion, medicine, and public health.

Because of the deep interpersonal significance of decisions made at the end of life, it is not surprising that religion has played an important role in patient and family decision making. Specific religious concerns about death and dying have led to religious advance directives. Advance directives offer a case study of models of interaction between religious communities and secular institutions. This paper examines why such directives have been created and how they may affect health care decisions. An analysis of their strengths and weaknesses concludes that specific religious instructions are unnecessary in written directives and may undermine both the religious and health care goals of patients.     

河南省农村卫生适宜技术推广应用实践与长效机制建设探讨

为改善农民健康，减轻农民经济负担，河南省从“十五”到“十一五”期间持续开展对农村卫生适宜技术推广应用的研究工作，取得了初步成效，积累了可行的经验，在此基础上，对农村卫生适宜技术推广模式和长效机制的建设进行了深入思考与探讨。     

Measurement in abstinence education. Critique and recommendations

The purpose of this article is to identify, assess, and offer solutions to common measurement errors found in sexual abstinence education evaluation. A critical review of the methodology of adolescent sexuality research was performed. "Gold standards" of their measurement strategy were derived and applied against 14 selected studies. Many of the articles reviewed had substantial limitations in their measurement strategies. However, several articles demonstrated excellence and serve as models for future efforts. Sexual abstinence education evaluation is plagued by the inherent weaknesses of self-report and health outcome measures. However, with careful adherence to the gold standards proposed, it is possible to limit the threat from these weaknesses, maximizing the benefit of self-report surveys and county-level health indicators.     

无线远程中央监护系统的研究

无线远程中央监护系统克服了传统有线医疗监护技术的局限,将生理和病理的监护扩展到任何有网络覆盖的时间和地点。概述无线中央监护系统的相关技术和研究现状：以及对我国卫生事业的重要意义。     

Receding horizons of health: biocultural approaches to public health paradoxes

Worldwide challenges to health reflect a "paradox of success," whereby both the strengths and the weaknesses of current approaches in public health, epidemiology, and biomedicine have determined the nature of the health problems we now face. In detail, we analyze and illustrate five constituent paradoxes that fuel continued health risk even in the face of success, including: (1) unmasking, (2) local biology, (3) socialization, (4) emerging and reemerging disease, and (5) savage inequity. We trace the pathways behind the paradoxes and their effects on health, and demonstrate that biocultural dynamics are involved in each. Furthermore, we track the roots of health paradox to changes that divert or disrupt pathways for production of health. These analyses contribute to an emerging literature of research and praxis on integrative biocultural models of health.     

Automatic diet monitoring: a review of computer vision and wearable sensor-based methods

Food intake and eating habits have a significant impact on people’s health. Widespread diseases, such as diabetes and obesity, are directly related to eating habits. Therefore, monitoring diet can be a substantial base for developing methods and services to promote healthy lifestyle and improve personal and national health economy. Studies have demonstrated that manual reporting of food intake is inaccurate and often impractical. Thus, several methods have been proposed to automate the process. This article reviews the most relevant and recent researches on automatic diet monitoring, discussing their strengths and weaknesses. In particular, the article reviews two approaches to this problem, accounting for most of the work in the area. The first approach is based on image analysis and aims at extracting information about food content automatically from food images. The second one relies on wearable sensors and has the detection of eating behaviours as its main goal.     

The Role of Occupational Therapy in Back School

Multidisciplinary faculty collaboration within the health professions educational system is explored. The definitions for the concepts of intradisciplinary, multidisciplinary, interdisciplinary and transdisciplinary faculty teams are provided along with the strengths and weaknesses of collaborative teaching and course development across various health profession programs. Examples of these teaching models are described using case studies to illustrate collaborative course development by faculty from Occupational Therapy, Nursing, Physician Assistant, Social Work and Dental Hygiene, Nurse Anesthesia, and Health Services Management programs offered at the University of New England in Portland, Maine, United States of America.     

Integrating Design Science Theory and Methods to Improve the Development and Evaluation of Health Communication Programs

Traditional communication theory and research methods provide valuable guidance about designing and evaluating health communication programs. However, efforts to use health communication programs to educate, motivate, and support people to adopt healthy behaviors often fail to meet the desired goals. One reason for this failure is that health promotion issues are complex, changeable, and highly related to the specific needs and contexts of the intended audiences. It is a daunting challenge to effectively influence health behaviors, particularly culturally learned and reinforced behaviors concerning lifestyle factors related to diet, exercise, and substance (such as alcohol and tobacco) use. Too often, program development and evaluation are not adequately linked to provide rapid feedback to health communication program developers so that important revisions can be made to design the most relevant and personally motivating health communication programs for specific audiences. Design science theory and methods commonly used in engineering, computer science, and other fields can address such program and evaluation weaknesses. Design science researchers study human-created programs using tightly connected build-and-evaluate loops in which they use intensive participatory methods to understand problems and develop solutions concurrently and throughout the duration of the program. Such thinking and strategies are especially relevant to address complex health communication issues. In this article, the authors explore the history, scientific foundation, methods, and applications of design science and its potential to enhance health communication programs and their evaluation.     

人群健康综合测量——健康期望寿命的发展及应用

健康期望寿命是人群健康综合测量的代表性指标,本文介绍了其产生与发展的历程,总结了健康状态期望寿命与健康调整期望寿命两大类指标的特点：前者为两分或多分型指标,计算简便易于解释和理解;后者为权重调整型指标,在指标设计层面更为科学全面,但测算过程复杂。文章介绍了健康调整期望寿命、健康寿命年等指标在世界卫生组织、欧盟等国际组织及地区的应用现状,分析了各自的优劣及前景,并建议我国未来应重视健康期望寿命的研究和应用。     

A systematic analysis of influenza vaccine shortage policies

OBJECTIVES: The aim of this study was to apply SWOT analysis (strengths, weaknesses, opportunities, threats) to a domestic shortage of influenza vaccine, to identify lessons learned, and to generate effective solutions for future public health rationing emergencies. STUDY DESIGN/METHODS: SWOT and TOWS techniques were employed to characterize the vulnerability of the USA to disruptions in the supply of influenza vaccine. A group of five researchers reviewed relevant literature, engaged in group brainstorming, and categorized elements according to the SWOT framework. RESULTS: Three strengths, five weaknesses, five threats and seven opportunities were identified in the areas of vaccine production, purchasing and distribution, and provision. Four future recommendations emerged with respect to government investment, communications, sanctioning of physicians, and incident command. CONCLUSIONS: Application of the SWOT technique is highly relevant to the health policy realm and can assist public health planners in planning for future resource scarcity.     

African American women's preventative care usage: the role of social support and racial experiences and attitudes

Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low‐income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help‐seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.     

Disease management: definitions, difficulties and future directions.

The last decade has seen a wide range of experiments in health care reform intended to contain costs and promote effectiveness. In the USA, managed care and disease management have been major strategies in this endeavour. It has been argued that their apparent success has strong implications for reform in other countries. However, in this paper we ask whether they are so easily exportable. We explain the concepts involved and set the development of managed care and disease management programmes in the context of the USA. The constituent elements of disease management are identified and discussed. Disease management is considered from the perspectives of the major stakeholders in the United Kingdom, and the differences between the models of health care in the United Kingdom's National Health Service and the USA are noted. A review is presented of evaluations of disease management programmes and of the weaknesses they highlight. The prospects for disease management in Europe are also discussed.