贯彻医改会议精神 完善医疗保险制度

九江市作为国务院职工医疗保险制度改革的试点城市,经过4年运作,成效明显,但也凸现了一些深层次的矛盾。作者结合《决定》的主要政策,就下一步深化改革,与全国医改接轨,提出了医保筹资要量体裁衣、统账有机结合、建立费用制衡机制、发展补充保险等观点。     

我国医疗保障制度的历史沿革与当前的改革

完善的社会保障制度是现代市场经济国家的一个重要标志,它为市场经济公平、高效地运行创造了安定的社会环境。我国的医疗保障制度是在高度集中的计划经济体制下形成的,有必要对它过去几十年中所发挥的作用和存在的问题加以总结,根据新的改革要求,建立起一套完整的同市场经济体制相适应的医疗保障制度。     

中国医保制度的创新思考

本文针对我国现行医疗保险制度体系中基本医疗保障理论体系及实践构架设置、区域医疗卫生事业可持续性发展、建立“医保宏观经济模型”和“微观过程控制模型”、进一步完善我国医保定额补偿办法等制度的创新问题进行了思考论述。     

实行职工医疗保险制度的尝试

实行职工医疗保险制度的尝试江苏镇江医学院（２１２００１）沈荣林最近，全国职工医疗保障制度改革扩大试点工作会议在我市召开。国务委员彭佩云同志和到会的全体代表对我市１年来实行职工医疗保险制度的试点工作给予了高度评价。为了在全国医疗制度改革中进一步发挥抛砖...     

法国医疗保险制度及其改革

医疗制度改革是各国政府重要的政府课题。日本松田晋哉先生在《是本公共卫生杂志》１９９８年５３卷３期上撰文，介绍了法国医疗保险制度改革的基本情况，对推动我国医疗保险制度有一定参考意义。     

医疗保险制度启动中的几个关键问题

城镇职工基本医疗保险制度即将在全国普遍推开 ,但是在实际运作中尚有不少问题影响着这一制度的顺利启动。本文结合当前现实 ,就医疗保险管理机构、专业队伍、基金筹集、统筹单位、医生积极性等问题 ,进行了客观分析与探讨。     

关于建立城镇多层次医疗保险体系研究

医疗保险制度是社会保障制度的重要组成部分 ,建立科学、合理的医疗保险制度对完善我国社会保障制度、促进社会主义市场经济体制的顺利建立和社会的健康发展有着举足轻重的作用。我国的医疗保险制度改革历经1 0来年 ,形成了“两江式”、“海南式”、“三金式”和“深圳式”等模式。但事实上 ,这些模式都是只用一种单项的医疗保险制度来代替 5 0年代建立起来的公费医疗和劳保医疗 ,虽有其合理性 ,但在实践中也暴露出了一系列的矛盾和困难。我们认为 ,根据国家关于医疗保险制度改革的精神和借鉴国内外医疗保险制度改革的正反经验 ,建立和完善…     

日本医疗保险制度的改革方向

１９９４年日本保险制度进行了有重大转变意义的改革。其目的是为了适应迅速发展的老年化社会，谋求医疗保险制度的长期稳定，。此次改革对保险费支付内容进行了设计和调整。此外，还高速了保险结构，为创立护理保险铺平了道路。高木安雄在《病院》１９９５年５期撰文，以特定疗养费制度为中心，探讨了此次医院保险制度改革的意义和问题，并对２１世纪的老年化社会的保险制度作了展望。     

深圳医疗保险用药制度执行状况分析

介绍了深圳市现行的医疗保险用药制度和对约定医疗单位偿付办法，结合实践分析了药定医院执行用药制度的状况和实行平均标准偿付办法后医院用药出现的新问题，在此基础上提出了对策建议。     

母婴疾病防治领域的新兴医学科技进展

提高妇幼健康水平作为建设健康中国的重要任务之一,需要加强和推动医药健康科技创新,为保障和改善妇幼健康提供有力的科技支撑。因此,本文对基因诊断与基因治疗技术、多组学技术、干细胞技术、组织工程技术等前沿生物技术以及机器人技术、大数据与人工智能技术在母婴健康医学科技领域的发展现状和未来趋势作一概述,对新兴技术在母婴疾病防治中...     

江苏省儿童青少年超重与肥胖流行趋势分析

了解江苏省2005-2015年儿童青少年超重和肥胖的流行趋势,为采取有针对性的干预措施提供参考.方法 选取江苏省2005年、2010年和2015年7~22岁学生体质与健康调研资料,应用中国肥胖工作组(WGOC)“中国学龄儿童青少年超重、肥胖筛查BMI分类标准”,比较超重和肥胖变化情况.结果 江苏省2005年、2010年和2015年7~22岁儿童青少年超重检出率依次为10.67%,12.22%和13.79%,2015年超重检出率高于2005年和2010年(x2值分别为110.383,61.212,P值均<0.05);肥胖检出率依次为5.05%,5.54%和5.61%,2015年肥胖检出率高于2005年(x2=7.74,P<0.01).2005年、2010年和2014年男生超重检出率分别为13.67%,15.96%和17.43%,肥胖检出率分别为6.54%,7.79%和7.54%;女生超重检出率分别为7.65%,8.50%和10.18%,肥胖检出率分别为3.54%,3.29%和3.69%.城市超重检出率分别为13.08%,13.74%和15.08%,肥胖检出率分别为7.51%,6.66%和6.41%;乡村超重检出率分别为8.25%,10.74%和12.52%,肥胖检出率分别为2.57%,4.44%和4.82%.苏南地区(经济较好)超重检出率分别为12.66%,12.91%和12.24%,肥胖检出率分别为5.19%,6.04%和4.68%;苏北地区(经济较差)超重检出率分别为9.70%,12.99%和15.00%,肥胖检出率分别为6.88%,7.01%和9.03%.结论 2005-2015年江苏省7~ 22岁儿童青少年超重、肥胖比例持续增加,其中小学生群体、乡村地区和苏北地区增长迅速.     

Working through resistance in engaging boys and men towards gender equality and progressive masculinities

Over the last two decades, a focus on challenging and transforming dominant forms of masculinity and engaging boys and men towards gender equality and healthy masculinities has permeated South African social and health sciences and the humanities. This focus on men and boys has also been evident in intervention and activist work. However, the turn to boys, men and masculinities has not gone without resistance, contestation and contradictions. A range of localised and global realities has frustrated much of the enthusiasm for rapid, sweeping and concrete changes regarding gender justice and the making of progressive masculinities. Among the discursive and material forces that oppose work that engages boys and men are those to do with income-related issues, race and racism, cultural traditions and gender itself. Because of this, it is contended that engagement with boys and men needs to consider not only gender but also economic inequality, poverty and unemployment, divisions created by race, and struggles around tradition. This paper discusses these forces that undermine and counteract work with boys and men and how we might work through resistance in engaging with men and boys.     

我国地(市)、县级疾病预防控制机构艾滋病防制任务及其工作内容研究

目的研制我国地(市)、县级疾病预防控制机构艾滋病防制任务及其工作内容,为实施艾滋病防制项目管理、人力、财力和物力的项目零基预算界定了工作范围。方法在系统文献查阅的基础上,运用头脑风暴法和焦点小组访谈相结合的方法,对102位专家进行了14轮540人次的咨询与论证,并经过全国180个被调查样本机构和11个模拟运作机构的意向调查加以完善。结果我国地(市)、县级疾病预防控制机构必须开展包括基线调查和制订防制规划、健康教育、艾滋病防制的行为干预、检测实验室网络建设及管理、综合监测、艾滋病自愿咨询检测等在内的11项防制任务及其工作内容,该11项任务及其工作内容得到了全国180个样本机构的高度一致认可(总体认可程度达到了99.0%)。     

Effects of nutritional status on contents of tryptophan, serotonin and 5-hydroxyindoleacetic acid in rat brain]

Effects of nutritional status on the levels of tryptophan (Trp), serotonin (5HT), and its metabolite, 5-hydroxyindoleacetic acid (5HIAA) in six brain regions of rats were investigated. 1) A low-protein high-carbohydrate diet decreased Trp, 5HT and 5HIAA levels in the cortex and hippocampus, and those of 5HT and 5HIAA in the hypothalamus. This diet did not affect the contents of Trp and 5HT in the midbrain, but decreased 5HIAA. No significant changes of Trp, 5HT and 5HIAA were observed in the pons and medulla and striatum. 2) A low-carbohydrate high-protein diet increased the levels of Trp, 5HT and 5HIAA in the striatum, and 5HT and 5HIAA in the cortex, but showed no effect on the contents of Trp, 5HT and 5HIAA in the hippocampus, midbrain, pons and medulla and hypothalamus. 3) An energy-restriction low-carbohydrate diet increased Trp, 5HT and 5HIAA contents in the striatum, and 5HT and 5HIAA in the cortex and pons and medulla. In the hypothalamus, only 5HIAA was increased by this diet. The diet did not influence Trp, 5HT and 5HIAA contents of the midbrain and hippocampus. These results suggest that i) lowered fat and carbohydrate intakes enhance 5HT synthesis and metabolism in the cortex and that lowered carbohydrate intake enhances them in the striatum, ii) energy restriction enhances the 5HT metabolism in the cortex, pons and medulla and hypothalamus, and 5HT synthesis in the cortex and pons and medulla, iii) lowered protein intake inhibits 5HT metabolism in the cortex, midbrain, hippocampus and hypothalamus, and 5HT synthesis in the cortex, hippocampus and hypothalamus.     

Access to and use of NHS Patient Advice and Liaison Service (PALS): the views of children, young people, parents and PALS staff

Background The English National Health Service Patient Advice and Liaison Service (PALS) was set up to provide patients and their relatives with a way of obtaining information or expressing concerns about their health care. This study examined children's, young people's and parents' access to and use of PALS, and how this could be improved. Methods Qualitative and quantitative methods were used to obtain the views of children, young people, parents and PALS staff, on the inclusiveness of the service. These methods included discussion groups and interviews with 30 young people and 16 parents; a postal survey of PALS users, to which 171 (21%) parents responded; and telephone interviews with 14 PALS staff. The data were analysed using qualitative and quantitative methods, and the views of participants on key topics were examined. Results Children and young people were found to be low users of PALS, but thought that the service was potentially useful. They and parents and PALS staff all highlighted ways in which access to and use of the service could be improved. Participants' views on the following topics are reported: awareness of PALS existence and role; access to and use of PALS; effectiveness of and satisfaction with PALS; and training of staff. Conclusions and recommendations Patient Advice and Liaison Service has not been designed and developed in ways that are fully inclusive of children, young people and parents. Based on their views and experiences, and the suggestions of PALS staff, the authors recommend that access to and use of the service could be improved, increasing awareness of PALS, facilitating access to and use of the service, providing training for PALS staff on dealing with young people and their issues, and developing links between PALS and other organizations that deal with young people and parents.     

Position of the American Dietetic Association: food insecurity and hunger in the United States

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.     

Gender equity and socioeconomic inequality: a framework for the patterning of women's health

This paper explores the interrelationship of gender equity and socioeconomic inequality and how they affect women's health at the macro- (country) and micro- (household and individual) levels. An integrated framework draws theoretical perspectives from both approaches and from public health. Determinants of women's health in the geopolitical environment include country-specific history and geography, policies and services, legal rights, organizations and institutions, and structures that shape gender and economic inequality. Culture, norms and sanctions at the country and community level, and sociodemographic characteristics at the individual level, influence women's productive and reproductive roles in the household and workplace. Social capital, roles, psychosocial stresses and resources. health services, and behaviors mediate social, economic and cultural effects on health outcomes. Inequality between and within households contributes to the patterning of women's health. Within the framework, relationships may vary depending upon women's lifestage and cohort experience. Examples of other relevant theoretical frameworks are discussed. The conclusion suggests strategies to improve data, influence policy, and extend research to better understand the effect of gender and socioeconomic inequality on women's health.     

Parental pressure, dietary patterns, and weight status among girls who are "picky eaters"

OBJECTIVE: To determine whether mothers' fruit and vegetable intake and mothers' use of pressure in the feeding domain when their daughters were 7 years old predicted picky eating and dietary intake when their daughters were 9 years old, and to examine diet and weight status in picky and nonpicky eaters. DESIGN/SUBJECTS: Participants were 173 9-year-old non-Hispanic white girls and their mothers. A longitudinal analysis was used to assess maternal influences on picky eating and diet. A cross-sectional analysis was used to examine diet and weight status between picky and nonpicky eaters. Measures included maternal feeding practices, daughters' pickiness, mothers' fruit and vegetable intake, daughters' food intake, and weight status. STATISTICAL ANALYSES: t tests examined differences between picky and nonpicky eaters. Structural equation modeling examined relationships among mothers' fruit and vegetable intake; child feeding practices; daughters' pickiness; and fruit, vegetable, micronutrient, and fiber intakes. RESULTS: Mothers consuming more fruits and vegetables were less likely to pressure their daughters to eat and had daughters who were less picky and consumed more fruits and vegetables. Picky eaters consumed fewer fruits and vegetables, but also fewer fats and sweets. All girls consumed low amounts of vitamin E, calcium, and magnesium, but more picky girls were at risk for not meeting recommendations for vitamins E and C and also consumed significantly less fiber. In addition, picky eaters were less likely to be overweight. CONCLUSIONS: Mothers influenced daughters' fruit and vegetable intake via their own patterns of fruit and vegetable intake and by influencing their daughters' tendencies to be picky eaters. Both picky and nonpicky eaters had aspects of their diets that did not meet recommendations. Taken together, these findings suggest that parents should focus less on "picky eating" behavior and more on modeling fruit and vegetable consumption for their children.     

医疗纠纷中的因素分析及护理防范

近年来，医疗和护患纠纷逐年上升并呈现出新的趋势和变化。文章参考了近几年来有关医疗纠纷和护患纠纷的文献，分析总结出现阶段医疗和护患纠纷的一些新的特点。同时，从医疗从业人员、患方、以及社会这3个方面对医疗和护患纠纷的产生及其发生变化的原因进行了剖析。归纳总结了一些医院实施减少医疗和护患纠纷的方法，根据国务院最新颁发的《医疗事故处理条例》及相关配套文件的要求，结合现阶段我国的情况提出了对医疗和护患纠纷的防范措施，希望能够对完善我国医疗护理服务；在新形势下建立和维持良好的护患关系；减少医疗和护患纠纷有所帮助。