A structural equation modeling approach to examining the predictive power of determinants of individuals' health expenditures

Understanding the determinants of health expenditures is essential for a fair and effective utilization profiling, particularly in the setting of capitation rates in risk-adjustment models. The objective of the study was to examine the relative importance of determinants in predicting future health expenditures, using structural equation modeling. Based on Andersen's behavioral system model, individual determinants along with prior utilization and measures of health status from 1994 are evaluated in a longitudinal design for their predictive power for health expenditures in 1995. A total of 4255 policyholders enrolled in three health plans at Trigon BlueCross/BlueShield of Virginia who responded to a mail survey were included for analysis. Person-level annual charges for health services utilization were used as the dependent variable. Five health scales were excerpted from Health Survey SF-36 to represent an individual's health status. Excluding prior utilization in 1994, health status ( = –0.19, p < 0.001)=" and=" having=" diabetes="> = 0.08, p < 0.001)=" are=" two=" statistically=" significant=" predictors=" of=" health=" expenditures=" in=" 1995.=" including=" prior=" utilization,=" both=" health=" status="> = –0.15, p < 0.001)=" and=" prior=" utilization="> = 0.15, p < 0.001)=" are=" the=" most=" important=" predictors,=" followed=" by=" having=" diabetes="> = 0.08, p < 0.001).=" health=" status=" is=" a=" powerful=" predictor=" of=" future=" health=" expenditures,=" even=" when=" prior=" utilization=" is=">     

边防海岛战士的自我效能感与亚健康关系的研究

目的探讨边防海岛战士的自我效能感与亚健康的关系。方法应用焦虑自评量表、抑郁自评量表和一般自我效能感量表对240名边防海岛战士进行测试,采用相关分析和t检验的统计方法进行分析。结果边防海岛战士在自我效能感各分量表上的成绩与焦虑、抑郁量表的得分呈负相关;高自我效能感的边防海岛战士与低自我效能感的边防海岛战士相比较,其在焦虑与抑郁量表上的得分明显较低。结论自我效能感的高低影响着边防海岛战士的健康水平,高自我效能感的边防海岛战士健康水平维持在较高的状态,低自我效能感的边防海岛战士较多地处于亚健康状态。     

Health care web sites: are they reliable?

Locating reliable health care information on the World Wide Web is difficult and confusing. Thus, Internet users must choose the appropriate resources to guide their health care decisions. This paper will describe the typical Internet user. Then, it will compare the three most comprehensive web site guidelines. Finally, it will summarize what criteria are necessary to create and maintain reliable health care web sites.     

Adolescent girls' use of the Internet for health information: issues beyond access

Whilst the digital divide in access to Internet technology has rightly concerned commentators on health inequalities, there are issues beyond physical access that must be tackled if adolescents and adults are to optimize the benefits of this developing medium. Emerging themes from an exploratory qualitative study of adolescents' use of the Internet for information about health and medicines describe four major challenges. Access issues persist if there are insufficient school computers that are unable to cope with increasing Web site sophistication. Software on school-based machines preventing exposure to material that is deemed to be unsuitable may also prohibit access to educational sites about sexual health and drug misuse. Strategies to manage the volume of available information are needed. The interplay of active and passive information seeking challenges whether the Internet can be truly useful during acute illnessepisodes. This exploration with future health service users highlights important questions for further study.     

少数民族中以社区为基础的疟疾控制：一个中缅边境佤族社区的疟疾防治进展

案例研究可为卫生政策的制定和调整提供有用的信息和启示。本文根据1997年以来中缅边境地区一个佤族社区疟疾防治进展,经验和教训的总结,分析影响疟疾流行及其控制的因素,讨论国家和国际公共卫生问题,以及给卫生政策的启示。     

Proposal for Canadian-style single-payer health care receives cool reception in US.

Is health care reform dead in the US? It may be, if the reception given President Clinton's reform plan and a proposal for a single-payer program in California is any indication. There has been a dramatic move to the right south of the border, where people have lined up to oppose "big government" and additional government programs. Still, American proponents of a single-payer program similar to Canada's insist that the battle for reform is not yet over.     

边境吸毒人群童年期负性事件与成年期注射吸毒行为的研究

目的 了解边境地区吸毒人群的基本特征,探讨目标人群童年期负性事件与成年期注射吸毒行为的关系。方法 采用自编毒品使用及不良健康行为调查问卷、童年期负性事件调查问卷对某边境地区的405名吸毒者进行现场调查。结果 目标人群存在注射吸毒行为的人占12.3%,成年期出现注射吸毒行为以男性、39岁以上、少数民族、未婚、有小孩、小学及以下文化程度及有职业的人群为主;海洛因平均使用年限15年,冰毒片剂和晶体10年左右,摇头丸为13年;首次使用毒品的平均年龄22～28岁,ATS的首次使用平均年龄22～23岁。ACEs事件超过1件以上者在存在注射吸毒行为者中占84.0%。Logistics回归结果显示,ACE严重程度、年龄及民族可能是目标人群存在注射吸毒行为的影响因素（P <0.05）。结论 在边境吸毒人群中,有童年期负性事件经历者较多,与成年后注射吸毒行为密切相关,对戒毒实践及早期干预有一定指导意义。     

乳糖酶缺乏基础研究进展

乳糖酶是存在于哺乳动物小肠黏膜微绒毛膜表面上的一种双糖酶。乳糖酶缺乏(LD)是个世界性的问题,影响了全世界近2/3的人口,亚洲的患病率高达95%~100%。LD会造成乳糖吸收不良,甚至出现一系列乳糖不耐受的症状,对人类的健康造成很大的威胁。现就LD的分子生物学研究进展综述如下。     

云南腾冲县2008年出境回归人员疟疾发病调查

目的了解腾冲县2008年出境回归人员疟疾发病情况及相关影响因素。方法采用多阶段抽样和定量相结合方法对腾冲县三个乡（镇）的出境回归人群进行问卷调查。结果调查1267人中,有227例（21．86％）患过疟疾,其中在境外治疗的病人占0．72％,在国内卫生院治疗的占24．91％,在国内个体诊所治疗的占1．08％,在医院治疗的占73．29％;疟疾病人中规范治疗,用药1d、3d、4d、5d、6d、7d、8d的分别占0．72％、0.36％、6．14％、4．33％、2．17％、0．72％、85．56％。Logistic回归分析显示,出境务工类别、务工时间、性别三个变量进入影响因素。结论腾冲县出境务工人群疟疾患病率较高,是重点防治人群,应开展对疟疾传播途径、预防和患疟疾要及时到医疗机构进行规范治疗等健康教育,提高出境回归人群的及时就诊和规范治疗意识。     

An Intelligent Tele-Healthcare Environment Offering Person-Centric and Wellness-Maintenance Services

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift—patient centerd services as opposed to provider centerd services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE—Tele–Healthcare Information and Diagnostic Environment. TIDE manifests an intelligent healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services—i.e., both wellness maintenance and illness management services—ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role—spanning from wellness to illness issues—the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro–active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies—Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics—to implement a sophisticated healthcare delivery infostructure.     

龙陵县缅籍媳妇艾滋病相关知识知晓率与影响因素调查

目的了解中国边境保山市龙陵县渉缅事实婚姻家庭缅籍媳妇艾滋病相关知识的知晓状况及其影响因素。方法采用普查法,于2010~2011年度对全县渉缅事实婚姻家庭中的缅籍媳妇进行艾滋病相关知识的问卷调查。结果调查对象共845人,应答率为100%,平均年龄28.5岁。艾滋病相关知识知晓率为66.0%,8个条目艾滋病相关知识完全知晓率为41.5%,完全不知晓率为17.9%。龙陵县渉缅事实婚姻家庭艾滋病知识知晓率的主要影响因素为不同年龄段、文化程度、在缅甸的婚姻状况、进入中国的时间分段、在缅甸时的职业分布、在缅甸时HIV检测情况(P0.05)。结论龙陵县渉缅婚姻家庭人员艾滋病相关知识普遍不足,且知识掌握程度在不同特征人群分布不均,需要通过多种形式健康教育在该人群中加强艾滋病防治知识的宣传。     

Assessment of Psychosocial Work Environment in Primary Care-Development of a Questionnaire

Recent studies have indicated deteriorated working conditions of health care personnel. To have an efficient health care organization requires good working conditions and the well-being of the personnel. Today there are no gold-standard assessment tools measuring psychosocial working conditions. The aim of this study was to develop two valid and reliable questionnaires, one generic and one specific, measuring psychosocial working conditions for general practitioners (GPs) and district nurses (DNs) in Sweden, with a special emphasis on organizational changes. The construction of the questionnaires were made after a stepwise developing phase including literature review, interviews, and a pilot study. The pilot study included GPs n = 42 and DNs n = 39. The questionnaires were later on used in a main study (GPs n = 465, DNs n = 465). A factor analysis was carried out and showed that there were fewer items in the main study that had factor loading 0.40 in more than one factor, compared to the pilot study. The factors from the main study were easier to label and had good correspondence with other studies. After this stepwise development phase good construct validity and internal consistency were established for the questionnaire.     

SARS在香港的流行病学调查与防治

目的 总结香港特区严重急性呼吸系统综合征(SARS)流行病学的调查结果与防治经验。方法 回顾SARS疫症在香港的爆发经过,收集有关资料,进行流行病学分析;介绍政府从公共卫生角度采取的一系列防疫的行政措施。结果 根据流行病学调查,该病潜伏期一般为2～7d,亦可长达十多日。SARS病毒的主要传播途径是经飞沫传播,即接触到患者分泌物的飞沫或污染的传病媒介。感染者多为医护人员及与患者有紧密接触者。采取控制疫情的措施包括：第一、控制传染源,做到早发现、早诊断、早报告、早隔离和早治疗。第二、切断传播途径。第三、保护易感人群。第四、公布疫情资料。同时也配合其他措施,包括出入境检疫措施、与病人接触者的隔离措施、学校停课等,使得香港的SARS疫情日趋稳定。结论 防治传染病要制定宏观统筹的策略,进行有效的监察,发现疫情时应采取快速果断的防疫措施。     

云南省边境地区乡级防保人员疟防知识调查

平均有31.92％的所测试的基本概念和方法乡级防保人员尚未掌握,平均每题有31.99％的乡级防保人员未掌握,恶性疟治疗方案和灭疟后期的概念,婴幼儿疟疾治疗用药禁忌和疟疾传染源的概念,治疗疟疾的原则和治疗抗氯喹恶性疟药品,及疟疾发病率的计算的错答率分别居前四位。说明云南省边境地区乡级防保人员的疟防知识和技术较差,其为我省边境地区疟疾流行水平较高的原因之一。     

Hippocrates’ counselling with regard to physical exercise, gymnastics, dietetics and health

The aim of this study is the investigation of Hippocrates’ consultative theory with regard to man’s physical exercise, gymnastics, diet and health, on the basis of his work “Regimen” and his other works. The aforementioned issues are thematised in the works in question. By means of this thematisation, a medical counselling is formed, according to which exercise, gymnastics and diet aim at the maintenance and restoration of man’s health; dietetics, maintenance of well-being, recovery and amelioration of man’s health are involved in this thematisation. Hippocrates’ views on the aforementioned issues constitute a basis for the discussion and pedagogical exploitation of them in contemporary education and, particularly, in sports education and physical exercise.

rhTNF-α对正常人精子运动及其超微结构影响的实验研究

目的 :观察 rh TNF- α在体外对正常人精子的运动及其超微结构的影响。方法 :2 6例健康成年男性手淫法获得精液。Percoll梯度离心法得到的精子为精子模型 ,将精子密度调整为 1 0× 1 0 6 /ml;在 37℃、5 % CO2 的环境中 ,分别与终浓度为 60 pg/ml、90 pg/ml、2 70 pg/ml的 rh TNF- α孵育 ,同时设立对照组。在 0 .5 h和 4h时间段取样 ,CASA观察实验组和对照组精子的运动能力 ,TEM观察实验组和对照组精子的超微结构。结果 :与对照组相比较 60 pg/ml、90 pg/ml、2 70 pg/ml各组的精子运动能力明显降低 ( P<0 .0 1 )。精子超微结构发生程度不同的变化 :细胞膜变薄、扭曲或呈波浪状改变 ,大部分精子细胞膜不连续 ;细胞膜与顶体外膜间隙增宽 ,透亮度增强 ,顶体变厚 ,甚至可见顶体外膜破裂 ,顶体内容物流失 ;线粒体密度降低 ,透光度增强 ,严重者线粒体外形变圆 ,内有空泡形成 ;核膜与核内染色质未发生改变 ;纤维轴丝 9+ 2模式未改变。结论 :rh TNF- α可降低精子运动能力 ,同时破坏精子的顶体和膜结构而降低精子受精能力     

Good progress with DOTS in the South-East Asia Region

The South-East Asia Region (SEAR) accounts for 38% of the global tuberculosis (TB). Encouraging progress has been made since the DOTS strategy was introduced in all SEAR Member States between 1993-94. Operational guidelines for and joint plans of action for disease control activities in the border districts of Bangladesh, Bhutan, India and Nepal have been drawn up. The key issues involved in the good progress with DOTS are: Resource mobilisation, case detection, case management, drugs and logistics, supervision, monitoring and surveillance, preventing emergence of multidrug resistant TB and lastly health sector reform. Given the current momentum and commitment, it is expected that the region will active the set targets of universal coverage by 2006.     

Testing the Usability of Two Automated Home-Based Patient-Management Systems

To explore to what extent observation and semistructured in-depth interviews provide effective tools for usability testing of two automated home-based systems aimed at monitoring patients' health status at home and improving self-care. Telephone-Linked Care for Diet Adherence in Dyslipidemia (TLC-DietAid) used computer telephony to interact with users and Home Asthma Telemonitoring System (HAT System) used a combination of Personal Digital Assistant (palmtops) and the Internet for similar purposes. Both systems were evaluated in two separate pilot studies. Our pilot studies uncovered medium-specific and content-specific issues that addressed either the process of the interaction or its content. The results demonstrated that patient-users tended to evaluate each system on the basis of how it fit into everyday life and corresponded to personal preferences. The methodology also allowed the system designers to understand users' concerns and the context of adoption in order to introduce necessary changes to the design to address such concerns.     

颈阔肌的应用解剖

用手术显微镜对50例成人的颈阔肌作了观察和测量。将每侧颈部分为9个区,颈阔肌位于前6区。肌的内侧界约相当于颏舌骨连线中点稍下到锁骨胸骨端稍外侧处的连线,左右侧肌夹有40°角;外侧界为下颌角稍后到锁骨肩峰端内侧3cm处的连线;下界在第一肋间隙平面,有的肌下份出现一些较宽的裂隙;上界在下颌骨体,并与某些表情肌相连续。肌的面积约150cm~2,锁骨上部约占120cm~2。后份肌纤维略呈S形弯曲。肌与深层结构联系较松。本文还对面神经和颈丛与颈阔肌有关的分支,进行了观察。对和颈面部临床应用等有关的问题进行了讨论。     

云南省应对缅甸输入疫苗衍生脊髓灰质炎病毒病例实验室监测作用分析

目的分析云南省临沧市1例缅甸输入疫苗衍生脊髓灰质炎（脊灰）病毒（vaccine-derived poliovirus,VDPV）病例调查中实验室的监测情况,为云南省应对缅甸输入VDPV提供实验室依据。方法对与缅甸接壤地区入境就诊的急性弛缓性麻痹（AFP）病例标本进行脊灰病毒（PV）特异性引物逆转录-聚合酶链反应（RT-PCR）快速检测,现场采集病例密切接触者及边境地区健康儿童粪便标本开展脊灰病毒监测和肠道病毒型别特征分析;在病例所到过的临翔区和与缅甸接壤的镇康县连续6个月采集环境污水标本开展PV检测分析;采集境内外健康儿童血标本开展脊灰中和抗体水平分析,对输入风险进行评估。结果经实验室分析证实在中国消灭和维持无脊灰工作进程中监测到首例缅甸输入VDPV病例,病毒型别为Ⅰ型VDPV,有21个核苷酸变异,变异率2.3%。在病例密切接触者、健康儿童及外环境中未检测到同类病毒。在健康儿童中检测到NPEV 13株,在环境标本中检测到NPEV 5株,PVⅢ1株,境内儿童脊灰中和抗体Ⅰ、Ⅱ、Ⅲ型阳性率分别是100.00%、100.00%、98.00%;境外儿童三型阳性率分别是94.34%、100.00%、84.91%。结论云南省脊灰监测系统敏感性高,具备及时发现输入疫情的能力,病例输入后开展人际监测和环境监测,证实边境地区有较好的免疫屏障,未在云南省境内引起二代病例,但云南省面临再次输入的风险较大,应充分发挥实验室监测作用,严防病例或病毒输入后引起本地传播流行。