国家集中带量采购中选药品的供应短缺问题研究

目的：分析我国集中带量采购中选药品的供应短缺现状,提出相关建议。方法：收集全国前5批集采药品的采购和供应数据,对药品供应短缺情况进行分析。结果：集采药品在中选后一年内出现供应短缺的占比达82%,东部和中部地区、临床用量大和价格低的集采药品供应短缺情况更为严重。结论：加强中选企业行为的履约监管,建立参与主体的信用评价制度,综合考虑地区、药理类型和价格因素,优化集采招标规则,提升集采中选药品生产供应保障能力。     

基于间断时间序列的国家药品集中带量采购协议期满品种接续工作实施效果研究——以河北省为例

目的：为完善国家组织药品集中带量采购协议期满后的接续工作提出建议。方法：筛选2020年11月—2022年9月河北省国采第三批中采购期为一年的品种及相关可替代品种的采购数据,采用描述性统计和间断时间序列的方法,分析药品采购量、采购金额和日均费用三个指标的变化情况。结果：接续政策实施后,中选产品三个指标均下降,且变化不显著;未中选产品采购量、采购金额持续增加,日均费用持续下降;集采品种三个指标也呈不显著下降趋势;可替代品种短期内日均费用显著上涨,其采购量、采购金额无显著变化。建议：各地以稳定为核心科学制定接续规则,合理设定价格基线及区间,促进药品价格回归合理水平,同时加强可替代品种量价监测,逐步扩大集采品种。     

辽宁省医疗机构2009年度药品采购和使用情况调查

2009年．我国全面推行政府主导、以省为单位药品集中采购制度。通过选取辽宁省5个地区、5个级别的45个医疗机构对2009年药品采购价格进行调查,发现了不同级别医疗机构药品采购价格和使用情况存在较大差异,而不同地区药品价格和使用情况无显著差异,根据调查结果提出建议,希望对药品集中采购政策的改革和完善有一定的启示。     

集采政策对医疗机构心血管药品采购的影响研究

目的：分析药品集采政策对不同等级医疗机构心血管药品采购的影响,为药品集采政策的调整与优化提供参考。方法：分析心血管药品在各级医疗机构的采购量变化情况,采用Mann-Kendall(M-K)趋势性检验判断心血管药品采购量的长期变化趋势。结果：药品集采政策实施后,心血管药品中选产品采购量大幅增长;各级医疗机构集采品种采购量增幅随采购周期的延长而降低;试点地区基层医疗机构中选产品采购量显著增长,联盟地区仅基层医疗机构非中选产品采购量显著下降,基层医疗机构可替代品种采购量呈下降趋势。结论：药品集采政策效应可能存在滞后性,且随采购周期的延长而逐渐弱化,可替代品种的采购量增长值得进一步关注。     

我国药品集中带量采购政策执行情况分析

目的：分析各省(区、市)前四批国家组织药品集中带量采购的首年采购完成情况，为更好地执行政策提供参考。方法：根据首年采购数据，对比分析前四批带量采购药品的约定采购量完成率和中选产品采购占比。结果：随着带量采购批次的增加，医疗机构报量趋于准确且完成率的季度波动幅度逐步缩小，中选产品采购占比维持在80%左右且逐季递增。结论：前四批药品带量采购政策执行情况总体较好，但后续需完善医保基金结余留用机制，引导医疗机构准确报量；实时对接医疗机构信息系统，防止滥用非中选产品；关注非正常中选价格，消除可能的寻租空间；鼓励医疗机构积极开展过评仿制药的真实世界研究。     

国家组织药品带量采购政策的降价持续性研究

目的：分析国家组织药品带量采购政策降价的持续效果,探索集采药品价格稳定运行的措施。方法：基于国家组织药品集中采购综合服务平台全国医疗机构前五批集采药品的采购数据,利用拉氏价格指数和费式价格指数,描述集采药品的价格变化。结果：集采中选药品“断崖式”降价、降幅达50%～85%,同通用名的未中选药品“波动式”降价、降幅达10%～40%,且降价效应持久,部分药品中选后价格反而升高。结论：国家集采政策不仅可以持续、大幅降低中选药品价格,所产生的溢出效应也使得同通用名未中选药品价格有所降低。建议构建集采药品价格运行的监测预警体系,加强药价监测,扩大药品集采范围。     

抗菌药物实施国家集中带量采购的政策效果分析*

目的：分析国家药品集中采购政策对中选抗菌药物销售额、销量、用药厂牌、用药频度、仿制药替代率、药品价格、日均费用和潜在节省费用的影响,探究抗菌药物国家药品集中采购实施效果并提出政策建议,为完善抗菌药物集采规则和配套政策提供参考。方法：选取第3批国家药品集中采购6个中选抗菌药物2020—2021年1~3季度的销售数据,描述性统计分析抗菌药物集采实施效果。结果：国家药品集中采购显著影响抗菌药物市场规模并重塑抗菌药物市场竞争格局;改变抗菌药物的用药行为和调整用药结构;影响中选品种各厂牌价格并显著降低用药费用。结论：抗菌药物集采取得了显著的政策效果,同时基于抗菌药物的特殊性需要重点关注国家药品集中采购政策效果与抗菌药物合理用药的关系。     

国家组织药品集中带量采购价格降幅影响因素分析

目的：分析国家组织药品集中带量采购过程中生产企业是否中选及中选价格的影响因素,探讨带量采购政策效果及是否仍有提升空间。方法：选取第二批至第五批药品集中带量采购涉及品种进行分析,以中选企业是否中选以及价格降幅为因变量,企业特征和竞争因素相关指标为自变量,采用Heckman两阶段模型分析药品价格降幅及是否中选的影响因素,并控制潜在的选择偏倚。结果：原研企业相较于仿制药企业中选概率更低,但是一旦中选其价格降幅相较于仿制药企业高41%;市场份额较小企业相较于原有市场份额较高企业(>50%)中选概率更大,但价格降幅低7%;具备原料药生产加工资质的企业更易中选,但是价格降幅相较于不具备相关资质企业没有显著差异;潜在竞争者数量每增加1%,中选价格降幅增加0.26个百分点,企业中选概率也更低。结论：药品带量采购可以有效促进原研药产生“专利悬崖”现象,理顺药品价格形成机制。具备原料药生产加工资质的企业体现出更强的成本控制能力。同时,在规则设计中可以进一步突出保障供应在中标规则中的重要性、制定动态触发机制或者尝试建立组合投标机制,有利于进一步运用市场机制降低药品价格。     

国家集采常态化视域下药品集团采购模式对比及发展对策研究

药品集团采购是目前国内区域药品集采的典型模式,与国家集采常态化运行的协同发展,对建立国家药品市场化采购体系具有重要意义。本文通过分析国内药品集团采购模式的发展现状,从管理机制、价格策略、市场竞争、采购规则四个方面比较分析了国家药品集中带量采购与药品集团采购的差异,重点围绕监管机制、服务功能、市场竞争与协同发展,讨论了国内药品集团采购的未来发展挑战,并给出了相应的发展对策。研究成果能够为优化药品集团采购管理实践、促进药品带量集采高质量协同发展提供助力。     

新一轮药品集中采购价格10省份间对比研究

目的研究我国10省份新一轮药品集中采购药品中标价格差异,为进一步完善我国各省份药品集中采购工作提供参考。方法基于"2015年全国样本医院药品采购排行榜"和各省份新一轮集中采购目录选择15种药品,通过对比研究法对15种药品的省份间价格、国产药与进口药的价格进行分析,在借鉴世界卫生组织/国际卫生行动组织药品价格标准调查法的基础上,将各省份的药品价格与国际参考价格进行对比分析。结果同种药品在各省份的采购价格不相同,福建省价格明显低于其他省份价格,少数进口药价格明显高于国产药价格,部分药品的中位价格比值超过了合理区间。结论建议各省份参考福建在药品集中采购方面的有益经验,完善各自的集中采购方案;各省份应对国产通过一致性评价的仿制药、进口专利或原研药一视同仁,给予两者公平竞价的机会;将国际参考价格纳入限价参考体系中,制定更加合理的限价标准。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.