医疗保险对健康状况的影响研究综述

本文回顾了国内外学者对医疗保险和健康状况关系的研究。首先综述了关于医疗保险和健康状况关系的三种观点;其次依据研究的数据来源,将国外文献分为三个层次进行综述;最后,总结了近年来国内学者的相关研究。研究发现:(1)大多数基于观察数据的研究只能证明医疗保险与健康之间存在相关关系,要建立二者之间的因果关系,必须找到克服医疗保险内生性的方法。(2)不同研究的结论不同,但这些结论并不必然矛盾,其原因在于研究对象和研究方法存在差异。(3)研究结论并不是普遍适用的,未来的研究需要关注医疗保险对不同人群健康的长期影响。     

A review of the health effects of ingested asbestos.

Occupational studies indicate that a human health hazard may exist for ingested asbestos since the death rates due to digestive system cancers are elevated in asbestos workers. This finding may be related to the swallowing of asbestos that was inhaled and cleared from the respiratory system via the respiratory clearance mechanism. Published animal ingestion experiments have serious shortcomings in their design and execution which make their interpretation very difficult. Animal ingestion and human autopsy studies suggest that asbestos fibers may penetrate the digestive tract and migrate to other locations in the body.     

A review of health effects of aircraft noise*

Abstract: Social surveys have established dose–response relationships between aircraft noise and annoyance, with a number of psychological symptoms being positively related to annoyance. Evidence that exposure to aircraft noise is associated with higher psychiatric hospital admission rates is mixed. Some evidence exists of an association between aircraft noise exposure and use of psychotropic medications. People with a pre–existing psychological or psychiatric condition may be more susceptible to the effects of exposure to aircraft noise. Aircraft noise can produce effects on electroencephalogram sleep patterns and cause wakefulness and difficulty in sleeping. Attendances at general practitioners, self–reported health problems and use of medications, have been associated with exposure to aircraft noise, but some findings are inconsistent. Some association between aircraft noise exposure and elevated mean blood pressure has been observed in cross–sectional studies of schoolchildren, but with little confirmation from cohort studies. There is no convincing evidence to suggest that all–cause or cause–specific mortality is increased by exposure to aircraft noise. There is no strong evidence that aircraft noise has significant perinatal effects. Using the World Health Organization definition of health, which includes positive mental and social wellbeing, aircraft noise is responsible for considerable ill–health. However, population–based studies have not found strong evidence that people living near or under aircraft flight paths suffer higher rates of clinical morbidity or mortality as a consequence of exposure to aircraft noise. A dearth of high quality studies in this area precludes drawing substantive conclusions.     

政治体制对政府医疗卫生支出及健康产出的影响综述

大多数发展中国家的政府医疗卫生支出及健康产出长期处于较低水平,与发达国家有较大差距。这种差距并不能仅仅由经济因素解释,政府主导了卫生资源的分配,因此分析理性政府在公共资源分配中的激励问责机制尤为重要。本文分析了政治体制对政府提供医疗卫生服务的激励问责机制,综述了近年来有关政治体制影响政府医疗卫生支出及健康产出的实证研究。大量研究结果表明与非民主政治体制相比,民主政治体制在增加政府医疗卫生支出、提高健康产出方面有显著的积极作用。     

A comprehensive review of the effects of worksite health promotion on health-related outcomes

PURPOSE: This article provides the foundation for a series of literature reviews that critically examine the effectiveness of worksite health promotion programs. This issue reviews the exercise, health risk appraisal, nutrition and cholesterol, and weight control literatures; a future issue will review the alcohol, HIV/AIDS, multicomponent program, seat belt, smoking, and stress management literatures. METHODS: The literature search used a four-step process that included a computerized database search, a reference search, a manual search of relevant health promotion journals, and the writing of the review by a recognized expert in the area being searched. The databases were searched from 1968 through 1994 and included Medline, Aidsline, Psychological Abstracts, Combined Health Information Database, Employee Benefits Infosource, National Prevention Evaluation Research Collection, National Resource Center on Worksite Health Promotion, National Technical Information Service, and the Substance Abuse Information database. A total of 288 articles were identified by the search, not including the 37 articles in the hypertension literature. Authors of each review were requested to incorporate additional studies not identified by the search, provide a research rating for each individual article, and a rating for the overall literature for their respective area. The authors reviewed 316 studies. FINDINGS: The overall ratings for the reviews reported in this issue were suggestive for exercise, weak for health risk appraisals, suggestive/indicative for both nutrition and cholesterol, and indicative for weight control. The ratings for the other reviews will be reported in the subsequent issue. CONCLUSIONS: Research reported in these reviews suggests the effectiveness of worksite health promotion programs, however, additional research is required to provide conclusive evidence of their impact.     

Summary review of the health effects associated with phenol

Phenol, a monohydroxy derivative of benzene, occurs naturally in animal waste and by decomposition of organic wastes. It is also produced by man, originally by fractional distillation of coal tar, but more recently by cumene hydroperoxidation and toluene oxidation. As a result of large production volume and natural sources, occupational and environmental exposure to phenol is likely. Phenol poisoning can occur by skin absorption, vapor inhalation, or ingestion, and, regardless of route of exposure, can result in detrimental health effects. Acute toxicity has been observed in man and experimental animals, resulting in muscle weakness, convulsions, and coma. In addition, studies have shown that although teratogenic effects have not been associated with exposure to phenol by either inhalation or oral route, high doses of phenol are fetotoxic. This paper addresses these studies and others in an attempt to determine if human health is at risk to those levels of phenol present in the environment and workplace. However, because data are limited, further research is necessary to analyze the mutagenic and carcinogenic potential of this chemical.     

A review of instrumental variables estimation of treatment effects in the applied health sciences

Health scientists often use observational data to estimate treatment effects when controlled experiments are not feasible. A limitation of observational research is non-random selection of subjects into different treatments, potentially leading to selection bias. The two commonly used solutions to this problem—covariate adjustment and fully parametric models—are limited by strong and untestable assumptions. Instrumental variables (IV) estimation can be a viable alternative. In this paper, I review examples of the application of IV in the health sciences, I show how the IV estimator works, I discuss the factors that affect its performance, I review how the interpretation of the IV estimator changes when treatment effects vary by individual, and consider the application of IV to nonlinear models.     

预防艾滋病健康教育媒体材料效果评价比较研究

目的评价4种预防艾滋病健康教育媒体材料的信息传播效果和材料效果。该材料由课题组于2003-2005年间设计制作，包括“艾滋病知识”折页、“了解艾滋病”海报、“预防艾滋病健康教育手册”和“认识艾滋病”宣教片等4种。方法2005年12月在珠海市选取小学以上文化程度的18～60岁外来工为测试对象，随机分组对4种材料分别进行评价，各调查了251、248、257和252人，共1008人。通过问卷调查了解受访者的一般情况和对材料信息的可接受性、通俗性和材料形式的生动性等8项指标的评价，采用分级定量赋分的方法进行量化评分，采用SPSS10．1统计软件进行统计分析、比较。结果4种材料的信息传播效果和材料效果总得分平均值分别为74．2±15．0、77．7±13．5、73．0±13．8和77．2±13．6，得分最高的是海报，为77．7±13．5分，最低的是手册，为73．0±13．8分，差异有统计学意义，这种差异主要体现在信息传播效果的差异，而材料效果的差异无统计学意义。通俗性、简明性、生动性和可接受性是影响得分高低的主要因素。结论海报是最适合用于城市外来工进行预防艾滋病健康教育的传播材料，其次是宣教片。     

预防艾滋病健康教育传播材料干预效果研究

目的评价不同预防艾滋病健康教育传播材料的干预效果。方法从前来珠海市疾控中心进行健康体检的外来工中随机选择4组干预对象,每组接受一种预防艾滋病健康教育材料干预,包括阅读“艾滋病知识”折页(折页)、“了解艾滋病”海报(海报)、“预防艾滋病健康教育手册”(手册)和观看“认识艾滋病”宣教录像片(VCD)4种材料。结合4种教材的核心信息设计统一调查表,内容包括干预对象的一般情况和艾滋病相关知识的10个主要问题,干预前后分别进行问卷调查和比较。结果共调查1 008人,干预前其对卖淫嫖娼、共用注射器吸毒、母婴传播等艾滋病主要传播途径回答正确率分别为92.5%、89.3%和86.6%;对蚊虫叮咬、同桌吃饭、日常生活与工作接触、握手拥抱等非艾滋病传播途径的回答正确率分别为36.3%、54.9%、63.3%和70.5%;对使用安全套能预防艾滋病的知晓率为73.1%。折页、海报、手册及VCD 4组干预对象分别为251、248、257和252人,4组干预对象干预前对艾滋病相关知识的回答总正确率分别为73.1%、75.2%、72.0%和69.1%;干预后分别为79.4%、84.6%、76.7%和84.7%;各组分别上升了6.3%、9.4%、4.7%和15.6%;前后比较差异均有统计学意义(均P<0.01)。结论城市外来工对预防艾滋病知识的了解还不够全面;健康教育传播材料核心信息的表达形式与传播方式不同所产生的干预效果不同,观看录像片的干预效果最佳,阅读手册的干预效果最差。     

A critical review of the epidemiologic literature on health effects of occupational exposure to vinyl chloride

We have attempted to critically review and summarise the collective epidemiologic evidence concerning the association of occupational vinyl-chloride exposure with human health outcomes, including cancer, liver cirrhosis, cardiovascular disease, nonmalignant respiratory disease and acroosteolysis. Based on data from individual reports, qualitative and, where possible, quantitative summaries are presented. With respect to cancer, which has been extensively studied, angiosarcoma of the liver is the only malignancy causally related to vinyl-chloride exposure. Hypothesised associations between vinyl chloride and cancers of other sites, namely lung, brain and lymphohaematopoietic system, are not consistently supported by the available data. Similarly, the epidemiologic data relating vinyl chloride to nonmalignant disease, while quantitatively limited and qualitatively suboptimal, do not support a causal association for any of the studied disorders. In summary, a comprehensive review of the relevant epidemiologic literature revealed that occupational vinyl-chloride exposure has not been conclusively or causally linked to any adverse health outcome, with the exception of angiosarcoma of the liver.     

The effects of the school environment on student health: A systematic review of multi-level studies

Health outcomes vary between schools and it is theorised that this may be partly attributable to variation in the school environment. Existing systematic reviews have not drawn authoritative conclusions because of methodological limitations in the review or studies available. We identified 42 multi-level studies, ten of which were judged of sufficient quality to narratively synthesize. There was consistent evidence that schools with higher attainment and attendance than would be expected from student intake had lower rates of substance use. Findings on the influence of smoking/alcohol policies were mixed. Three studies examined the health effects variously associated with school campus area and observability, year structure, school size and pupil-to-teacher ratio with mixed findings. The studies reviewed support the potential influence of the school environment on student health.     

A review of environmental characteristics and health effects of barium in public water supplies

A comprehensive review is made of sources, occurrence, removal, health effects and water quality standard of barium in public drinking water supplies. The primary source of naturally occurring barium in drinking water results from the leaching and eroding of this metal from sedimentary rocks into the aquifers of ground water. It is a localized problem in several areas of the United States. The removal of barium from drinking water appears to be most efficiently accomplished utilizing ion exchange softening. Health effects studies are based primarily on animal experimentation. Such effects include stimulation of smooth, striated, and cardiac muscle, elevation of blood pressure, initiation of catecholamine release, rapid and preferential deposition in bone, and excretion principally in the feces. Humans over 60 years of age appear to be at high risk to developing cardiac arrhythmias following the barium enema. The current United States drinking water standard of 1.0 mg/l is based on several faulty assumptions and should be critically reevaluated.     

Palladium--a review of exposure and effects to human health

Palladium is a metal the output and use of which has more than doubled in the past ten years. It is used in dental appliances, chemical catalysts, electrical appliances and jewellery, but the greatest increase in Pd demand has been in automotive emission control catalysts. Studies on Pd concentrations in ancient ice and recent snow samples reflect the increase in mining, smelting and use of palladium in the last decades. Increases of palladium in the environment have been shown in air and dust samples. There is no data as yet available to assess the effect of this exposure

A major source of health concern is the sensitization risk of Pd as very low doses are sufficient to cause allergic reactions in susceptible individuals. Persons with known nickel allergy may be especially susceptible. Workers occupationally exposed to Pd include miners, dental technicians and chemical workers. The latter are exposed mainly to Pd salts several of which may cause primary skin and eye irritations. It is advised that persons with known Pd allergy should not work with Pd compounds. The general population may come into contact with palladium mainly through mucosal contact with dental restorations and jewellery containing palladium and possibly via emissions from Pd catalysts. Protection of the public from related adverse effects may be achieved by the use of alloys with high corrosion stability and thus minimal release of palladium. In general, in dental patients who are sensitive to Pd, restorations using Pd-containing materials should not be used although Pd has been used without allergic effects in some of these individuals. Further, those patients who have an allergy to nickel should be informed that use of Pd-containing dental materials may cause Pd allergy, though this risk appears to be low.