行政干预在经济转型晚期生育健康服务中不可忽视的积极作用

在经济体制转型前，人们往往过分强调市场经济体制而忽视了行政的积极作用。本文通过对云南省华宁县实施降低孕产妇死亡率干预方案的案例分析指出，由于生育一已习惯自上而下的工作方式，各级领导机构可以而且应当发挥积极的行政干预作用，充分和现有服务资源，动员社会各 积极参与，在不增加投入的前提下有效地改善生育健康服务。     

云南农村生育健康服务资源的现状

通过对云南省4县11个乡(镇)有代表性的个案调查发现:4县社会经济均有明显发展,政府拨出的生育健康服务费用也在逐年增加,但不平衡。调查4县中县、乡、村三级生育健康服务机构健全,县级机构有足够的卫技人员,有为开展生育健康服务所必需的医疗设备、床位及业务用房。乡级生育健康服务资源不如县级,专业人员很少,设备也很简陋。4县按人口平均卫技人员数量不少,然而生育健康专业人员素质偏低,尤其是乡村两级有待培训提高。如何改革云南农村现行生育健康服务体制及经营机制,提高生育健康服务的效率和效益,值得进一步研究。     

云南农村县级生育健康服务费用案例研究

本文根据在云南省4个县收集的有关资料,对县级生育健康服务费用作一案例分析。结果表明,各县政府投入的生育健康服务经费均逐年增长,但总量仍较小,特别是在妇幼保健方面的投入不足。各生育健康服务机构业务收入逐年增长,但其中有的机构药费收入的比重过大且逐年上升,值得重视。     

云南农村生育健康服务的提供与效果

据在云南省4个县收集的有关资料对其生育健康服务的提供及效果作一案例分析。结果表明,所调查县、乡生育健康服务机构均能提供规定的基本生育健康服务项目,服务量逐年增加,但某些服务效果的指标改善尚不明显,服务质量的问题亟待研究。     

论生育登记的法律属性及其制度设计

对生育两个以内孩子的家庭实行生育登记服务制度,是贯彻落实"全面两孩"政策的重要举措。实践中各地在登记对象、登记机构、登记时间、办理方式和引导措施等方面都表现出较强的区域性。基于生育登记的法律属性和制度初衷,它具有行政性、开放性和中立性三个特征。与之相应,生育登记机构须是行政主体,登记机构应主动服务且不宜排除非婚生育,同时,生育登记不是生育行为真实合法性的判定依据。     

计划生育服务的改进在生殖健康方面的重要性

随着计划生育水平的不断提高,以及人们对生育观念、生育意愿的转变,计划生育工作从单纯的控制人口逐渐转变为优生优育与健康相结合,从简单的行政管理转向计划生育优质服务与生育健康服务转变;由狭义的避孕技术服务向更广泛,更深刻的生殖保健服务迈进[1]。计划生育服务内容     

健康教育项目中发挥社区卫生服务机构的重要作用

合肥市开展社区健康教育与烟草控制项目中充分发挥社区卫生服务机构的重要作用,在居民小区以社区卫生服务机构为健康教育中心,采取多种形式和综合干预的方法,开展社区健康教育工作,在社区健康教育项目实践中取得不少工作成效。     

健康教育消灭脊灰的综合干预作用

２０００年目标———无脊髓灰质炎世界，健康教育应为实现这一目标做出积极贡献。本文介绍了山西省晋城市通过法制干预、行政干预、自觉干预、行为干预等方法开展消灭脊髓灰质炎的经验。并通过效果调查，充分肯定健康教育在消灭脊髓灰质炎中的综合干预作用。     

四川省人口计生委出台实施出生缺陷干预提高出生人口素质的意见

为大力提高出生人口素质，最近，四川省人口计生委出台了《关于实施出生缺陷干预提高出生人口素质的意见》（简称《意见》）。要求全省各级人口计生部门要立足于履行人口计生部门的工作职责和工作任务，充分利用行政管理、宣传教育、技术服务、信息服务、群众队伍等网络优势，围绕宣传、咨询、指导、服务，科学制定提高出生人口素质的规划及行动计划，认真做好出生缺陷一级干预工作。各级人口计生部门在开展出生缺陷干预工作中，要以孕前和产前预防为重点把出生缺陷干预工作重点放在知识干预之上，开展有针对性的健康教育，加强婚前及新婚期遗传与优生咨询服务和指导，加强已婚待生育或不宜生育者采取适宜的避孕措施。     

不孕不育三级防治技术体系建立的可行性探索

目的:了解重庆市三级计划生育技术服务机构技术资源、技术服务能力现状及开展不育服务的意愿,探索建立不孕不育三级技术服务体系的可行性。方法:采取统一的调查表,现场查看、与管理和技术人员访谈、专业技术人员填写问卷等方式,对市、县、乡技术服务机构的现况进行调研和分析。结果:在现有可利用资源的基础上,各级计划生育技术服务机构可以在不孕不育的预防和治疗方面发挥重要作用。乡镇服务站能为不育患者提供生育与不育的信息咨询、生殖健康科普宣传;区县生殖健康中心能提供初步的检查、诊断、治疗和指导;市级机构能提供进一步的病因检查、手术治疗和辅助生育技术。结论:在计划生育系统建立不孕不育三级防治技术体系是可行的。     

Financial analysis in the health administration curriculum: a survey of ACEHSA programs.

Among the continuing curriculum issues in health administration programs is the appropriate amount of financial analysis. This field covers economics and financial management, with both subjects being given importance in the ACEHSA accreditation guidelines. This paper reports on a national survey of health administration programs intending to discover the importance placed on the study of economics and financial management. A second survey gathered information from alumni and preceptors of a specific ACEHSA program (the University of Massachusetts at Amherst) on their perception of the appropriate curriculum content for financial analysis. The most important conclusion of this study is the discovery that the long-accepted schism between school of public health and school of management programs does not exist. There are far more similarities than differences, at least in terms of financial management and economics. Financial analysis is a broad area and at present a great amount of diversity among programs is acceptable. The accreditation process may require narrower standards for this important content area.     

Nutrition education in junior high schools: incorporating behavior change strategies into home economics courses

A study designed to assess the effectiveness of a seventh gradesocial norms and skills-based educational program was developedand implemented in collaboration with home economics teachersat four junior high schools in Bergen, Norway. Healthly eatingbehavior and healthy eating knowledge were assessed prior to,and 5 and 12 months after the initiation of the nutrition program.Surveys including a short food-frequency questionnaire and questionsregarding knowledge of healthy eating were administered to participatingseventh grade students. A total of 447 students (92.0%) participatedat both baseline and first follow-up survey, while 415 (85.4%)participated at baseline and second follow-up. The implementationof this program demonstrated that it is feasible to integratecurriculum activities designed to modify students' eating behaviorin home economics courses. Furthermore, the results indicatedthat females receiving the intervention reported healthier eatingbehaviors both at 5 and 12 months follow-ups. For males, weobserved a significant short-term positive effect on eatingbehavior as well as a maintained positive impact on healthyeating knowledge. It is recommended that future school-basednutrition education research focus on providing models for effectiveuse and incorporation of behavioral change strategies into existingschool curricula.     

美国1853—2010年学校供餐计划的历史考察

从1853年纽约市儿童援助协会为当地职业技术学校的学生提供免费午餐，至1975年美国学校早餐计划获得国会永久授权，美国学校供餐计划经历了一个从萌芽、起步到成型发展的历史过程。美国公众对该项目的持续关注与监督，营养改革者、家庭经济学家等进步人士的舆论引导是重要的外在推力；联邦政府对法律的及时颁布和与时俱进，高层领导的高度重视是重要的前提保障；项目设计者将其与本国农业发展战略相结合，贯彻整体发展理念，是其保持持久生命力的关键；对儿童身体健康的重视，是美国学校供餐项目由注重儿童饮食数量到关注儿童营养质量的核心原因。     

辽宁省庄河市胃癌高发区胃癌筛检的卫生经济学评价

目的采用卫生经济学方法评价2001—2003年在辽宁省庄河市胃癌高发区开展的胃癌筛检项目，评估其经济上的可行性，为在胃癌高发区推广两轮筛检法提供依据。方法采用了三种基本的卫生经济学评价方法：成本一效果分析（CEA）、成本一效益分析（CBA）和成本一效用分析（CUA）。CEA以“减少死亡”作为效果进行评估，计算了每减少一例死亡所需投人的直接成本；CBA计算了直接成本、间接成本和直接效益、间接效益，并计算了成本一效益比；CUA评估了筛检措施挽回的质量调整生命年，并计算了每挽回一个质量调整生命年所耗费的直接成本。结果CEA显示，在庄河地区高危人群中每多投人8448元人民币进行筛检治疗就可以减少一例胃癌的死亡；CBA显示，成本为1300621元，产生效益2555979元，成本效益比为1：1，97；CUA显示，筛检共挽回331．44个质量调整寿命年（QALY），每避免一例胃癌死亡增加11．43个QALY。在庄河地区高危人群中每挽回一个QALY花费3802元。结论在胃癌高发区开展两轮胃癌筛检可以挽回更多胃癌患者的生命，是一项经济、社会效益较好，值得推广的一级预防措施。     

The economics of animal health in farmed livestock at the herd level.

Animal health economics is a relatively new discipline which makes use of concepts, procedures and data to support the decision-making process with the objective of optimising animal health management. As the economic impact of most diseases that afflict farmed livestock is typically greater at the sub-clinical rather than the clinical level, animal health management often involves decisions regarding expenditure on preventive measure as well as the treatment of obviously sick animals. Animal health programmes have been shown to provide a very high return on investment. This is because reduction of the impact of disease increases the efficiency of production, often without the need for additional inputs such as feed or labour. The analytical techniques described in this chapter are the simplest, most useful, and most commonly used by animal health economists. Most decisions in animal health economics at the farm level can be arrived at by using partial budgeting, decision tree analysis, or cost-benefit analysis techniques--either alone or in combination. Regardless of the technique chosen, the analysis is only as good as the quality of the data used.     

Cross-disciplinary communication needed to promote the effective use of indicators in making decisions

This paper examines problems of assessment and decision-making that result from poor or inadequate communication of indicators among the disciplines of public health, the physical sciences, and economics. The specific examples used are drawn from climate impacts in the Americas although the issues are more general to environmental health. In terms of physical processes, problems arise in confusion about indicators at different steps along the DPSEEA framework of environmental health indicators and general scientific uncertainty about the underlying physical processes. Communication between public health and economics is hindered by a lack of understanding of economic costs used in making decisions and the presence of implicit value judgments in economic analysis. Organizational structures may further inhibit the effective use of indicators. Finally, the paper discusses the Pan American Health Organization proposal to enhance the communication of indicators by using information technology networking to support communication among program managers and decision-makers at the national and local levels. The aim of this initiative is to establish a better environment for making decisions. The problem of cholera in Peru is shown as an example of the need for better communication.     

Long-term results evaluation in medical management programs

The evaluation of multiyear programs in medical management becomes increasingly difficult as the program continues. As programs continue to run over a number of years, calculation of results becomes problematic as the comparison "baseline" recedes into the past and program impact reaches a steady state. Purchasers of services to begin to doubt program effectiveness, while methods for calculating economic impact seem increasingly unreliable. The economics of program impact across time requires insight into the drivers of savings and costs at the program level and how each changes with continued program activity. This article will review key concepts in the economic impact of medical management programs over time, and how some of these issues are addressed.     

新疫苗纳入国家免疫规划的评价维度及指标分析

目的 对新疫苗纳入国家免疫规划涉及的决策要素相关的文献进行系统梳理。方法 通过8个中英文文献数据库检索国内外相关文献,归纳各国进行免疫决策时的评价维度及核心指标等。结果 纳入41篇文献,内容以案例研究为主,实证研究较少。各文献基本遵循疾病、疫苗、卫生系统的评价框架,但有不同程度的延伸。疾病死亡率、疫苗安全性及有效性、成本效果评价等为高频评价指标。本研究梳理出基于“疾病-疫苗-能力-效益评价”的4维度13个要素43个指标的评价体系。结论 国内外关于疫苗决策的研究处于发展阶段,我国应增强疫苗纳入免疫规划的评价框架的可操作性及广度,注重本土的流行病学、卫生经济学数据收集,进一步发挥国家免疫规划技术工作组在疫苗循证决策中的作用。     

Oportunidades to reduce overweight and obesity in Mexico?

This paper investigates the causal effect of Oportunidades, a conditional cash-transfer program in Mexico, on overweight and obesity of adolescents living in poor rural areas. Affecting youth weight was not a goal of this program. However, health economics research suggests that the provision of schooling, health information sessions and sizable cash transfers to Oportunidades participants could have substantially changed their overweight and obesity rates. Exploiting an exogenous jump in program participation by means of a fuzzy Regression Discontinuity (RD) design, the evidence of this paper suggests that Oportunidades decreased obesity among participant women. The identified local average treatment effect (LATE) at the threshold for program eligibility suggests that female obesity would decrease if the program was expanded to cover slightly better-off households. The design of the program does not allow disentangling the causal pathways that contributed to the lower prevalence of obesity among women, but the effect likely resulted from increased access to information and schooling, improved dietary quality, increased monitoring of health outcomes and (possibly) increased physical activity. Suggestive evidence shows that teen pregnancy rates were higher among non-participants. Therefore, weight gain after childbirth might also explain higher obesity rates among non-participant females.     

Dissemination and Use of a School-Based Nutrition Education Program For Secondary School Students

ABSTRACT: Program dissemination and implementation represent critical components of effective school-based health promotion interventions. This study examined the dissemination and implementation of a nutrition teaching program, Nutrition For Life, in New York State secondary schools. Some 1,312 health, home economics, and physical education teachers in junior and senior high schools provided information through random sample mail surveys. Logistic regression procedures examined teacher and school characteristics associated with receipt and use of the program. Overall, 50% of junior high school and 33% of senior high school teachers received the program and three-quarters of these teachers used it. At both levels, home economics teachers were more likely to receive and use the program than health teachers. Peer-led teacher training workshops organized through an existing community-based network provide an effective and efficient mechanism for disseminating nutrition teaching programs.