新增工伤康复服务项目遴选及支付标准探索*

通过梳理工伤康复服务项目规范与支付标准制定等相关政策,阐述“国家版”和“广东省版”工伤康复服务项目和支付标准制定情况,分析新增工伤康复服务项目管理现状。选择广东省40家协议医院为样本,基于专家咨询法,计算专家采纳率,建立新增工伤康复服务项目目录,并通过基准项目赋值定价,为新增工伤康复服务项目遴选及支付标准提出管理措施。文章建议进一步细化新增工伤康复服务价格项目立项审批流程,建立新增工伤康复服务项目管理办法,规范管理制度。探索新增工伤康复服务项目纳入工伤保险目录管理机制,同时,充分发挥行业学会或协会的作用,加强卫生技术评估准入评审与价格制定管理决策中的广泛应用。     

Development and Measurement of the Treatment Perceptions Survey (TPS) for Clients with Substance Use Disorders

The Journal of Behavioral Health Services & Research - Statistical reliability of the Treatment Perceptions Survey (TPS) questionnaire was examined using data from 19 California counties. The...     

Effects of a single bout of short-duration high-intensity and long-duration low-intensity exercise on insulin resistance and adiponectin/leptin ratio

ObjectivesModerate-intensity exercise improves insulin sensitivity, which may depend on the intensity, duration, and frequency of exercise. We examined the effects of a single bout of short-duration high-intensity exercise (HIE) and long-duration lowintensity exercise (LIE) on insulin sensitivity and the adiponectin/leptin ratio in individuals with different body mass indices (BMIs) who do not exercise regularly.MethodsWe enrolled 42 healthy volunteers aged 20–64 years and divided them into two groups based on BMI: BMI <24 kg/m² and BMI ≥27 kg/m². They were randomly assigned to either the short-duration (20 min) HIE (70%–80% heart rate reserve, HRR) or long-duration (60 min) LIE training groups (30%–40% HRR). Glucose, insulin, adiponectin, and leptin levels were assessed before training and at 0, 30, 60, and 120 min after training.ResultsWe finally analyzed 27 normal weight and 9 obese individuals. No significant differences were observed in the baseline information of both BMI groups. Homeostatic model assessment for insulin resistance significantly improved for both exercise patterns in the normal weight group and for the HIE pattern in the obese group (P < 0.01), whereas the adiponectin/leptin ratio increased significantly only among normal weight participants with the LIE intervention.ConclusionBoth exercise patterns in BMI <24 kg/m² and BMI ≥27 kg/m² benefit on insulin resistance. Therefore, people can choose the way they can fit to improve insulin resistance both short-duration high-intensity exercise and long-duration low-intensity exercise.     

Optimal Household Water Access Fosters the Attainment of Minimum Dietary Diversity among Children Aged 6–23 Months in Malawi

Along with sanitation and hygiene, water is a well-known driver of child undernutrition. However, a more direct role of household (HH) water access in shaping dietary diversity remains unexplored. We assessed the association between HH water access and achievement of minimum dietary diversity (MDD) among young children. We utilized nationally-representative cross-sectional data from the 2015/16 Malawi Demographic and Health Survey, which included 4727 mother–child dyads, respectively, (26.8 ± 6.8 years, range 15–49 years) and (13.9 ± 4.9 months, range 6–23 months). HH water access was categorized as (1) basic or no access, (2) intermediate, or (3) optimal. MDD was defined as feeding a child, during the previous day, at least four of the food groups defined by the World Health Organization. Only 27.7% of the children achieved MDD standards; most of the children who achieved MDD were from HHs with optimal water access (58.4%, p < 0.001). However, only 5.9% of the mother–child dyads were from HHs with optimal water access. After adjusting for covariates, children from HHs with optimal water access had higher odds of achieving MDD than those from HHs with basic or no water access (aOR = 1.74, CI = 1.24–2.46). Our results highlight the need to incorporate water-based strategies into national nutritional policies to increase dietary diversity among Malawian infants and young children.     

Less Is Better: How Nutrition and Low-Carbon Labels Jointly Backfire on the Evaluation of Food Products

(1) Background: Labeling is one of the significant strategies to guide sustainable consumption behaviors. Nowadays, multi labels being displayed on the front-of-pack of food products is a common phenomenon. However, labels seldom operate solo, and competition or complement effects may be exerted on different labels. Therefore, the research objective is to explore the interaction effect when nutrition and low-carbon labels appear simultaneously; (2) Methods: Across four scenario-based experiments, including ice cream, yogurt, steak, and toast, this study manipulated the separate and joint occurrences of low-carbon and nutrition labels, the interaction effect of joint labels was tested, and the serial mediation model, which includes resource allocation and anticipated enjoyment of food consumption, was verified; (3) Results: Results show that people have a positive preference for the nutrition label and the carbon label, respectively, while these two labels working simultaneously attenuate the positive effect of the single label. When facing nutrition and carbon labels simultaneously, people would infer partial resources are allocated to healthy and environmental aspects so they have a lower anticipated enjoyment from food consumption. Thus, these two labels working simultaneously attenuate the positive effect of the single label, and consumers have a lower evaluation of food products. In addition, the joint backfire on the effect is only exerted on people with a higher level of zero-sum bias and only when joint labels have a high consistency of labels; (4) Conclusions: This study solved the contradictory problem of the joint effect of positive labels. The findings in this research contribute to promote sustainable food consumption. We suggest that similar labels should be avoided in the same front-of-pack of food, and manufacturers need to use ads to bring down consumers’ zero-sum bias.     

Evaluation of Serum Zinc Status of Pregnant Women in the China Adult Chronic Disease and Nutrition Surveillance (CACDNS) 2015

Objective: The purpose of this study was to evaluate serum zinc status of pregnant women in the China Adult Chronic Disease and Nutrition Surveillance (CACDNS) in 2015–2016. Methods: A total of 7147 apparently healthy pregnant women were randomly selected in 302 national monitoring sites. Information on age, race, residence region, education, pregnancy, and family income per annum was collected, and the concentration of serum zinc was determined. The evaluation of serum zinc status was further performed according to the recommendations by the International Zinc Nutrition Consultative Group (IZiNCG). Results: The median concentration of serum zinc was 858.9 μg/L with an interquartile range (IQR) of 712.9 μg/L and 1048.9 μg/L, while the overall prevalence of zinc deficiency was 3.5% with a 95% confidence interval (CI) of 3.0% and 3.9%. Serum zinc status of pregnant women changed greatly in the different categories, particular in pregnancy and family income per annum (p < 0.05), but no significant difference was observed in the prevalence of zinc deficiency (p > 0.05). Conclusions: The lower prevalence of zinc deficiency generally indicated a better zinc status for pregnant women in the CACDNS in 2015–2016. However, a well-designed evaluation system of zinc status for pregnant women should be continually optimized and improved by inducing more parameters such as biochemical, dietary, or functional indicators.     

Association between Reduced Serum Zinc and Diastolic Dysfunction in Maintenance Hemodialysis Patients

Diastolic dysfunction is an emerging challenge among hemodialysis (HD) patients, and the associations between serum zinc with echocardiographic parameters and diastolic function remain uncertain. A total of 185 maintenance HD patients were stratified by the tertiles of serum zinc level to compare their clinical characteristics and echocardiography. Correlations of serum zinc levels with echocardiographic parameters were examined using Pearson’s analysis. Univariate and multivariate logistic regression analyses were performed to investigate the determinants of E/e’ ratio >15 and left atrial volume index (LAVI) > 34 mL/m², both indicators of diastolic dysfunction. Patients belonging to the first tertile of serum zinc level had a significantly higher E/e’ ratio and LAVI. Serum zinc levels were negatively correlated with E (r = −0.204, p = 0.005), E/e’ ratio (r = −0.217, p = 0.003), and LAVI (r = −0.197, p = 0.007). In a multivariate analysis, older age, diabetes, coronary artery disease, and lower serum zinc levels (OR = 0.974, 95% CI = 0.950–0.999, p = 0.039) were significantly associated with E/e’ ratio >15. Furthermore, diabetes and lower serum zinc levels (OR = 0.978, 95% CI = 0.958–0.999, p = 0.041) were significantly associated with LAVI >34 mL/m². Reduced serum zinc level was significantly associated with diastolic dysfunction among HD patients. Further prospective studies are warranted to investigate whether zinc supplementation can attenuate cardiac dysfunction in maintenance HD patients.     

Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030

ObjectivesUnderstanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030.MethodWe calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries.ResultsThe total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario.ConclusionResource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.     

产褥期乳腺炎影响因素分析

目的探讨导致产妇发生产褥期乳腺炎(PM)的影响因素。 方法选择2020年9月1日至12月31日,在成都市某三甲妇女儿童医院分娩,并进行产后42 d随访的1 162例产妇为研究对象。根据产妇产后42 d内是否发生PM,将其分为PM组(n＝103)与对照组(n＝1 059)。采用本研究自行设计的《产褥期乳腺炎相关影响因素调查问卷》(以下简称为《调查问卷》),联合《中国简式心理状态剖面图(POMS)量表》(以下简称为《POMS量表》),分别对2组产妇进行调查。《调查问卷》内容主要包括产妇一般人口学资料、妊娠及疾病、药物使用、母乳喂养、饮食及生活习惯等10个维度,共计50个条目。《POMS量表》包括心理焦虑等7个维度,共计40个条目。对2组产妇《调查问卷》条目及《POMS量表》评分,采用独立样本t检验、χ²检验及Fisher确切概率法等进行统计学比较。本研究遵循的程序符合病例收集医院医学伦理委员会要求,经过该伦理委员会批准[审批文号：科研伦审2021(29)],并与研究对象签署临床研究知情同意书。2组产妇的年龄等一般临床资料比较,差异无统计学意义(P>0.05)。 结果①本研究纳入产妇的PM发生率为8.9%(103/1 162),产后第3、4周PM发生率最高,分别为2.7%(31/1 162)与2.4%(28/1 162)。②本研究2组产妇围生期补充铁剂及口服益生菌占比,乳头皲裂程度、吸奶器使用时间及频率、乳头保护罩与乳头保护霜使用频率构成比,哺乳衔接姿势正确率,哺乳时乳房疼痛程度、哺乳内衣穿戴率等分别比较,差异均有统计学意义(P<0.05)。③PM组产妇《POMS量表》焦虑评分为(7.1±5.0)分,显著高于对照组的(5.3±4.1)分,并且差异有统计学意义(t＝-3.540、P＝0.001)。④将上述影响产妇发生PM的单因素分析中差异有统计学意义因素,并结合已有研究结果与临床经验,纳入10项影响因素,进行多因素非条件logistic回归分析结果显示,产妇围生期补充铁剂(OR＝3.351,95%CI：1.949~5.758,P<0.001),乳头皲裂(OR＝3.564,95%CI：1.909~6.654,P<0.001),吸奶器使用频率>1次/d(OR＝5.102,95%CI：1.047~24.876,P＝0.044),乳头保护霜使用频率>1次/d(OR＝2.147,95%CI：1.156~3.987,P＝0.016),哺乳衔接姿势不正确(OR＝2.311,95%CI：1.202~4.445,P＝0.012),穿戴不舒适哺乳内衣(OR＝2.322,95%CI：1.008~5.347,P＝0.048),不穿戴哺乳内衣(OR＝3.516,95%CI：1.821~6.789,P<0.001),焦虑评分高(OR＝1.073,95%CI：1.007~1.143,P＝0.029),均为导致产妇发生PM的独立危险因素;而围生期口服益生菌(OR＝0.110,95%CI：0.025~0.478,P＝0.003)是其独立保护因素。 结论通过制定临床干预措施,指导产褥期产妇纠正不正确行为,如围生期补充铁剂、吸奶器与乳头保护霜使用不当,哺乳内衣穿戴及哺乳行为不规范等,提倡产妇围生期口服益生菌,缓解产妇焦虑情绪,对预防产妇PM发生具有重要意义。     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。