中越卫生合作需求与策略

目的:通过分析越南的卫生合作需求,提出中越卫生合作的策略建议。方法:通过二手资料收集和定性访谈,收集健康相关可持续发展目标(SDG)数据、越南卫生发展规划、国际组织对越援助以及中越卫生合作现况。结果:越南以SDG为基础,规划优先发展领域。国际组织对越南卫生发展起到重要作用,但随着越南的经济发展,部分组织开始撤资。中越目前主要在多边合作框架下开展卫生合作,合作内容涉及卫生安全、卫生发展和医学创新。结论:中越卫生合作应根据两国卫生发展水平、卫生合作基础及国家发展规划决定合作的领域和方式。两国的卫生合作应随双方的发展进程和需求变化而动态调整。除了中越两国的资源,其他国际资源的有效利用也有助于卫生合作的推进。     

Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls

BackgroundFood insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls.ObjectiveThis study examined the relationship between self-reported food insecurity and dietary intake among boys and girls.DesignCross-sectional survey data were used from the Children’s PowerPlay! Campaign evaluation.Participants and settingIn all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment.Main outcome measuresIndividual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls.Statistical analysesMultivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics.ResultsGirls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys.ConclusionsFood insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.     

An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia

One of the most important components of the ambitious 2014 National Health Insurance reform in Indonesia is the implementation of prospective payment system known as capitation grants, paid monthly to the primary health providers based on the enrolment rate. This has ushered in additional financial resources for the health managers in resource allocations, especially in the hiring of manpower. Drawing data from the Indonesia Family Life Survey (1993‐2015), this paper uses difference‐in‐differences method to evaluate the effects of the payment method reform on the allocation of human resources for health among the primary health providers. To our surprise, there was no statistically significant change in the total number of full‐time staff among the capitated facilities after the reform. However, capitation grants caused an increase in the number of full‐time equivalent and part‐time equivalent contract staff, but a significant decline in the number of full‐time permanent staff among the urban capitated facilities. It is likely that more contract health workers were hired at the expense of full‐time permanent staff among the capitated facilities in the urban regions. This unintended consequence shed light on the need to develop nuanced and contextual understanding of payment reforms in developing countries.     

质量保障视角下中药材追溯机制研究

目的：构建质量保障视角下的中药材追溯机制。方法：文献资料法。结果：中药材追溯机制缺乏完备的法律法规,导致中药材追溯无法可依;信息不对称问题突出,导致中药材追溯管理混乱;中药材追溯成本较高,导致中药材追溯研究积极性低;中药材“大、散、长”现象明显,导致中药材追溯难度大。结论：通过以上分析,建议采取建立健全相关法律法规,为中药材追溯提供法律依据;整合各方面优势资源,成立中药材追溯专门机构;建立3P 认证制度,提高中药材标准化水平;加强监督管理,为中药材追溯提供保障等措施,探索质量保障视角下中药材追溯机制构建的有效途径。     

A Survey of Physicians' Attitudes and Practices about the Human Papillomavirus (HPV) Vaccine in Hawai‘i

The human papillomavirus (HPV) vaccine has the potential to decrease the incidence of several cancers that affect women and men. Despite recommendations by the medical and public health community, and the incorporation of the vaccine into the adolescent immunization schedule, uptake of the vaccine remains well below target goals. To understand potential physician barriers to recommendation and provision of the vaccine, a cross-sectional survey was administered to Hawai‘i pediatricians and family physicians from July 2012 to September 2012 on their attitudes, practices, and perceived barriers regarding HPV vaccination. Surveys were mailed to 465 members of the local pediatrics and family medicine professional chapters, and 87 responses were received for a response rate of 19%. After excluding 14 responses, 73 surveys were included in the analysis. Although almost all of the respondents reported stocking and administering the HPV vaccine in their offices, only 71% reported strongly recommending the HPV vaccine to girls 11–12 years, and only 57% strongly recommend the vaccine to boys 11–12 years old. Lack of insurance coverage and other financial considerations were barriers to provision of the vaccine by physicians. Physicians who felt it is necessary to discuss sexuality with patients prior to recommending the vaccine were significantly less likely to strongly recommend the vaccine to boys 11–12 years old. Public health efforts should focus on addressing the financial barriers and encouraging physicians to recommend the HPV vaccine according to the guidelines.     

人工智能技术在宫颈细胞筛查中的应用进展和挑战

子宫颈癌是女性最常见的恶性肿瘤之一,通过人类乳头瘤病毒(human papillomavirus,HPV)检测和宫颈细胞学筛查,进行早期诊断和早期治疗能够控制宫颈癌的发病和死亡。由于缺乏宫颈细胞筛查人员,使其收效甚微。人工智能(artificial intelligency,AI)技术应用宫颈癌筛查,可望提供最佳的解决方案。通过文献复习和归纳,本文阐述了AI辅助宫颈癌筛查的进展,包括不同的AI算法模型的利弊,人工筛查与AI辅助筛查之间不同的人机交互筛查工作模式和应用于场景;分析了目前AI辅助宫颈癌筛查的结果和应用优势;例举了开发AI辅助宫颈癌筛查中遇到的问题和挑战。旨在为开发和利用AI辅助宫颈细胞筛查提供借鉴和思考,促进AI辅助宫颈癌筛查产品早日落地和应用,减少我国宫颈癌的发病率和死亡率。     

家兔脂肪肝超声图像特征指标量化的方法学探讨

脂肪肝超声图像具有一定的纹理特征,通过对大白兔脂肪肝超声图像的特征分析,采用计算机辅助分析技术,对大白兔脂肪肝图像进行小波收缩法抑制散斑噪,然后分别从直方图,行程矩阵等进行量化指标的提取,并通过多组家兔动物实验对比分析各特征参数及实际纹理含义,从而为脂肪肝超声影像检查和病情分型提供量化依据。     

2014年中国慢性非传染性疾病预防控制能力评估

目的 了解我国慢性非传染性疾病（慢性病）预防控制能力现状。方法 2014年9月至2015年3月通过网络问卷调查全国省、地（市）和县（区）级3 395个CDC和3 000个基层医疗卫生机构,了解慢性病预防控制相关的政策能力、基础配置能力、培训指导能力、合作与参与能力、监测能力、干预与管理能力、评估能力和科研能力。结果 （1）政策能力：23个（71.9%）省级、139个（40.6%）地市级和919个（31.2%）县（区）级政府或卫生行政部门有现行慢性病防控相关规划。（2）基础配置能力：25个（78.1%）省级、136个（39.8%）地市级和529个（18.0%）县（区）级CDC设置了专门承担慢性病防控工作的部门。各级CDC有9 787人从事慢性病防控工作,占CDC总在岗人员的5.0%。68.1%的CDC配置了慢性病防控工作经费。（3）培训指导能力：2 485个（74.9%）CDC举办过慢性病防控相关培训班。2 571个（87.3%）县（区）级CDC对基层医疗卫生机构开展过指导。（4）合作与参与能力：CDC与媒体开展合作的比例最高（42.0%）。（5）监测能力：各级CDC开展死因监测的比例为73.8%;开展各类慢性病及危险因素监测的比例均不到50.0%。基层医疗卫生机构开展新发脑卒中和急性心肌梗死病例报告的比例分别为32.4%和29.9%。（6）干预与管理能力：各级CDC开展高血压和糖尿病患者个体化干预的比例分别为69.1%和68.2%,开展其他各类慢性病及危险因素干预的比例均不到40.0%。超过90.0%的基层医疗卫生机构开展了高血压或糖尿病患者随访管理工作,但高血压和糖尿病患者管理率分别仅为17.4%和13.7%,规范管理率分别为83.7%和80.4%,控制率分别为59.2%和55.2%。（7）评估能力：32.4%的卫生行政部门或CDC对本辖区慢性病应对情况开展了定期评估。（8）科研能力：省级CDC科研能力明显高于地（市）和县（区）。结论 与前两次调查结果相比,各级慢性病防控政策能力呈稳步提高趋势,但总体仍较为薄弱;县（区）级CDC慢性病防控能力与省和地（市）级仍有较大差距,亟待提高;开展慢性病管理工作的基层医疗卫生机构比例较高,但管理效果不佳,与2010年和2012年的调查结果一致。