HIV treatment and worker absenteeism: Quasi-experimental evidence from a large-scale health program in South Africa

Over the past decade, large-scale HIV antiretroviral therapy (ART) programs have proven hugely successful in improving the life expectancy of people living with HIV. However, the extent to which treatment allows patients to maintain a productive work life remains an open question. We applied an instrumental variable method based on individual CD4 counts and exogenously changing treatment guidelines to identify the causal effect of ART on health-related absenteeism rates among workers living with HIV. We used monthly data from the occupational health program of one of the world's largest mining companies in South Africa (128,052 observations among 1,924 workers, from 2009 to 2017). Eighteen months after ART initiation, the treatment significantly reduced absenteeism by 1.033 days per worker and month. Using publicly available wage and treatment cost data, we find that the cost savings due to the absenteeism effect of ART alone outweigh treatment costs in the mining sector in several sub-Saharan African countries.     

A Comparison of Outpatient Healthcare Expenditures Between Public and Private Medical Institutions in Urban China: An Instrumental Variable Approach

The growth of healthcare expenditure provokes constant comments and discussions, as countries battle the issues on cost containment and cost effectiveness. Prior to 1978, medical institutions in China were either state‐owned or were collective public hospitals. Since 1978, China has been trying to rebuild its healthcare system, which was destroyed during the ‘cultural revolution’, allowing private medical institutions to deliver healthcare services. As a result, private medical institutions have grown from 0% to 28.57% between 1978 and 2010. In this context, we compare outpatient healthcare expenditures between public and private medical institutions. The central problem of this comparison is that the choice of medical institution is endogenous. So we apply an instrumental variable (IV) framework utilizing geographic information (whether the closest medical institution is private) as the instrument while controlling for severity of health and other relevant confounding factors. Using China's Urban Resident Basic Medical Insurance Survey 2008–2010, we found that there is no difference in expenditure between public and private medical institutions when IV framework is used. Our econometric tests suggest that our IV model is specified appropriately. However, the ordinary least square model, which is inconsistent in the presence of endogenous regressor(s), reveals that public medical institutions are more expensive. Copyright © 2013 John Wiley & Sons, Ltd.     

中国癌症患者家庭照护者照护经历的质性Meta整合

背景随着中国人口老龄化的加深与癌症发病率的不断攀升,癌症患者的照护需求也随之增加,家庭照护是其中重要的一个方面。照护行为和经历会给家庭照护者带来不同层面的影响,因此系统且全面地对中国癌症患者家庭照护者的照护经历和体验进行研究是极其必要的。目的系统整合与评价中国癌症患者家庭照护者的照护经历与体验。方法2021年1—5月,系统检索Web of Science、PubMed、EmBase、Medline、Cochrane Library、Grew Literature in the Health Sciences、中国知网（CNKI）和万方数据知识服务平台中与中国癌症患者家庭照护者经历有关的质性研究,检索时限为建库至2021-05-23。采用2016版澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心质性研究质量评价标准对文献质量进行评价,纳入符合标准的质性研究,并采用质性Meta整合的方法对所有纳入研究的结果进行综合分析。结果最终纳入符合要求的质性研究19篇（中文6篇和英文13篇）,共计295例研究对象（家庭照护者）。其中,9篇文献质量评价结果为A级,偏倚风险很低;10篇评价结果为B级,偏倚风险较低。通过对19篇文献的研究主题进行整合分析,归纳整合为3个一级主题和15个二级主题,3个一级主题分别为以患者为中心的照护需求、照护的负担和照护的正向积极作用。结论通过对中国癌症患者家庭照护者照护经历的质性Meta整合,深入、全面地呈现了中国癌症患者家庭照护者的经历。本研究的结果能够助力完善满足以患者为中心的照护需求的医疗体制建设;在微观、中观和宏观层面加强影响照护经历的积极因素,并且进行死亡和生命教育等干预措施来减轻文化因素对照护经历的负面影响。     

医学生基层就业意向及影响因素分析

目的：了解医学生基层就业意向,分析其影响因素,为解决当前医学生就业难与基层人才短缺的结构性矛盾提供参考与建议.方法：采用自行设计的问卷调查表,对杭州师范大学、浙江医学高等专科学校的482名医学生进行调查,通过卡方检验与二分类Logistic多元回归分析医学生基层就业意向的主要影响因素.结果：44.4％的医学生不愿意去基层就业,仅有8.5％表示非常愿意去基层就业.多因素分析结果显示：女医学生的基层就业意向是男生2.5倍（P ＜0.001）;农村户口医学生的基层就业意向是城市户口医学生的2.1倍（P =0.007）;医学生的基层就业意向与政府政策和学校的基层就业指导的效果呈正相关.结论：制定积极的政策、做好宣传与引导工作、探索合理的用人机制、加强学校就业指导和深化教育教学改革是引导医学毕业生面向基层就业的重要措施.     

Neonatal status: an objective scoring method for identifying infants at risk for poor outcome

The likelihood of sustaining neurological, sensory or cognitive deficits is considerably greater for very low birthweight (VLBW) infants who require intensive care in early postnatal life than those without major neonatal illness. Identifying which, if any, medical events are responsible for an adverse outcome is most difficult in the face of multiple concurrent complications. In this research, a principal components analysis was performed in order to arrive at a set of orthogonal variables which succinctly described clinical involvement in the nursery. With this procedure, a single hypothetical factor depicting neonatal status (NS) was computed. Principal component scores were then generated for NS and assigned to 252 VLBW (< 1500 g) infants. These subjects were followed prospectively from birth to 4 years of age. Standardized measures of neuorological, sensory and intellectual function were regularly administered. Neonatal status was shown to be significantly correlated with the various test results and predictive of long-term development. When subjects were divided into quartiles with respect to NS, a specific subgroup was identified as “at high risk” for poor outcome. Those subjects falling into the lower quartile incurred more neurological abnormalities persisting beyond the first year. They also suffered a higher incidence of intracranial hemorrhage and sensorineural hearing loss. In addition, the lower 25%, as a group, scored well below all others on traditional tests of mental ability. These differences were sustained throughout infancy and early childhood and could not be attributed to a number of demographic variables including sex, gestational age, birthweight, Apgar scores or parental educational level.     

Studies on preventive effects of diphenyl diselenide on acetaminophen-induced hepatotoxicity in rats

Organoselenium are compounds with important antioxidant activity and with many biological activities interesting from pharmacological point of view. The aim of this study was to evaluate the protective effect of diphenyl diselenide (PhSe)₂ on hepatotoxicity caused by administration of acetaminophen (AA) in rats. Rats received (PhSe)₂ orally (31 mg/kg, dissolved in canola oil) for 2 days. After the second day of treatment, rats received AA orally (2 g/kg) in unique dose. Twenty-four hours after the last administration of AA, plasma was used for biochemical assays aspartate (AST) and alanine aminotransferases (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), γ-glutamyl transferase (γ-GT) activities. Glutathione-S-transferase (GST), δ-aminolevulinic dehydratase (δ-ALA-D) and catalase activities as well as ascorbic acid and TBARS levels were determined in the liver of rats. (PhSe)₂ protected against the increase in AST, ALT, ALP, LDH and γ-GT activities induced by AA exposure to rats. The histological data showed that sections of liver from AA-exposed rats presented intense cellular necrosis, characterized by the presence of Kupffer cells and other infiltrating cells, mainly around of the centrilobular vein. (PhSe)₂ significantly attenuated AA-induced hepatic histopathological alterations. Administration of (PhSe)₂ protected against the increase in TBARS levels and the decrease in δ-ALA-D and GST activities as well as ascorbic acid content induced by AA exposure in rats. Catalase activity remained unaltered in all treated groups. The protective effect of (PhSe)₂ against hepatotoxicity caused by AA exposure in rats was demonstrated.     

经典的再生

培根的名篇Of Studies语言简练、说理深刻,堪称经典中的经典。在我国,Of Studies的译本已达十多种。其中受到普遍肯定和称道的当属王佐良先生的译本。本文在分析原文及所选的三个译本的文体风格的基础上结合本雅明（Walter Benjamin）的翻译思想,对王佐良、水天同以及何新的三个译本进行简单的分析与比较,试图证明王佐良先生的译本不仅充分展现了原作的风姿和神韵,更使原作焕发出新的生机,成为译入语的经典翻译文学作品。     

Physician investment in hospitals: Specialization,selection, and quality in cardiac care

Physician ownership of hospitals involves several competing economic forces. Physician-owners may be incentivized to “cherry-pick” and treat profitable patients at their facilities. However, physician-owned hospitals are often specialized and may provide higher-quality care for well-matched patients. Using multiple identification approaches, I document no significant mortality improvement for cardiac patients treated at physician-owned hospitals. Using aggregate data on ownership to infer physician-owner preferences in a hospital choice model, my results rule out significant cherry-picking within physician-owners’ patient populations. However, both facility location and a healthier overall patient population among physician-owners drive advantageous selection of patients into physician-owned hospitals.     

Parental attachment,self-control,and depressive symptoms in Chinese and Italian adolescents: Test of a mediation model

The current study investigated the relationship between parental attachment and depressive symptoms as well as the mediating effect of self-control in two different cultures. Samples were 1305 Chinese and 1327 Italian adolescents. They completed the Inventory of Parental and Peer Attachment, the Self-Restraint Subscale of the Adolescents' Self-Consciousness Scale, and the Children's Depression Inventory that assessed parental attachment, self-control, and depressive symptoms, respectively. Results showed that: (1) Few cultural differences in depressive symptom were observed. (2) Parental attachment and self-control were negatively related to depressive symptoms in both cultures. (3) Self-control mediated the relations between parental attachment and depressive symptoms in both cultures. (4) The direct and indirect effects were invariant across cultures. In conclusion, parental attachment and self-control are important for adolescents' depressive symptoms in Chinese and Italian adolescents.