药品回扣现象的成因及对策综述

最近几年,药品回扣、虚高定价现象肆虐,已经成为我国卫生行业中的一个不容忽视的问题,越来越受到党和政府及社会的普遍关注。对此,笔者在阅读大量文献的基础上,对我国的药品回扣成因及现状做一综述,并针对问题提出解决办法。     

社会资本在健康领域的应用现状

在解释收入不平等对健康差异的影响作用时，流行病学家引入了社会资本的概念，尽管社会资本理论自身还存在很多争议，但其与健康关系的研究引起了众多学者的兴趣。本文从各种社会资本的概念，社会资本在健康领域研究中的应用，社会资本影响健康的可能机制，各种测量方法和存在的不足以及在中国目前的应用现状等方面进行了浅析。     

伽玛刀运行成本及效率研究

通过对4所医院伽玛刀的使用效率、运营成本情况的调查研究,结果发现,伽玛刀设备价格昂贵,运行成本较高,治疗费用高,但目前伽玛刀设备的利用率不足,并且虽然伽玛刀设备投资巨大,运行成本较高,但伽玛刀治疗的成本回收率高。因此,建议政府应优化伽玛刀的配置,限制伽玛刀的装备,调整目前的配置结构,实现资源共享、合理定价,提高设备利用率。     

Police drug crackdowns and hospitalisation rates for illicit-injection-related infections in New York City

Using longitudinal data, this analysis tests the hypothesis that eight police drug crackdowns implemented in 27 New York City police precincts between 1995 and 1999 were associated with subsequent increases in monthly precinct-specific hospitalisation rates for illicit-injection-related abscesses, cellulitis, and endocarditis. Crackdowns are sustained police initiatives designed to reduce the possession and sale of illicit drugs through heightened surveillance and arrests of drug users and street-level dealers. We linked hospitalisation data (48,986 illicit-injection-related abscess or cellulitis cases and 5452 illicit-injection-related endocarditis cases) and arrest and United States Census data to police precincts to calculate hospitalisation and arrest rates. Analyses indicate that drug-related arrest rates climbed 39% in the crackdowns’ first year compared with the previous year. Contrary to our hypothesis, we found evidence of a stasis or decline in hospitalisation rates in the crackdowns’ first year, based on multivariate Poisson regression models that included sensitivity analyses that accounted for the increased incarceration of injectors after each crackdown's onset. We discuss several possible explanations for these findings and conclude that future research is warranted regarding the relationship between police strategies and drug users’ health that incorporates inmate health data and both individual-level and precinct-level data.     

经济转型期公立医院管理者的激励与约束机制研究概述

目的 探索在市场经济条件下对公立医院管理者有效的激励与约束机制,建立医院管理岗位的创新机制。方法 通过现场调查访问,结合文献综述、座谈法,收集数据;通过描述性统计方法、主成分分析等统计分析方法进行数据分析。结果 通过对现在公立医院管理者的激励与约束措施和意向调查分析,找出了现在公立医院管理者激励机制和约束机制中的问题,提出了在实行医院产权制度改革的基础上建立新的分配机制,建立公立医院管理者任用竞争机制,对医院管理岗位实行人力资本管理的创新机制,加强法律法规和卫生政策对医院管理者权力的约束。结论 提出了建立适应市场经济条件下医院管理者的有效激励与约束机制的运作模式。     

A system for high performance liquid chromatography of 99mTc-compounds with on-line radiometric detection and data processing

A system for HPLC with on-line γ activity (two channels) and u.v.-detection is described, including software for the on-line data processing with a microcomputer.It was developed for the analysis of ^99mTc-diphosphonates. Example of some of its features are given using the separation of ^99mTc and ¹¹³Sn labeled Tc(Sn)EHDP complexes with ion-pair-chromatography.     

Evaluating a Model of Added Sugar Intake Based on Amino Acid Carbon Isotope Ratios in a Controlled Feeding Study of U.S. Adults

Previous studies suggest that amino acid carbon stable isotope ratios (CIR_AAs) may serve as biomarkers of added sugar (AS) intake, but this has not been tested in a demographically diverse population. We conducted a 15-day feeding study of U.S. adults, recruited across sex, age, and BMI groups. Participants consumed personalized diets that resembled habitual intake, assessed using two consecutive 7-day food records. We measured serum (n = 99) CIR_AAs collected at the end of the feeding period and determined correlations with diet. We used forward selection to model AS intake using participant characteristics and 15 CIR_AAs. This model was internally validated using bootstrap optimism correction. Median (25th, 75th percentile) AS intake was 65.2 g/day (44.7, 81.4) and 9.5% (7.2%, 12.4%) of energy. The CIR of alanine had the highest, although modest, correlation with AS intake (r = 0.32, p = 0.001). Serum CIR_AAs were more highly correlated with animal food intakes, especially the ratio of animal to total protein. The AS model included sex, body weight and 6 CIR_AAs. This model had modest explanatory power (multiple R² = 0.38), and the optimism-corrected R² was lower (R² = 0.15). Further investigations in populations with wider ranges of AS intake are warranted.     

Costs and effects of secondary prevention with perindopril in stable coronary heart disease in Poland: an analysis of the EUROPA study including 1251 Polish patients

OBJECTIVES: To estimate the long-term impact of treatment with perindopril on costs and health effects in patients with stable coronary artery disease in Poland. METHODS: The cost-effectiveness analysis was based on data from a randomized double-blind, placebo-controlled trial. A decision-tree analysis was employed, including Monte Carlo and bootstrapping techniques. This study was a sub-study of the EUROPA (European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) trial (n = 12 218; mean follow-up 4.2 years). Resource use was based on data from Polish EUROPA study patients (n = 1251), while effectiveness was based on the whole EUROPA study. The health gain of perindopril in life-years was based on overall EUROPA study results, and the adapted Polish life expectancy of patients not dying during the trial. Costs were calculated in new Polish zloty (PLN), year 2003 values; euro1 = PLN4.053. Only direct healthcare costs related to cardiovascular events and medication use were studied. RESULTS: When observed mortality was combined with life expectancy beyond the end of the study, perindopril use showed a gain in life expectancy of 0.182 life-years (SD +/- 0.129) at a cost of PLN1983 (SD +/- 103) with discounting of 5% per annum on costs and no discounting on effects. This resulted in an incremental cost-effectiveness ratio (ICER) of PLN10 896 per life-year gained. The probability that the ICER for perindopril was below the threshold of PLN60 000 was 88%. The overall results were insensitive to discount rates for costs and life-years. CONCLUSIONS: Perindopril leads to a reduction in the risk of coronary events among patients with stable heart disease. When the expected improvement in life expectancy is combined with associated medical costs, there is a high probability that perindopril is cost effective, given the threshold of PLN60 000 per life-year gained.     

中国农村居民健康影响因素分析

目的 分析中国农村居民自评健康状况及影响因素,为提高中国农村居民健康水平提供参考依据。方法 于2011年1月-2012年4月应用多阶段随机抽样、概率与规模成比例抽样方法在河南、河北、山东、黑龙江、江苏、海南、宁夏省和北京市抽取10161名年龄≥18岁农村居民进行入户调查,采用Kruskal-Wallis秩和检验、Spearman等级相关检验、多分类有序logistic回归对数据进行统计分析。结果 10161名年龄≥18岁农村居民中,男性4116人(40.51%),女性6045人(59.49%);平均年龄47.08岁;学历中小学及以下4654人(45.81%),初中4249人(41.82%),高中及以上1258人(12.37%);务农7594人(74.74%),其他职业2567人(25.26%);71.47%(7262/10161)的农村居民自评健康状况非常好/较好,仍有28.53%(2899/10161)的居民对自身健康状况不十分满意;多因素分析显示,农村居民随着年龄增大自评健康水平逐渐下降(P<0.01);随着受教育水平升高自评健康水平升高(P<0.01);农民、打工者和个体工商业者的健康水平明显低于固定工作者(P<0.05);河北、海南、宁夏、北京的农村居民健康水平低于河南省,而山东、黑龙江、江苏相对较高(P<0.05);患有慢病者较无慢病者自评健康水平高(P<0.01);无医疗保险者健康水平高于有医疗保险者(P<0.01);贫困户健康水平低于普通人群(P<0.01);自评经济地位越高,自评健康水平越高(P<0.01);越容易向周围人借到5000元钱者自评健康水平越高(P<0.01);随着家庭医疗支出的升高,自评健康水平下降(P<0.01)。结论 中国农村居民自评健康与年龄和家庭医疗支出水平负相关,与受教育水平、社会经济地位和向周围人借款5000元的难易程度正相关,患慢病人群、贫困户、有医疗保险者、农民、打工者和个体工商业者的自评健康水平较低,地区间自评健康水平也存在差异。