内蒙古某市日托幼儿园儿童膳食及营养状况调查

目的了解开展计划膳食后的幼儿园膳食质量及儿童营养与健康状况。方法采用整群抽样方法,对两年计划膳食的日托幼儿园进行调查,同时进行体格检查和血红蛋白的测定。结果热能、铁、硫胺素、尼克酸、抗坏血酸等都达到中国居民膳食推荐摄入量的标准,蛋白质、钙、核黄素摄入不足,午点热能摄入不足。结论应进一步加强对幼儿园膳食营养的指导监督。     

妇女围绝经期症状及保健需求调查

目的:了解上海妇女围绝经期症状发生情况、对围绝经期的认识及围绝经期的保健需求,以指导干预。方法:以社区为基础进行抽样,采用入户面访的方式进行问卷调查。结果:平均绝经年龄(49.96±3.13)岁,围绝经期症状发生率为62.37%。50~和55~岁年龄组症状发生率分别为61.99%和62.85%。9.5%的人认为有必要进行定期的妇科检查,只有32.52%的人近两年做过妇科检查,对各种妇女保健知识需求选择“是”的均在70%以上,有52.13%的人希望医生来居委会提供服务。结论:妇女围绝经期症状发生比例较高,保健意识还有待提高,对社区的围绝经期卫生保健服务及有关知识需求较高。     

Using Cost-Effectiveness Analysis to Address Health Equity Concerns

This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health—the objective underpinning conventional CEA—and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and—crucially—who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.     

从数量到价值：医保支付如何驱动医疗卫生体系整合

从以数量为基础,到以价值为导向,是医保支付改革的趋势。在“健康中国”大背景下,我国医保支付方式改革应开启以公共利益为先的合作共赢模式,从注重费用控制到关注医疗质量和人群健康,从关注单个医疗机构到关注对整个医疗卫生体系的影响。在已有支付方式改革的基础上,引入按绩效付费、捆绑付费、以人群为基础的付费等新型医保支付方式,驱动整合型医疗卫生服务体系的构建。     

分级诊疗实施后对医务人员的影响及其认知状况调查

目的:了解分级诊疗制度实施后对试点地区各级医疗机构医务人员的影响,以及医务人员对分级诊疗的认知状况和影响因素。方法:采用多阶段随机抽样方法,对15个试点地区各级医疗机构的435名医务人员进行问卷调查。结果:制度实施后,不同级别医疗机构医务人员在月总收入、绩效工资占比、工作负担和医患关系方面存在差异;各级医疗机构医务人员对分级诊疗的总体认知率达81.4%,其中三级医院依次高于乡镇卫生院、社区卫生服务中心和二级医院;不同科室类别、职称级别、绩效工资占比和薪酬变化的医务人员对分级诊疗认知状况有差异。结论:要进一步发挥医务人员对分级诊疗的关键作用,提升基层服务能力的同时,加大对二级医院的关注,改革薪酬制度,调动医疗机构和医务人员的积极性,促进分级诊疗制度更好地发展。     

Perinatal care needs and expectations of women with low vision or total blindness in Warsaw,Poland

Background

As estimated from the number of published studies, in Poland the research into the perinatal care experiences of women with low vision or total blindness remains limited.

全科医疗特征功能的评价、影响因素分析及政策涵义

目的:全科医疗特征功能是构成基础保健高绩效的基础,是区别于专科医疗的核心所在。本研究将测量全科医疗特征功能,剖析其影响因素,探讨问题原因,为制定强化全科医疗特征功能政策提供依据。方法:使用本土化的基础保健测量工具PCAT-AE,选择8家社区卫生服务中心和深圳市港大医院全科医疗门诊部作为调查机构。采用面对面、一对一形式的问卷调查方法,共调查1 712名病人,有效问卷1 645份。结果:全科医疗特征功能总分49.0分,首诊利用(69.8)、连续性(63.1)和文化胜任力(51.2)维度得分相对较高,可及性(40.8)和以社区为导向(31.0)维度得分相对较低。全科医疗特征功能得分受人口社会学特征、健康特征和服务利用等多种因素影响,特征功能对病人的满意度起积极作用(OR1)。结论:国内全科医疗特征功能得分较低,与国外相比差距较大。可以从病人个体、组织和系统三个层面,全面强化全科医疗特征功能。     

广州、东莞和深圳的全科医疗特征功能比较研究

目的:评价和比较广州、东莞和深圳三个城市四种全科医疗模式下全科医疗特征功能,为制定政策和强化全科医疗特征功能提供依据。方法:采用二阶段抽样,首先抽取广州市3家社区卫生服务中心,东莞市2家社区卫生服务中心,深圳市3家社康中心和深圳市1家公立医院,然后采用方便抽样的方法,使用本土化后的基础保健工具PCAT-AE对社区卫生服务中心/医院的病人进行问卷调查,测量病人对基础保健服务的体验。共有1 712名病人参与调查,其中有效问卷为1 645份。结果:深圳港大医院的全科医疗特征功能总体得分(55.3)要高于广州社区(45.9)、东莞社区(49.2)和深圳社区(51.7)的得分,且P0.05。结论:全科医疗特征功能总体较低,不同全科医疗实践模式显现不同特点,要针对每个地区的具体情况不断完善全科医疗功能服务。     

Who Is Responsible? A Man With Dementia Wanders From Home,Is Hit by a Train,and Dies

The impact of dementia and Alzheimer's disease extends far beyond the healthcare needs of the person with dementia. As the disease progresses, individuals with dementia often require ongoing formal or informal care for their basic daily routine because of behavior changes and continuing loss of cognitive function. Most of the care for people with dementia takes place at home, and the unpaid, informal caregivers are often spouses or other relatives. Providing long-term informal care at home for someone with dementia is psychologically, physically, and financially draining. The tragedy described in this case elucidates the far-reaching societal impact of dementia care and the implicit health policy considerations.In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when he wandered from home, was hit by a train, and died, immediately affecting the Central Japan Railway Company operations and, subsequently, legal practice as well as Japanese elder care policy. The railway sued the man's wife and son for negligence and lost revenue, winning both trials at the local and district courts. This ruling shocked families and caregivers in Japan, where care for elderly parents traditionally falls on the oldest son, and brought attention to the complex issues related to dementia care. A decade later, we revisit this case to provoke a renewed dialogue about the matrix of responsibilities and liabilities associated with caregiving; to illuminate the unmet needs of the person with dementia, as well as his or her informal caregivers; and the financial implications related to long-term care policy. We close with 2 practical suggestions which preserve the dignity of the individual and provide reassurance for caregivers.     

某公交公司驾驶员纯音听力损伤调查

目的目的调查公交车驾驶员纯音听力损伤情况,提出防治对策。方法对公交车驾驶员双耳纯音听力的测试结果进行分析。结果在633例公交车司机中,有117人听力损伤,其中双耳高频听力损伤的比例明显高于语频听力损伤比例,差异有统计学意义(P0.01);工龄在10年内听力损伤出现的比例大于其他工龄段(P0.05)。结论噪声影响公交车驾驶员的高频听力,要早期发现职业禁忌证,减少职业性噪声聋的发生。