粤港澳大湾区公共卫生体系建设的现状及思考

粤港澳大湾区（大湾区）同时具有三种不同体制下的公共卫生体系,在我国公共卫生体系建设中具有重要地位。进一步加强大湾区公共卫生体系建设对我国未来公共卫生体系优化和升级具有重要借鉴作用。本文基于中国工程院重大战略研究与咨询项目“我国现代公共卫生体系及能力建设战略研究”,深入分析大湾区公共卫生体系建设的现状和存在的问题,提出要健全和创新大湾区公共卫生风险协同防控、资源协同和共研共享、信息共享和交流、人才培养和队伍建设等机制,全面提升大湾区公共卫生体系的能力,助推健康中国建设。     

Doctors, their mental health and capacity for work

Background Information about doctors’ mental ill-healthis limited. This study looks at doctors’ careers followingmental illness and the strategies that helped them return towork. Aim To examine the effect of mental ill-health on doctors’careers. Methods Questionnaire survey of members of the Doctors SupportNetwork (DSN). The DSN is a peer support group for doctors whohave experienced, or are experiencing, mental ill-health. Results One hundred and sixteen doctors (35% response rate)returned completed questionnaires (n = 116, 63% female, 37%male). Prior to their ill-health, 80% worked full time, 15%part-time, 2% were not working and 3% were medical students.Following illness, 33% worked full time (P < 0.05), 36% part-time(P < 0.05) and 29% were not working (P < 0.01). Flexibleworking practices were the most helpful reported strategy forenabling a doctor to return to work. Conclusions Following mental ill-health, a doctor’s capacityto work full time is reduced. Most doctors return to full-timeor part-time work. With improved support, more doctors may beable to return to work.     

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。     

通过多种形式组织专题 提升科技期刊质量

【目的】探索医学期刊组织专题的有效途径,为国内医学期刊提供借鉴与参考。【方法】以《放射学实践》杂志为例,介绍其通过与协办单位合作、及时报道重大科研成果、围绕突发公共卫生事件等多种方式进行专题组稿的经验和体会;比较、分析专题论文和非专题论文的质量。【结果】《放射学实践》近3年成功组织了22个专题,极大地扩大了本刊在业内的影响。专题论文的篇均被引频次和篇均下载量均明显高于非专题论文。【结论】医学期刊编辑应该结合自身杂志特点,充分发挥积极性和主动性,勇于探索,敢于创新,不断开拓专题组稿的新方法和新形式,为提高期刊质量不懈努力。     

Assessment of in-country capacity to maintain communicable disease surveillance and response services after polio eradication—Somalia

One objective of the 2013–2018 Global Polio Eradication Initiative (GPEI) Strategic Plan was the transition of GPEI polio essential functions to other public health programs [1]. For many developing countries, in addition to polio essential functions, GPEI funding has been supporting integrated communicable disease surveillance and routine immunization programs. As GPEI progresses toward polio eradication, GPEI funding for some polio-free countries is being scaled back. The Somalia Polio Eradication Program, led by international organizations in collaboration with local authorities, is a critical source of immunizations for >2.5 million children. In addition, the polio program has been supporting a range of communicable disease surveillance, basic health services (e.g. routine immunizations) as well as emergency response activities (e.g. outbreak response). To assess current capacities in Somalia, interviews were conducted with representatives of relief organizations and ministries of health (MoHs) from Somaliland, Puntland, and South-Central political zones to elicit their opinions on their agency’s capacity to assume public health activities currently supported by GPEI funds. Seventy percent of international and 62% of representatives of domestic relief agencies reported low capacity to conduct communicable disease surveillance without GPEI funds. Responses from MoH representatives for the three zones in Somalia ranged from “very weak” to “strong” regarding capacity to conduct both polio and non-polio related communicable disease surveillance and outbreak response activities. Zones programs are unprepared to provide communicable diseases services if GPEI funding were substantially reduced abruptly. Polio transition planning must strategically plan for shifting of GPEI staffing, operational assets and funding to support identified gaps in Somalia’s public health infrastructure.     

Building immunization decision-making capacity within the World Health Organization European Region

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provides evidence-based recommendations to policy-makers, assisting them in making sound immunization policy and programme decisions. The World Health Organization (WHO) Regional Office for Europe is working to strengthen the capacity of newly-established NITAGs and has targeted efforts on low- and middle-income countries. The Regional Office, in collaboration with WHO Headquarters and USA Centers for Disease Control and Prevention (CDC), developed a new training strategy and held training workshops to improve NITAGs’ functioning and ability to make evidence-based recommendations. Feedback from countries that participated in trainings indicated that the updated training materials and interactive approach with follow-up technical support enabled them to align their NITAG charters and processes with WHO recommendations. To ensure continued progress, global and regional partners such as WHO and CDC should continue providing technical support to recently established NITAGs.     

β-烷基胺基酮类化合物高效液相色谱参数logk'的测定

本文报导了β-烷基胺基酮类化合物HPLC参数logk'的测定方法。简述了logk'与logP的线性关系。经此法间接测得的logP与π加和法估算的logP值相近,结果令人满意。HPLC参数logk'的测定为药物定量构效关系(QSAR)的研究提供一个快速而有效的参数信息。     

我国女性性工作者领域社会组织参与艾滋病防治项目管理能力建设需求研究

目的 了解为女性性工作者（FSW）提供艾滋病防治服务的社会组织项目管理能力建设需求。方法 向2017-2018年参与国家艾滋病防治基金项目的社会组织负责人开展问卷调查及访谈,结合基金项目管理信息系统相关数据,利用Excel 2016软件和SPSS 25.0软件整理分析社会组织的分布与基金获得情况,以及社会组织对项目管理能力的需求。结果 2017-2018年参与执行基金FSW项目的社会组织共184个,完成问卷调查的社会组织156个,主要集中在西部地区（44.0%,81/184）,以四川省、广西壮族自治区和云南省居多;东部地区获得的基金支持最多;社会组织对项目数据收集及分析利用的需求最高,占68.6%（107/156）,其次是项目风险分析应对及质控,占64.1%（100/156）;社会组织负责人学历对项目计划管理和项目财务管理能力建设需求的差异有统计学意义（χ²=5.78,P=0.016;χ²=8.99,P=0.003）。结论 当前我国FSW领域的社会组织数量和基金获得比例的分布,与异性性传播的艾滋病疫情分布不一致。仍需继续鼓励、引导扶持社会组织的发展资金;结合社会组织对能力建设的需求针对性的制定项目能力建设计划。     

Family-centered Care for Sick Newborns: A Thumbnail View

Family-centered care (FCC) for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It seeks to transforming a provider-centered model into a client-centered one and thus build a new therapeutic alliance. FCC is the cornerstone of continuum of care, imparting caregiving competencies to parents/caregivers both within institutions as well as after the discharge. This has potential gains for the newborn, family members, and facility-level staff. The initial model piloted in tertiary-care settings is now undergoing translation at five sites across the country; the outcomes are keenly awaited.     

医学院校全球卫生能力建设的国际经验及启示

全球化正在不可逆转地改变着人们的健康状况和卫生保健服务,也对未来医学院校的毕业生提出了新的要求,医学院校加强全球卫生的能力建设势在必行。本文总结了医学院校全球卫生能力建设的国际经验,主要包括成立全球卫生部门,将全球卫生内容整合到医学课程中,开展全球卫生的国际临床选修课程,参与全球卫生实践活动。在此基础上,对加强我国医学院校全球卫生能力建设而改革医学教育提出了相关意见：开展全球卫生研究和教学的平台建设,构建新的课程体系,将全球卫生知识融入现有的学生境外交流活动中等。