34家医院医保精细化管理案例的定性比较

目的探究实现我国医院医保精细化管理的不同路径。方法采用模糊集定性比较分析方法（fsQCA）对34家医院医保精细化管理案例进行组态分析。结果路径一:组织建设+制度建设+创新模式建设（边缘条件）;路径二:制度建设+创新模式建设;路径三:组织建设+信息化建设;路径四:信息化建设+创新模式建设。结论我国医院医保精细化管理实现路径可分为传统驱动型、创新技术驱动型和综合驱动型3种模式。医院可多元性选择,进一步探索医保精细化管理的现实路径。     

深化校企合作培养高素质药学人才的思考

校企合作是贯彻落实科教兴国和人才强国战略的重要举措。药学的实践性与应用性决定了药学教育必须走理论联系实际、教育教学与生产实践相结合的育人道路。药学院校需要进一步提高对校企合作重要性及必要性的认识,深化拓展校企合作,培养高素质药学人才。     

自我管理、健康素养对社区COPD患者生活质量影响的路径分析

目的 探讨社区慢性阻塞性肺疾病患者的自我管理、健康素养对生活质量的影响,探讨三者之间的关系并分析其影响路径。方法 采用便利抽样法,于2017年5月~10月抽取湖南省长沙市咸嘉湖、望月湖和定王台3个社区的100例COPD患者进行问卷调查。调查工具包括一般资料调查表、COPD患者自我管理量表、COPD患者健康素养量表及圣乔治呼吸问卷。结果 社区COPD患者的自我管理与生活质量总分呈负相关（P＜0.05）,自我管理水平越高,生活质量得分越低,生活质量越高;健康素养与生活质量总分呈负相关（P＜0.05）,健康素养越高,生活质量得分越低,生活质量越高。路径分析显示自我管理对生活质量总分有直接负向预测作用,路径系数为-0.36,且健康素养可通过自我管理间接影响生活质量。结论 社区COPD患者的自我管理水平、健康素养和生活质量处于中下水平,社区医护人员需完善COPD慢病管理制度,提高COPD患者的健康素养,提升自我管理水平,从而降低生活质量得分,提高生活质量水平。     

我国医防融合理论与实践研究进展

实行医防融合是推动新医改的重要手段,是实现以治病为中心向以人民健康为中心的重要途径.本文系统梳理了我国医防融合的研究现状,总结了国内医防融合研究成果,重点分析了国内医防融合研究的不足,认为目前研究多集中于医防融合实践模式和促进模式的研究,还存在相关理论研究不够深入、医防融合顶层设计缺乏、相关的政策制度不系统等问题,在此...     

地震灾区中学生肠易激综合征影响因素的通径分析

[目的]探讨地震灾区中学生肠易激综合征(IBS)的影响因素。[方法]选取四川地震灾区3所中学初、高中学生2594人进行问卷调查,采用Logistic回归分析和通径分析方法。[结果]Logistic回归分析显示焦虑对IBS的影响最大,OR值为1.922,95%CI为1.712~2.157。通径分析表明胃肠道感染对IBS有直接作用,失眠、悲观通过焦虑作用对IBS有间接作用,疲劳、自己受伤或被埋、亲人或同学遇难对IBS既有直接又有间接作用。[结论]初步建立了灾区中学生IBS影响因素的作用路径。对地震灾区IBS的患病学生的诊疗应注意了解有无应激事件和焦虑心理。重视接诊过程中的"治疗"作用。     

Cytokine and chemokine responses in serum and brain after single and repeated injections of lipopolysaccharide: multiplex quantification with path analysis

Administration of the proinflammatory molecule lipopolysaccharide (LPS) alters transport rates for many peptides across the blood–brain barrier (BBB). We and others have previously shown that effects of LPS on BBB transport are highly dependent on the injection paradigm used, and timing of the study. Cytokine expression in both brain and serum compartments influences the BBB response to an inflammatory stimulus, and mediates changes in BBB transport. Here, we used multianalyte technology to simultaneously determine the responses of 13 cytokines and chemokines (G-CSF, GM-CSF, IL-1α, IL-1β, IL-6, IL-10, IL-13, IP-10, KC, MCP-1, MIP-1α, RANTES, and TNF-α) in brain and blood to single and repeated injections of LPS and path analysis to determine the major relations among these analytes. Major findings are: (1) in comparison to measurements taken from a time course after a single injection of LPS, the three injection regimen of LPS produced significantly higher levels in brain for G-CSF, IL-1α, IL-6, MCP-1, MIP-1α, and TNF and in serum for G-CSF, IL-6, and GM-CSF and (2) path analysis distinguished direct from indirect correlations between analyte pairs, with MCP-1, IL-6, G-CSF, and KC mediating relations among these cytokines both within and between serum and brain compartments. These results suggest that potentiation of cytokine levels in brain and serum compartments could play important roles in the regulation of BBB transport, and that our novel application of an established statistical method can be used to assess direct correlations within multiplexed datasets.     

路径式带教法在中医本科生急诊学临床带教的应用研究

目的 观察路径式带教法在中医专业本科生临床带教中的应用效果.方法 采用随机对照单盲的试验设计,将60名临床实习医学生随机分为两组,路径式带教组采用路径式带教法,传统带教组采用传统带教法,对出科考试成绩和问卷调查满意度进行组间对比.结果 路径式带教组的出科考试成绩、学生问卷调查满意度优于传统带教组.结论 路径式带教法对于中医本科生在急诊科的学习具有良好的效果.     

桂林市麻风病家庭内传染254例临床分析

目的了解桂林市麻风病家庭发病情况,为制定麻风防治规划提供科学参考。方法对2009年桂林市报告登记的1806例麻风病资料进行统计,并对其中198户麻风病人家庭内发现的254例麻风病人进行现场调查。结果 254例继发病人中,男168例(66.14%),女86例(33.86%),一个家庭有3例以上麻风病人44户(22.22%)。顺向传染144例(56.69%),平向传染82例(32.28%),逆向传染19例(7.48%),其他传染9例(3.54%)。结论麻风发病具有明显的家庭内聚集现象,顺向传染明显高于其他传染,麻风家庭等高危人群的密切监测和健康教育应成为麻风低流行地区防治工作的重点。     

The sequelae of political violence: assessing trauma, suffering and dislocation in the Peruvian highlands

In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for coping and survival. When assessing the overall mental health impact of exposure to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.     

健康信念对流动人口艾滋病预防行为的影响研究

目的 应用健康信念模式对1 447名流动人口的社会心理因素与艾滋病预防行为关系进行分析.方法 以健康信念模式理论为基础设计问卷,对张家港和丹阳两市流动人群进行随机抽样调查,应用多元回归方法进行统计分析.结果 调整后的健康信念模式分析结果表明,4个信念因素中知觉到易感性和知觉到严重性与艾滋病预防行为关系无统计学关联,而知觉到益处(py11=10.51,P=0.000)和知觉到障碍(py12=-2.59,P=0.010)分别与预防行为有统计学关联.性别、婚姻状况、居住情况和社会交往等社会文化因素对行为的直接影响有显著性,艾滋病知识通过4个健康信念对行为有间接影响.结论 健康信念模式中各因素对艾滋病预防行为的作用是不同的,城市流动人口艾滋病的预防控制应有针对性地制定健康教育策略.