我国贫困地区县域内健康扶贫工作进展与政策建议

通过健康扶贫政策梳理、定量分析卫生健康统计数据和典型案例分析,研究我国县域内健康扶贫工作的进展、成效及问题,提出后脱贫期县域内医疗卫生服务改革与发展的建议。整体上看,我国健康扶贫工作成效显著:医疗卫生机构"三个一"和医疗服务能力"三条线"目标基本实现;卫生技术人员配置基本达到"三个一"要求;贫困县床位和设备配置达到或接近全国平均水平;通过新建临床专科、开展新技术和新项目等,贫困县专科服务能力得到提升;此外,部分贫困地区积极探索县域内医疗卫生综合改革。今后,新脱贫地区面临的主要挑战是县域内卫生服务体系建设仍需加强,基层卫生人才队伍差距和财政投入与卫生改革协同不足三大主要问题。建议中央财政继续支持县域内卫生服务体系建设;以人才建设为抓手,提升县域内医疗服务能力;强化保障措施,推进县域内医疗卫生综合改革。     

Choice of primary care provider: results from a population survey in three Swedish counties

Recent reforms in Swedish primary care have involved choice of provider for the population combined with freedom of establishment and privatisation of providers. This study focus to what extent individuals feel they have exercised a choice of provider, why they exercise choice and where they search for information, based on a population survey in three Swedish counties. The design of the study enabled for studying behaviour with respect to differences in time since introduction of the reform and differences in number of alternative providers and establishments of new providers in connection with the reform. About 60% of the population in the three counties felt that they had made a choice of provider in connection with or after the introduction of a reform focusing on choice and privatisation. Establishments of new providers and having enough information increased the likelihood whereas preferences for direct access to a specialist decreased the likelihood of making a choice. The data further suggests that individuals were rather passive in their search for information and tended to choose providers that they previously had been in contact with. This is in line with results from previous studies and poses challenges for county councils governance of reforms.     

Influenza seasonality goes south in the Yucatan Peninsula: The case for a different influenza vaccine calendar in this Mexican region

IntroductionWhile vaccination may be relatively straightforward for regions with a well-defined winter season, the situation is quite different for tropical regions. Influenza activity in tropical regions might be out of phase with the dynamics predicted for their hemispheric group thereby impacting the effectiveness of the immunization campaign.ObjectiveTo investigate how the climatic diversity of Mexico hinders its existing influenza immunization strategy and to suggest that the hemispheric vaccine recommendations be tailored to the regional level in order to optimize vaccine effectiveness.MethodsWe studied the seasonality of influenza throughout Mexico by modeling virological and mortality data. De-trended time series of each Mexican state were analyzed by Fourier decomposition to describe the amplitude and timing of annual influenza epidemic cycles and to compare with each the timing of the WHO's Northern and Southern Hemispheric vaccination schedule.FindingsThe timings of the primary (major) peaks of both virological and mortality data for most Mexican states are well aligned with the Northern Hemisphere winter (December–February) and vaccine schedule. However, influenza peaks in September in the three states of the Yucatan Peninsula. Influenza-related mortality also peaks in September in Quintana Roo and Yucatan whereas it peaks in May in Campeche. As the current timing of vaccination in Mexico is between October and November, more than half of the annual influenza cases have already occurred in the Yucatan Peninsula states by the time the Northern Hemispheric vaccine is delivered and administered.ConclusionThe current Northern Hemispheric influenza calendar adopted for Mexico is not optimal for the Yucatan Peninsula states thereby likely reducing the effectiveness of the immunization of the population. We recommend that Mexico tailor its immunization strategy to better reflect its climatologic and epidemiological diversity and adopt the WHO Southern Hemisphere influenza vaccine and schedule for the Yucatan Peninsula.     

高校图书馆网上图书荐购系统存在的问题与优化

阐述了高校图书馆网上荐购系统的研究现状、流程及类型,分析了当前图书荐购系统存在的主要问题,探讨了优化荐购系统的路径,包括完善荐购系统的功能、建立动态荐购知识库、增强荐购时效性、加大电子资源荐购力度及注重荐购绩效评估等。     

Provider communication with adolescent and young females during sexual and reproductive health visits: findings from the 2011–2015 National Survey of Family Growth

Objective

This study assesses provider communication with adolescent and young women about birth control, emergency contraception and condoms during sexual and reproductive health visits.

Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning*

Background: Although intravenous lipid emulsion (ILE) was first used to treat life-threatening local anesthetic (LA) toxicity, its use has expanded to include both non-local anesthetic (non-LA) poisoning and less severe manifestations of toxicity. A collaborative workgroup appraised the literature and provides evidence-based recommendations for the use of ILE in poisoning.

Methods: Following a systematic review of the literature, data were summarized in four publications: LA and non-LA poisoning efficacy, adverse effects, and analytical interferences. Twenty-two toxins or toxin categories and three clinical situations were selected for voting. Voting statements were proposed using a predetermined format. A two-round modified Delphi method was used to reach consensus on the voting statements. Disagreement was quantified using RAND/UCLA Appropriateness Method.

Results: For the management of cardiac arrest, we recommend using ILE with bupivacaine toxicity, while our recommendations are neutral regarding its use for all other toxins. For the management of life-threatening toxicity, (1) as first line therapy, we suggest not to use ILE with toxicity from amitriptyline, non-lipid soluble beta receptor antagonists, bupropion, calcium channel blockers, cocaine, diphenhydramine, lamotrigine, malathion but are neutral for other toxins, (2) as part of treatment modalities, we suggest using ILE in bupivacaine toxicity if other therapies fail, but are neutral for other toxins, (3) if other therapies fail, we recommend ILE for bupivacaine toxicity and we suggest using ILE for toxicity due to other LAs, amitriptyline, and bupropion, but our recommendations are neutral for all other toxins. In the treatment of non-life-threatening toxicity, recommendations are variable according to the balance of expected risks and benefits for each toxin.

For LA-toxicity we suggest the use of Intralipid^® 20% as it is the formulation the most often reported. There is no evidence to support a recommendation for the best formulation of ILE for non-LAs. The voting panel is neutral regarding ILE dosing and infusion duration due to insufficient data for non-LAs. All recommendations were based on very low quality of evidence.

Conclusion: Clinical recommendations regarding the use of ILE in poisoning were only possible in a small number of scenarios and were based mainly on very low quality of evidence, balance of expected risks and benefits, adverse effects, laboratory interferences as well as related costs and resources. The workgroup emphasizes that dose-finding and controlled studies reflecting human poisoning scenarios are required to advance knowledge of limitations, indications, adverse effects, effectiveness, and best regimen for ILE treatment.     

完善我国基本药物制度的策略与政策建议

基于全国基层医疗卫生机构的抽样调查、基层医疗机构门诊处方的抽样调查、典型省市专题调查与知情人访谈,本文对基本药物目录的更新调整、基本药物的供应保障、基本药物零差率与基层医疗机构经济补偿以及进一步推动国家基本药物制度的全面实施等方面提出了完善策略和政策建议。     

“医疗欠费”陋相的法律分析及其治理措施——基于济宁市“先看病、后交钱”实践的逆向启示

“先看病、后交钱”和组建“医院讨债队”是当今医疗机构“医疗欠费”陋相的两种表现形式.从法律角度揭示分析了“医疗欠费”行为的法律性质,并对预防和治理“医疗欠费”提出了一定的法律措施和建议.     

老年糖尿病的流行趋势和治疗策略

我国在老龄人口增加的同时,老年糖尿病人数也在大幅度增加,约占糖尿病总人数的2／5。老年糖尿病常合并多重心血管危险因素,患病情况和个体差异很大,是心脑血管病变、恶性肿瘤、肾脏损害的高发人群。对患者进行综合评估,提倡早查、早防、早治原则,关注多代谢异常的综合控制,选择个性化治疗目标和方案,改进患者和／或协助者自我管理和依从治疗的能力,可使患者更多获益。