国外妇幼卫生服务体系的现状与启示

妇女和儿童的健康关系到社会的发展和民族的未来,随着国际社会对妇幼健康的日益重视,各国妇幼卫生服务的质量和可及性都不断提高.选取了美国、澳大利亚、马来西亚和俄罗斯4国作为研究对象,分别从妇幼卫生服务的机构设置、人才培养、筹资机制和提供方式四方面分析其服务体系现状,并从中汲取经验,为我国妇幼卫生服务体系的进一步发展提供启示.     

The development of market approaches in Russia

In the late 1980s, it became clear that poor outcomes of the Russian health system were caused not only by underfunding but also by inadequate management of health care. Some features of the system led to great inefficiency in medical care provision and an irrational structure of medical care. The recognition of this fact has intensified the search for new methods of finance and management. The underlying idea of health care reforms in Russia is to weaken providers' dominance, to make them more responsive to consumer preferences, and to change the structure of medical care. The main developments of the reform parallel the reforms in Western countries. These are primarily the separation of finance and provision of medical care, with the shift from an integrated to a contractual model of relationships between payers and providers. But the specific characteristics of the health care situation, primarily the great underfunding and the absolute dominance of state-owned medical facilities, make the reform in the Russian health sector more radical. This paper highlights the issues of the current and planned developments in the Russian health sector. After presenting the main characteristics of the current health systems, it addresses economic experiments which are underway in several regions of the new Russian Federation. They are designed to introduce elements of market relations into a highly bureaucratic system. The main features and the impact of the experiments are discussed. Then the new model of finance, which is based on a transition from tax-financed to the health insurance system, is presented.     

Young people's mental health in context: comparing life in the city and small communities in Siberia

The study compares young people's mental health in the major Siberian city of Novosibirsk with small communities of the surrounding region, at the end of the statutory period of secondary education. Data are drawn from a school-based questionnaire survey of ninth graders and semi-structured interviews. In line with the findings of international comparative studies, general health profiles are not good by Western standards, but extending such findings, general health appears even poorer in small communities and is differentiated further by the rural household's impoverished socio-economic circumstances. However, despite poorer general health among rural youth, the study finds the opposite for more specific profiles of mental health, which are worse among city youth. In this, distinctive social factors are associated with mental health differently in the large city and small communities of the region. In the relatively affluent city of Novosibirsk, self-worth and depression are differentiated by family background and engagement with the education system. By contrast, in small communities social capital associated with family support and kin-based networks become important resources instead. Positive mental health is bound up with the local cultural context, centred on the family household and 'traditions' of rural society.     

Cold-adapted live attenuated influenza vaccines developed in Russia: Can they contribute to meeting the needs for influenza control in other countries?

It is now more than 30 years since the first cold-adapted influenza viruses were developed in Russia as potential live, attenuated vaccines. In the past 15–20 years considerable experience has been gained from Russian and joint Russian-US laboratory and clinical studies with type A monovalent and bivalent vaccines prepared with genetic reassortant viruses derived from one of these cold-adapted viruses in particular, A/Leningrad/134/57. More recent experiences include use of trivalent cold-adapted vaccines with a type B component. The overall high level of safety of individual and combined vaccines in pre-school and school-aged children, with illness reductions in open field trials equivalent to that seen with inactivated vaccines, is such as to suggest that practical measures might now be justified to facilitate expansion of the use of these vaccines to other countries. It is proposed that further experimentation with the Russian cold-adapted live attenuated vaccines should be focused on issues that will relate to the public health perspective, i.e. selection of the single best candidiate type A and B vaccines for intense study using as criteria their potential for meeting licensing requirements outside Russia, and documenting the clinical protective efficacy of a single vaccine dose compared to two doses as studied until now. Resolution of these issues is important to ensure that costs for future live vaccine production, control, and utilization will be kept at lowest levels so that expanded use of live vaccines will have maximum cost-benefit and affordability. To guide those interested in these issues, examples are given of populations for whom a licensed live cold-adapted vaccine might be considered, together with indications of extra data needed to fully validate each suggested use.     

Genetic diversity and forensic parameters of autosomal STR markers included PowerPlex® CS7 panel in the general population of the Russian Federation

PowerPlex® CS7 multiplex is commonly used as a source of supplementary markers in parentage and kinship studies. We analysed a total of 687 unrelated individuals from 94 geographically different localities across all Federal Districts of the Russian Federation and provide forensically important parameters and allele frequencies. The paper also presents results of an intra-population genetic diversity study between the populations of the Federal Districts and comparison with populations from various regions of the world.     

The Frustration of Knowledge—Medicine in Russia

Russian physicians face financial restraints which hinder the supply of lifesaving medications. Drugs which are not available include surfactant—a treatment for respiratory distress syndrome in neonates. The author recently visited Tver, Russia, and comments on the maternal-newborn programme in this academic centre.     

美、俄未成年人心理抑郁问题概况及特点

目的 以美国和俄罗斯为例了解未成年人抑郁的流行状况及影响因素.方法 访谈,资料检索和比较研究的方法.结果 美国和俄罗斯未成年人都有较高的抑郁发生率;产生抑郁主要有3种因素,生物学因素、遗传因素和外部因素.结论 抑郁会发生在各个年龄时期,甚至在婴幼儿时期;抑郁症状在生长发育的不同阶段有不同的心理特点,而且很多表现形式很掩藏.     

Behavioral Assessments in Russian Addiction Treatment Inpatients: A Comparison of Audio Computer-Assisted Self-Interviewing and Interviewer-Administered Questionnaires

Abstract

Purpose: Assess agreement between reported sex and drug use behaviors from audio computer-assisted self-interviewing (ACASI) and interviewer-administered questionnaire (IAQ). Method: Participants (N = 180) enrolled in an HIV intervention trial in Russia completed ACASI and IAQ on the same day. Agreement between responses was evaluated. Results: Of the 13 sex behavior questions, 10 items had excellent agreement (kappas/ICC 0.80–0.95) and 3 items had moderate agreement (kappas/ICC 0.59–0.75). The 3 drug behavior questions had excellent agreement (kappas/ICC 0.94–0.97). Among HIV-specific questions asked of HIV-positive participants (n = 21) only, 2 items had excellent agreement (kappas 1.0) and 3 items had moderate agreement (kappas 0.40–0.71). Conclusions: Assessment of drug and sex risk behaviors by ACASI and IAQ had generally strong agreement for the majority of items. The lack of discrepancy may result from these Russian subjects’ perception that computers do not ensure privacy. Another potential explanatory factor is that both interviews were delivered on the same day. These data raise questions as to whether use of ACASI is uniformly beneficial in all settings, and what influence cultural factors have on its utility.     

Retroperitoneal Pancreas Transplantation With the Use of Duodenal Drainage via “Button Technique”: First Clinical Practice (Case Report)

The persistent relative high incidence of duodenum-associated surgical complications significantly reduces pancreas grafts' (PG) and recipients' survival rates. A 31-year-old female patient underwent retroperitoneal pancreas transplantation with the use of PG exocrine drainage into the recipient's duodenum via the “button technique” approach. An uncomplicated postoperative period with satisfactory function of both transplants (pancreas and kidney) was noted. This was the 1st time ever that the transplantation was performed with the use of retroperitoneal placement of the pancreas transplant and duodenal drainage via the “button technique” approach. It is possible that the absence of the duodenal stump in the donor's transplant has a number of benefits in the postoperative period, which can be confirmed during the follow-up observations.