神木“医改”启示录

神木医改折射出改革发展的巨大成就,神木的执政者视医疗卫生为社会发展的“重中之重”;神木医改体现了以人为本的执政理念,神木的执政者视医疗卫生为改善民生的首选项目：神木医改的价值在于突出公益和公平,神木的执政者视医疗卫生为社会公益事业;神木医改对增强医改探索的多样性有新贡献,神木的执政者视解除群众医疗卫生的后顾之忧为政府责任;神木医改是让广大群众分享发展成果的重要选项,神木的执政者视医疗卫生为“命根子”工程;神木医改具有超前性和探索性,神木的执政者视医疗卫生改革为不断探索和发展、完善的过程。     

谈社区卫生服务的福利性

社区卫生服务是城市卫生工作的重要组成部分,是实现人人享有初级卫生保健目标的基础环节。积极发展社区卫生服务,可以优化卫生资源,可以带动和促进医疗卫生、医疗保险、药品生产流通、医疗救助等方面的改革与发展,是有效缓解看病难、看病贵的切人点,是协调推进卫生综合改革的交汇点。文章从福利经济学的角度提出政府应加大对社区卫生服务体系建设的投入,以充分体现和落实社区卫生服务的福利性,让全体市民平等地享受到基本的健康服务,以体现机会平等的基本原则,使有限的国民收入再分配达到社会经济福利的最大化,最终实现社会的整体和谐与稳步发展。     

Development of mechanical and thermal nociceptive threshold testing devices in unrestrained birds (broiler chickens)

Behavioural signs of pain are difficult to quantify and interpret in animals. Nociceptive threshold testing is therefore a useful method for examining the perception and processing of noxious stimuli underlying pain states. Devices were developed to measure response thresholds to quantified, ramped mechanical and thermal nociceptive stimuli applied to the leg or keel of unrestrained birds. Up to 9 N mechanical force was delivered via a single round-ended 2 mm pin using a pneumatic actuator at 0.4 N s⁻¹. Heat was applied through a small copper element at 0.8 °C s⁻¹ to a maximum of 50 °C. The repeatability and reliability of threshold measures were validated using 10-12 broiler chickens (aged 49-66 days) per site and modality. Mechanical threshold, or skin and threshold temperature, were recorded over three sessions across a 36 h period. Both stimulus types elicited clear, reproducible behavioural responses. Mechanical threshold means and 95% confidence intervals were 3.0 (2.8-3.2) N for keel and 2.0 (1.8-2.1) N for leg sites. Keel thermal tests gave a mean skin temperature of 39.3 (39.1-39.5) °C, and threshold of 46.8 (46.6-47.1) °C. Leg skin temperature was 35.7 (35.6-35.9) °C and threshold 42.5 (42.2-42.8) °C. Threshold measures were consistent within and across sessions and birds showed individual repeatability across tests within sessions. Individual birds’ mechanical keel thresholds were also repeatable across sessions. The apparatus gave reliable, reproducible measurements of thresholds to noxious mechanical and thermal stimuli. The range recorded was comparable with previously published nociceptor thresholds in dissected chicken nerve filament fibres, and the method appears suitable for studying nociceptive processes in broiler chickens.     

Current Japanese regulatory situations of pharmacogenomics in drug administration

Pharmacogenomics (PGx) has the potential impact to improve drug-development efficiencies and proper usages of drugs in clinical practice. However, in order to translate PGx into practical applications, multidisciplinary challenges, such as cost and time in development, processes of genomic biomarker qualification, PGx test availabilities and reimbursements, and education on PGx, still remain in clinical, pharmaceutical and regulatory settings. Japanese regulatory bodies for drug approval (i.e., Ministry of Health, Labour and Welfare and Pharmaceutical and Medical Devices Agency) have been taking proactive actions, both internally and internationally, toward translating PGx from bench to bedside. In this article, we summarize the current situations and projects in regulatory implementations of PGx in drug administrations in Japan, including activities to promote PGx-based drug/device developments and therapies. Moreover, we also discuss the future tasks for utilization of PGx in drug evaluations and clinical practices.     

实验用鱼类福利的发展现状

伴随着鱼类作为科研重要材料的迅猛发展,实验用鱼类福利引起了人们的关注。本文旨在阐述国内外鱼类福利发展的历史和现状,剖析鱼类福利实施困难的因素,提供提高福利的参考对策,以期帮助科研工作者进一步地了解实验用鱼类福利,促进在实验过程中鱼类福利的发展。     

上海市福利机构159例孤残婴幼儿气质类型分析报告

目的:为了解上海市0～3岁孤残婴幼儿气质类型及特点,因材施教,为指导孤残婴幼儿教养方式,防止儿童行为问题提供理论依据。方法:选取上海市福利机构内0～3岁孤残婴幼儿159例,采用上海第二医科大学附属新华医院儿保科、信息中心联合研制开发的儿童气质软件及Carey制定的经张劲松等修订的婴幼儿气质测查问卷,询问孤残婴幼儿的主要照料者并填写问卷配以计算机录入分析结果的形式进行评估。结果:气质类型分布以中间型最多占43.39%、易养型25.79%、启动缓慢型25.16%、难养型5.66%、中间偏难养型为0。结论:目前上海市福利机构内0～3岁孤残婴幼儿的气质类型分布以中间偏易养型最多,易养型和启动缓慢型次之,难养型和中间偏难养型最少。     

Estimating the welfare gains from anti-retroviral therapy in Sub-Saharan Africa

Since the start of the century, many countries in Sub-Saharan Africa have experienced large gains in life expectancy and average consumption levels. Around the same time, an unprecedented international effort has taken place to combat HIV/AIDS mortality with the expansion of anti-retroviral therapy (ART) across many of the hardest hit countries. In this paper, I estimate the impact of ART on average welfare over time in 42 countries using the equivalent consumption approach. I decompose the change in welfare to isolate the relative contribution of ART-driven improvements in life expectancy and consumption. The results indicate that ART has accounted for around 12% of total welfare growth in SSA between 2000 and 2017. In those countries most affected by HIV/AIDS, this figure rises to around 40%. Moreover, the estimates suggest that welfare in some of the worst-hit countries would have declined over time without the ART expansion.     

利益相关者视角下的公立医院满意度评价

以利益相关者理论为指导,对公立医院医疗行为利益相关者进行剖析,并阐述了满意度评价范围,即内部满意度评价和外部满意度评价以及满意度评价方法,包括直接评价到直接与间接评价相结合,短期到短期与长期相结合,定性定量分析到定性与定量分析相结合等.在此基础上提出构建以综合满意度评价为导向的服务提供系统.     

Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with anticonvulsants in a Japanese population: Matched case–control and cohort studies

BackgroundEvidence for the risk and incidence of anticonvulsant-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in Japan is scarce.MethodsWe conducted a matched case–control study using a large-scale Japanese claims database. SJS/TEN cases were identified using a claims-based algorithm developed in a previous study (sensitivity 76.9%, specificity 99.0%). Conditional logistic regression with Firth's bias correction to address an issue of rare events was used to estimate odds ratios (ORs) for SJS/TEN for each anticonvulsant use (90 days before the index date) versus non-use. 90-day cumulative incidence of SJS/TEN per 100,000 new users was calculated for 33 anticonvulsants. Causality between anticonvulsant use and SJS/TEN in each exposed case was assessed using the algorithm of drug causality for epidermal necrolysis (ALDEN) score.ResultsFrom 5,114,492 subjects, we selected 71 SJS/TEN cases and 284 controls. We observed significantly increased ORs for SJS/TEN among new users of carbamazepine (OR 68.00) and lamotrigine (OR 36.00) with ALDEN scores of “probable” or higher. Cumulative incidence of SJS/TEN was 93.83 for carbamazepine and 84.33 for lamotrigine. One case newly exposed to phenytoin which developed SJS/TEN was rated “unlikely” in ALDEN causality, resulting in cumulative incidence of 66.27. Cumulative incidence of SJS/TEN was 25.23 for levetiracetam, 7.52 for clonazepam, and 1.23 for diazepam, but their ALDEN scores were “very unlikely”.ConclusionsThis study is the first to document the differential risk of SJS/TEN for anticonvulsants in a real-world setting in Japan. Exposure to carbamazepine and lamotrigine was associated with an increased risk of SJS/TEN.