医生组织支持感及心理资本与抑郁症状关系

目的 探讨医生组织支持感与抑郁症状关系,以及心理资本在两者关系中的中介作用.方法 采用整群抽样方法选择辽宁省三级甲等医院1300名医生进行问卷调查,运用SPSS17.0和Amos7.0软件进行数据分析;采用多元逐步回归分析方法验证组织支持感与抑郁症状关系及心理资本的中介作用,应用结构方程模型验证该中介作用的假设模型,分析组织支持感对抑郁症状的直接效应和间接效应.结果 医生组织支持感与抑郁症状呈明显负相关( β=-0.35,P<0.05),其对抑郁症状的变异解释度为12.0%;在加入心理资本后,组织支持感与抑郁症状的回归系数绝对值降低( β=-0.21,P<0.05),且心理资本与抑郁症状也呈负相关( β=-0.33,P<0.05),表明心理资本在组织支持感和抑郁症状之间起到中介作用;结构方程拟合效果显示,近似误差均方根(RMSEA)=0.05,比较拟合系数(CFI)=0.91,非标准拟合指数(TLI)=0.90,增量拟合系数(IFI)=0.91,χ²/df=3.64(2<χ²/df<5代表模型拟合较好);组织支持感对抑郁症状的直接效应系数为-0.15,间接效应系数为-0.11.结论 医生心理资本在组织支持感和抑郁症状关系中存在中介作用;组织支持感对抑郁症状影响包括直接效应与间接效应.     

医学伦理学何以可能

医学伦理学是否能成为一门独立的学科,在理论上仍然是个备受置疑、有待澄明的问题。医学伦理本身要自足完善,必须确立起自己的本体论、学术范式和原则。高尚精神是医学伦理学的“本体论承诺”,同情心是医学伦理学的学术范式,医学技术合理性、人道主义、社会性和历史性是医学伦理学的基本原则。基于此,医学伦理学才能达到逻辑上的自洽,确立起自身真实的根基。     

高校图书馆学科服务矩阵组织模式探究

通过对目前高校图书馆管理模式的剖析和相关概念的理论性探讨和界定，提出了构建高校图书馆学科服务矩阵组织管理模式所遵循的原则及其运作模式。     

Cost-effectiveness of 13-valent pneumococcal conjugate vaccination in Mongolia

ObjectiveThe Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.MethodsThe incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3 + 0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance’s advance market commitment tail price.ResultsThe ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.ConclusionIntroducing PCV13 as part of Mongolia’s national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.     

Organizational Characteristics as Predictors of Work Disability: A Prospective Study Among Sick Employees of For-Profit and Not-For-Profit Organizations

INTRODUCTION: This article reports a prospective study that focused on the influence of organizational structure and organizational culture on the outcome of sickness absence, return to work or work disability. Former studies of determinants of work disability hardly have given attention to organizational characteristics and, if so, not following a appropriate prospective design. METHODS: The study population consisted of 455 employees of 45 for-profit and not-for-profit companies participating in the Maastricht Cohort Study on fatigue at work who were on sick leave for at least 6 weeks. Both independent variables which were type of company, size, centralization of decision making and organizational culture, and covariates, which were sex, age, educational level, fatigue, and chronic illness, were all measured before employees reported sick. The dependent variable outcome of the sickness absence, mainly return to work or work disability, was measured 15 months after reporting sick. RESULTS: Multilevel logistic regression analysis, with organizational characteristics as level 2 independent variables and demographic and health characteristics as covariates, suggested that the type of company (for-profit/private or not-for-profit/public) is predictive of the outcome of sickness absence (crude OR = 2.21; CI: 1.16-4.20), but this may be partially due to a higher proportion of fatigued and chronically ill employees in not-for-profit companies (adjusted OR = 2.09; CI: 0.93-4.37). Findings about the role of some other organizational characteristics, like organizational culture, were inconclusive. CONCLUSIONS: Organizational characteristics should next to health characteristics be included in the models of studies which aim at predicting which sick employees are at risk for work disability. To prevent work disability not-for-profit companies might be stimulated to more active return-to-work policy by charging them with the costs of it.     

Transferable learning from international primary care developments

Alternative approaches to the comparative analysis of international health systems developments are reviewed in relation to the advent of new primary care organizations in countries with parallel 'modernizing' policies. A framework for transferable learning between these is articulated and its design described. This is derived from priorities defined by lead policy and practice representatives in UK primary care. It points to the benefits of examining the interaction of critical new public management and planning functions as an effective vehicle for identifying both individual country role models and shared international experiences. Illustrative examples are provided in five subject areas ranging from local engagement to multiple forms of financing.     

中国驻利比里亚维和二级医院建制特点与实施

本文对比分析了联合国与中国驻利维和二级医院人员、装备和基础设施等建制,提出维和二级医院的建制可参照联合国对维和二级医院的建制要求,由派出国根据被部署国家及所在任务区的战事情况、驻地维和部队的具体情况及当地流行病和多发病的特点等,灵活机动地对医院的建制作相应的调整,但基本原则是必须达到维和二级医院的标准,能完成其具体任务和要求.     

加强自身建设 锻造过硬队伍 为人民健康保驾护航

目的切实把党务工作与业务工作紧密结合,带动全体党员干部为确保食品药品安全发挥积极作用。方法重点介绍开展党务工作的思路、典型事例和主要成效。结果与结论只有加强领导班子建设、基层党组织建设和工作作风建设,充分发挥党委的领导核心作用、党支部的战斗堡垒作用和党员的先锋模范作用,才能有效发挥药检所的技术保障作用。     

Creating safer and healthier workplaces: role of organizational factors and job characteristics

BACKGROUND: A comprehensive understanding of workplace organizational risk factors for illness and injury and interventions to alleviate these factors is important for workplace prevention efforts. METHODS: We summarize the evidence for the role of workplace organizational factors and work factors in occupational health and safety (OHS). To the extent possible, we concentrate on factors at the level of the workplace, rather than the level of the individual. RESULTS: Three types of outcomes are considered: injuries, ill-health, and musculoskeletal problems; and we note the evidence for their relationship to work. We review workplace interventions intended to alleviate each type of outcome and note methodological limitations of previous research. CONCLUSIONS: Despite the methodological limitations, the balance of the literature supports the work-relatedness of the three types of outcomes, although questions remain about exact mechanisms and the effectiveness of specific interventions. We discuss barriers to and incentives for creating safer and healthier workplaces.