基于聚集度的我国城乡卫生人力资源规划评价

目的 对我国城乡卫生人力资源的数量、种类及分布进行评价,为缩小城乡差距、改善卫生人力资源可及性等问题提供参考依据。方法 基于集聚度的概念对卫生人力资源进行评价,分析不同区域间城乡卫生人力资源集聚度。结果 （1）城市卫生人力集聚度明显高于农村,农村卫生人力资源集聚度普遍小于1,反映出城乡卫生人力资源地理可及性差异明显;（2）城市部分地区卫生人力集聚度明显大于人口集聚度,而农村卫生人力集聚度普遍与人口集聚度接近,城市集聚的卫生人力资源相对过剩;（3）医师和护士在城乡间的分布明显不均衡,尤其是护士集聚度城市明显高于农村。结论 为促进我国卫生人力资源配置的合理性,应进一步提高农村卫生人力资源可及性,改善护理人员在城乡间分布的合理性,并科学设置资源配置标准,促进我国卫生人力资源布局的公平性。     

浙江省卫生人力资源配置现状及公平性研究

目的　评价2012年浙江省卫生人力资源配置现状及公平性,为区域卫生规划提供实证依据。方法　采用统计描述、洛伦兹曲线和基尼系数等方法来评价。结果　浙江省每千人口卫生技术人员、执业(助理)医师、注册护士数高于全国平均水平,但医护比与护士占卫技人员的百分比低于全国平均水准,医护比例倒置, 地域性差异显著,人口公平性优于地理公平性。结论　浙江省卫生人力资源配置总体上处于相对公平状态,但结构亟待改善,地理公平性需引起重视。     

浙江省护理人力资源配置公平性研究

目的 对浙江省护理人力资源配置公平性进行分析,为我省卫生行政部门加强护理人力资源的管理及合理配置提供借鉴。方法 采用洛伦兹曲线（Lorenz Curve）与基尼系数（Gini Coefficient）来评价浙江省护理人力资源配置公平性。结果 2011年浙江省各地护理人力资源按人口、面积分布的洛伦兹曲线均分布在绝对公平线附近;按人口分布的基尼系数为0.16,按面积分布的基尼系数为0.28。结论 浙江省护理人力资源配置总体上公平,但布局欠合理,其人口公平性优于地理公平性。     

广西壮族自治区县级医疗卫生资源配置的公平性研究

目的 对广西县级医疗卫生资源配置的公平性进行分析。方法 采用洛伦茨曲线和基尼系数等方法,从人口和地理分布对广西91个县域医疗卫生资源(床位、卫生技术人员、医生)的配置公平性进行分析。结果 广西县级医疗卫生资源中床位、卫生技术人员、医生按人口分布的基尼系数分别为0.230 3、0.239 6、0.250 4,按地理分布的基尼系数分别为0.346 1、0.353 4、
0.352 3。结论 广西县级医疗卫生资源配置的公平性较好,其中人口分布优于地理分布,床位分布优于卫生人力资源分布。广西县级医疗卫生资源配置的公平性低于广西总体水平,但优于城区医疗卫生资源的配置。应进一步加大县级医疗卫生资源的投入,不断缩小城乡差距,提高县级医疗卫生资源在人口和地理配置的公平性。     

浙江省县级综合医院卫生人力资源配置公平性研究

目的 分析2013年浙江省县级综合医院卫生人力资源配置及按人口分布的公平性,为合理配置卫生人力资源提供依据。方法 采用自填问卷的方式,调查浙江省11个地级市137家县级综合医院,同时用Lorenz曲线和基尼系数从人口分布来判断其公平性。 结果 编制外人员所占比例较大,尤其护理人员无编制情况严重;医护比、护理人员数占卫生技术人员总数的比例、每千人口卫生人员,均与标准差距较大;各地级市之间差距较大;卫生技术人员、执业医师、护理人员数按人口分布公平性较高。结论 应科学核定编制数,优化人员配置结构,合理开展区域卫生规划。     

基于集聚度的河南省卫生人力资源公平性评价

目的 描述分析河南省区域之间卫生人力资源分布差异和公平性,为政府优化配置卫生资源提供政策依据和参考。方法 收集2010—2014年河南省卫生人力资源的相关数据,运用集聚度的方法计算不同经济发展程度区域的卫生资源集聚度,分析河南省卫生人力资源配置的人口和地理公平性。 结果 河南省卫生人力资源的地理可及性整体较好,但卫生人力资源的分布不合理,各区域间差距明显;医师、护士公平性差距明显,护士的分化程度高于医生。结论 目前河南省不同经济发展区域的卫生人力资源配置方面存在明显差距,政府需充分整合卫生人力资源,寻求和建立不同经济区域卫生人力资源管理工作模式,促进全省范围内卫生人力资源的平衡。     

某省乙类大型医用设备配置的公平性分析

目的 以2009年和2014年为时间点,分析我国某省乙类大型医用设备配置的公平性，为乙类大型医用设备配置提供参考依据。方法 根据某省乙类大型医用设备统计报表以及统计年鉴的相关数据进行整理分析,从人口分布的角度绘制洛伦兹曲线并计算基尼系数，从而了解该省乙类大型医用设备配置公平性的现状及存在的问题。结果 2009年后该省乙类大型医用设备配置公平性整体水平有所改善。乙类大型医疗设备中的CT和MRI实现了卫生资源配置的最佳状态，DSA的配置状况比较合理，而SPECT和LA处在配置公平性的警戒状态。结论 由于设备本身的特殊性，还需要根据具体情况对不同设备的配置进行调整，以提高该省乙类大型医用设备配置公平性的整体水平。     

基于绿视率的武汉市绿地公平性评价

绿地是一种资源福祉，基于绿视率的绿地公平性评价对保证绿色资源的公平分配具有重要意义。以武汉市中心城区为研究对象，基于百度街景地图、百度热力图、卫星遥感影像等多源数据，利用区位熵、基尼系数以及洛伦兹曲线，对武汉市绿视率空间分布公平性进行评价。结果表明：武汉市中心城区绿视率水平在较差以下的点位数量共占87.6%,主要集中在青山区武汉钢铁工业基地以及严东湖以南；达到很好水平的点位数量最少，只有0.4%,主要集中在东湖周边。武汉市中心城区总体绿视率基尼系数为0.49,绿视率分配差异较大，比较不公平。其中，洪山区基尼系数最大，为0.64,绿视率资源分配差距悬殊，江汉区基尼系数最小，为0.47,分配差距较大。武汉市中心城区低熵值区域最多，达29.7%,高熵值区域最少，达15.4%;洪山区、青山区、武昌区内部熵值分配高、低两极明显。用地性质和线性绿化作用是影响研究区绿地公平性的主要因素。研究结果可为优化城市绿地布局提供一定的理论基础和规划参考。     

广东省城市资源环境基尼系数

广东省经济的快速发展与资源消耗、污染物排放是密切相关的,如何对资源消耗和污染物排放的公平性、合理性进行评价一直是个难题.构建资源环境基尼系数,用来评价广东省资源消耗和污染物排放的公平性、合理性.资源环境基尼系数是反映在经济贡献率相同的情况下,资源消耗、污染物排放公平程度的一个指标.选取广东省2005年能源消耗、COD排放、SO2排放和工业固体废物排放作为评价指标,计算其资源环境基尼系数,并以绿色贡献系数来判断资源消耗和污染物排放的不公平因子.结果表明,上述 4 项指标的资源环境基尼系数分别为 0.15,0.39,0.38,0.87.能源消耗处于绝对平均的范围内,COD和SO2排放处于相对合理的范围内,工业固废排放处于差距悬殊状态.广东省资源环境的分配差异较大,21个地市中,不公平因子主要集中在清远、韶关、云浮、河源这4个城市,而深圳、广州、中山3个城市体现出的是一种绿色发展模式.为缩小广东资源环境分配的空间差异,清远、韶关、云浮、河源等城市需要转变发展模式,实现经济与资源环境的协调发展.     

基于资源异质性的四川省医师资源公平性研究

目的 基于医师资源异质性假设对2008—2014年四川省医师资源配置公平性进行探讨研究,为进一步优化医师资源配置提供参考。方法 在对医师数量调整的基础上,运用基尼系数和密度指数从人口、地理和经济3个维度评价医师资源配置的公平性。结果 基层医疗机构医师占比逐年下降;四川省卫生资源密度指数高于全国;调整后,按人口和按地理分布的基尼系数值均变大,表明医师素质差异会影响医师资源配置的人口和地理公平性;而受经济分布的影响较小。结论 在医师资源配置中需考虑医师的素质差异,同时兼顾地理和经济因素。     

我国护理人力资源配置现状分析

?????? 目的 分析目前我国护理人力资源总体配置的现状,探讨在护理人力资源配置中目前存在的主要问题。方法 采用文献技术性分析方法。结果 我国护理人力资源配置量有所改善,但仍存在城乡差异大,队伍年轻化,结构欠合理;与国外主要国家比较医护比倒置,每千人口护士密度低。结论 应建立健全科学的护理人力资源配置标准,弹性排班,动态调整,合理使用护理人力资源。     

Health Workforce Equity in Urban Community Health Service of China

Objectives

To reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China.

Methods

A community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators.

Results

On average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001).

Conclusions

Health workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.     

Study on the Trend and Disease Burden of Injury Deaths in Chinese Population, 2004–2010

Injuries are a growing public health concern in China, accounting for more than 30% of all Person Years of Life Lost (PYLL) due to premature mortality. This study analyzes the trend and disease burden of injury deaths in Chinese population from 2004 to 2010, using data from the National Disease Surveillance Points (DSPs) system, as injury deaths are classified based on the International Classification of Disease-10^th Revision (ICD-10). We observed that injury death accounted for nearly 10% of all deaths in China throughout the period 2004–2010, and the injury mortality rates were higher in males than those in females, and higher in rural areas than in urban areas. Traffic crashes (33.79–38.47% of all injury deaths) and suicides (16.20–22.01%) were the two leading causes of injury deaths. Alarmingly, suicide surpassed traffic crashes as the leading cause of injury mortality in rural females, yet adults aged 65 and older suffered the greatest number of fatal falls (20,701 deaths, 2004–2010). The burden of injury among men (72.11%) was about three times more than that of women''s (28.89%). This study provides indispensible evidence that China Authority needs to improve the surveillance and deterrence of three major types of injuries: Traffic-related injury deaths should be targeted for injury prevention activities in all population, people aged 65+ should be encouraged to take individual fall precautions, and prevention of suicidal behavior in rural females should be another key priority for the government of China.     

环境正义视阈下城市公园绿地时空可达性及其影响因素

从环境正义视阈出发,重点关注选择步行和私家车出行的居民群体,采用高斯两步移动搜索（2SFCA）模型和基尼系数测度2000-2018年武汉市中心城区公园绿地可达性和公平性的时空差异,并运用梯度提升决策树（GBDT）模型进一步探析交通因素、用地因素和社会经济因素对公园绿地可达性的非线性影响及其阈值效应,以期为公平导向下的城市绿地规划提供相关参考。结果表明：（1）研究时段内公园绿地供给与需求均呈现较快的增长,居民出行成本在逐渐降低;（2）居民选择两种交通方式出行的公园绿地可达性高值区域均呈现扩大趋势,主要分布在长江两岸、湖泊和大型风景区周围,但是不同时期步行方式可达性低值区域均多于车行;同时,基尼系数显示研究时段内两种交通出行的居民享受公园绿地服务的机会均不公平,且步行可达不公平程度远大于车行;（3）用地结构和社会经济因素对不同时期公园绿地服务可达性存在协同性影响,而交通因素是不同交通方式出行可达性存在差异的主要原因;（4）非线性关系图显示关键变量的阈值效应能够为城市绿地精细化规划与管理提供量化参考。     

Indicators of Child Health,Service Utilization and Mortality in Zhejiang Province of China, 1998–2011

Objective

To investigate the levels of primary health care services for children and their changes in Zhejiang Province, China from 1998 to 2011.

Methods

The data were drawn from Zhejiang maternal and child health statistics collected under the supervision of the Health Bureau of Zhejiang Province. Primary health care coverage, hospital deliveries, low birth weight, postnatal visits, breastfeeding, underweight, early neonatal (<7 days) mortality, neonatal mortality, infant mortality and under-5 mortality were investigated.

Results

The coverage rates for children under 3 years old and children under 7 years old increased in the last 14 years. The hospital delivery rate was high during the study period, and the overall difference narrowed. There was a significant difference (P<0.001) between the prevalence of low birth weight in 1998 (2.03%) and the prevalence in 2011 (2.71%). The increase in low birth weight was more significant in urban areas than in rural areas. The postnatal visit rate increased from 95.00% to 98.45% with a significant difference (P<0.001). The breastfeeding rate was the highest in 2004 at 74.79% and lowest in 2008 at 53.86%. The prevalence of underweight in children under 5 years old decreased from 1.63% to 0.65%, and the prevalence was higher in rural areas. The early neonatal, neonatal, infant and under-5 mortality rates decreased from 6.66‰, 8.67‰, 11.99‰ and 15.28‰ to 1.69‰, 2.36‰, 3.89‰ and 5.42‰, respectively (P<0.001). The mortality rates in rural areas were slightly higher than those in urban areas each year, and the mortality rates were lower in Ningbo, Wenzhou, and Jiaxing regions and higher in Quzhou and Lishui regions.

Conclusion

Primary health care services for children in Zhejiang Province improved from 1998 to 2011. Continued high rates of low birth weight in urban areas and mortality in rural areas may be addressed with improvements in health awareness and medical technology.     

Life-cycle carbon emission assessment and permit allocation methods: A multi-region case study of China’s construction sector

China is making efforts to reduce carbon emissions from the building industry, and carrying out an allocation and trading system for building emissions. However, to date, methods for using existing statistical data to assess the emissions of the construction sector and to make decisions affecting permit allocation are still unclear. In this context, a process is proposed in this study to calculate the life-cycle emissions of regional construction sectors in China, and a multi-criteria Gini coefficient is introduced as an indicator for emission permit allocation. Statistical data of the construction sector for 2004–2013 were analyzed. The results indicated an overall trend of increased emissions from China’s construction sector, of which the production phase of buildings was shown to be the largest contributor. Various characteristics for different life-cycle sub-processes were also discussed at the provincial level. Finally, a case study of emissions from the construction sector was conducted on the basis of a multi-criteria Gini coefficient. Relevant analyses revealed the major regions in carbon reduction practices from a comprehensive view of efficiency and equality. In addition, suggestions were provided for allocating emissions for regional construction sectors. Overall, the present study would be helpful in the calculation, assessment, and allocation of emissions from China’s construction sector. It should also provide insight into decision-making about low-carbon development policy of the building industry.