研究者视角的中国卫生技术评估决策转化现状分析

目的 从研究人员视角描述中国卫生技术评估相关研究向决策转化的现状，并分析其中可能存在的影响因素，为促进我国卫生技术评估向决策转化提供建议。方法 采用问卷调查法和文献检索法，在全国范围内调查研究人员，收集研究人员对我国卫生技术评估现状，以及研究结果的政策转化和利用情况等观点。结果 研究共调查了382名研究人员。调查结果显示，尽管研究人员充分认可研究成果向政策转化的必要性，并且在进行选题时已经对决策转化有所考量，但多数卫生技术评估研究仍停滞在学术阶段，多数研究人员仅提交报告并在学术期刊上发表文章，仍缺乏决策转化的实际行动。此外，部分研究者未能获得充足的研究经费和研究时间，研究机构对卫生技术评估研究所给予的支持也仍显不足，这些也是影响卫生技术评估向决策转化的重要原因。结论 有必要建立卫生技术评估研究必要的规范，以统一并提高研究质量，为决策转化打下坚实的基础；并完善卫生技术评估的研究系统，以保障研究经费、高素质的研究人员，以及多样化的研究成果传播渠道。     

研究者视角的中国卫生技术评估决策转化情况分析

目的 从决策者的角度来研究中国卫生技术评估在决策中的转化和利用情况,探索其中可能存在的影响决策转化的因素,为促进卫生技术评估的决策转化提供参考。方法 采用问卷调查法对国家和地方层面的卫生政策决策人员利用卫生技术评估研究结果的情况进行调查,并进行描述性和统计分析。结果 调查共回收有效问卷112份。结果显示：决策人员对卫生技术评估能够一定程度上参考借鉴,或进行决策采纳,但在促进行动方面有所欠缺。决策部门内部相关培训、资助方面尚十分有限。但决策者对未来卫生技术评估在决策中能够起到的作用给予了很高的信心。决策者重视研究的时效性和语言的通俗易懂程度,因此与研究方也会较多地交流报告提交的方式,他们更倾向于收到报告的概述。结论 卫生技术评估决策转化程度和水平有待提升,决策部门对卫生技术评估的资助力度有待加大,将卫生技术评估引入决策过程的相关机制有待构建。     

医疗卫生人员的工作满意度现况调查和比较研究

目的 描述不同机构医疗卫生人员工作满意度现状及其差异。方法 结构问卷调查,样本机构是上海市某区所有卫生机构、医院和社区卫生服务中心,抽样方法为20%比例系统抽样,计划调查1 047人,实际回收问卷937份,问卷回收率为89.5%。调查内容为人际关系、工作前景、工作条件、医院管理、相对报酬、工作压力、工作强度、社会地位和职业风险。采用因子分析和百分折算法进行数据分析。结果 医疗卫生人员对人际关系满意程度最高,为88分;对相对报酬满意程度最低,为60分。这个结果在3类机构之间有一致性。此外,医院医疗卫生人员对各方面的满意程度明显低于社区卫生服务中心和卫生机构,尤其是社会地位。结论 应当全面提高医疗卫生人员的薪酬待遇,同时改善医院医疗卫生人员的社会地位。     

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。     

潍坊市乡镇卫生院人力资源现状分析

目的 了解潍坊市乡镇卫生院人力资源情况,为政府部门合理配置卫生人力资源和基层医疗机构综合改革提供参考。方法 对2010年潍坊市148个乡镇卫生院进行问卷调查。从整体上对乡镇卫生院的整体情况、年龄结构、学历结构、职称构成和专业构成情况进行分析。结果 潍坊市乡镇卫生院人员实有编制数及人员素质总体偏低。结论 应采取有效措施培训和引进人才,提高卫生技术人员的素质和能力。     

补偿机制改革对公立医院产出效率的影响 ——基于县级中医医院的实证研究

目的 对补偿机制改革前后江苏省县级中医医院产出效率进行评价,并考察导致效率变化的相关因素。方法 随机前沿分析方法分析县级中医医院产出效率,Tobit回归方法分析不同影响因素对产出效率的影响。结果 江苏省县级中医院产出效率较低,补偿机制改革导致县级中医院效率出现进一步下降;费用模型、支出模型和收入模型的回归分析表明不同因素对县级中医院产出效率的影响。结论 优化县级中医院补偿策略,调整收支结构,加大中医医疗服务补偿力度。     

卫生技术评估认知与需求现况调查

??????? 目的 了解浙江省卫生技术及管理人员对卫生技术评估（HTA）的认知和需求,为进一步开展HTA工作提供建议。方法 采用问卷调查与访谈相结合的方法对3家医院,1家公共卫生机构,8家卫生行政机构的102位运用HTA结果的潜在使用者和22位决策者进行了调查。结果 被调查者认为卫生技术相关政策法规在卫生技术信息来源最为重要,卫生技术临床疗效在用于决策的卫生技术相关信息中最为重要,相关研究质量太差是影响卫生技术评估的最大障碍。结论 浙江省卫生技术及管理人员对于HTA有一定的认知与需求,但关注度不够,针对遇到的障碍提出了HTA进一步发展的建议。     

患方不同人群对医患关系认知差异比较研究

目的 了解患方不同人群对医患关系认知的差异,从而对构建和谐医患关系提出具有针对性的对策、建议。方法 对北京市、武汉市、成都市的6家医疗机构的702名患者进行问卷调查。结果 不同性别、年龄、学历、地区、就医类型和医保类型的患者之间对医患关系认知存在差异。结论 微观个人因素影响患者对医患关系的认知,需加快医疗体制改革,缩小地区间差距,逐步提高医疗保险覆盖范围及报销费率,减少宏观经济保障因素对患者认知的影响;提高卫生系统反应性,针对不同类型的患者人群开展提高非技术性服务质量、缩小人群认知差距。     

医疗纠纷中医院与媒体博弈关系调查研究

目的 调查医疗纠纷中医院与媒体间的关系现状,进而为在医患纠纷中的医院与媒体的博弈提供解决依据。方法 采用自行设计问卷,选取长春市5家三级医院的400名医务人员、3家媒体机构的100名媒体工作人员做为调查对象,调查结果采用SPSS统计软件进行分析与处理。结果 不同工作职能的医务人员对医疗纠纷的认知不同;医务人员普遍经历过不同程度的医院工作场所暴力,主要表现在语言暴力、躯体暴力和性暴力;媒体在获取医疗纠纷事件的途径中,直接获取的途径所占比例较小,还需主要靠间接途径获取;医方与媒体方对医疗纠纷事件报道的客观真实性认知有差异;医方与媒体方对医疗纠纷事件产生的原因认知有差异。结论 寻求医方与媒体方之间的博弈对策,寻找二者的利益契合点,形成解决医疗纠纷的合力。     

基于DEA的全国中医医院卫生资源配置效率评价

目的 对2003—2014年全国中医医院卫生资源配置效率进行比较研究,探讨其投入、产出是否适当及存在问题,寻找有效的措施和途径以进一步优化其卫生资源配置。方法 利用数据包络分析的理论和方法,对全国中医医院的卫生资源配置进行横向分析和纵向分析评价。结果 数据包络分析横向评估中,卫生资源配置效率存在地区差异;数据包络分析纵向评估中,2003－2014年全国中医医院卫生资源配置综合效率总体稳定,规模效益递减。结论 统筹规划,重点加强弱势地区中医医院的医疗卫生服务体系建设。     

LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities

ObjectiveTo compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities.MethodsSecondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685).ResultsRates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year.ConclusionsThere are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.     

我国医药分开政策目的及其策略分析

目的 进一步明确医药分开政策目的及策略。方法 采用文献回顾性研究法,对医药利益链条及其形成原因,以及解决策略进行系统性地总结和分析。结果 现有研究一是认为医疗服务提供方拥有垄断地位造成利益链条存在,因而提出消除垄断;二是认为扭曲的“白色”或不良的“灰色”激励机制造成利益链条存在,因而提出完善“白色”或消除“灰色”激励机制的综合策略。结论 医药利益链条产生更深层次的原因是,非营利性的公立医疗机构不合理地追求经济利益,医生采用不合理方式追求部分合理经济利益。因此,医药分开目的应是让公立医疗机构真正成为非营利机构,使医生依靠技术获得合理的经济回报,让公立医疗机构、医生、政府、患者、药品企业及流通商间激励相容。建议采用外部补偿和内部薪酬制度为重点的综合改革策略,形成各利益相关方激励相容的良好局面,自然消除公立医疗机构、医生与药品销售间利益链条。     

Children’s book series and associated curricula support elementary education and outreach in water resources

Background: Water resources are of fundamental importance to society, and are better managed by stakeholders who understand resource issues. Gaining such knowledge is a lifelong process best begun at an early age and best supported by educational approaches integrating across science, technology, engineering and mathematics (STEM). Research scientists can bring resource education to young audiences through children’s books and curricula that emphasise and integrate across STEM principals.

Aims: To encourage empathy for the environment in younger students, researchers at the Niwot Ridge Long Term Ecological Research site have developed a children’s book series and methods for training teachers in water science education.

Methods: Children’s books in the My Water series are paired with curricula, hands-on learning kits, teacher development training and dissemination of materials through school districts to further water science education.

Results: Thousands of children and educators have received training through the My Water book series, and a more broadly focused, federally funded Schoolyard Children’s Book Series has grown out of these efforts towards water resource education.

Conclusions: Children’s books and curricula that integrate STEM principals can play a key role in the development of environmental empathy and lifelong learning to support resource management.     

Complementarity in the use of nitrogen forms in a temperate broad-leaved mixed forest

Background: The complementary use of different forms of soil nitrogen (N) might lead to a higher productivity of mixed forests than monocultures, but convincing evidence for temperate mixed forests is scarce.

Aims: We searched for species differences in N uptake rates and the preference for NH₄⁺, NO₃^? or glycine among five temperate broad?leaved tree species (Acer pseudoplatanus, Carpinus betulus, Fagus sylvatica, Fraxinus excelsior, Tilia cordata) in a mature mixed stand.

Methods: ¹⁵N tracer was added to the soil and its accumulation in fine root biomass was analysed after 10 min, 1 h and 1 d.

Results: The estimated root uptake rates of the species were in the range of 5–46 µg N g^?1 root h^?1 for NH₄⁺, 6–86 µg N g^?1 h^?1 for NO₃^? and 4–29 µg N g^?1 h^?1 for glycine during the first hour after tracer application. Carpinus, Tilia and Acer tended to prefer NH₄⁺ over NO₃^?, while Fraxinus showed equal preference for both N forms and Fagus seemed to prefer NO₃^?.

Conclusions: The five co-existing tree species differed in uptake rates and partly in their N form preference, but complementarity in the use of different N forms seems to be of minor importance in this forest because tree species appear to be rather flexible in their N form use.     

典型农田土壤中丛枝菌根真菌-根际细菌互作及与氮磷利用的关系

在农业生态系统中,土壤微生物是土壤-作物系统养分循环的重要驱动力,其中丛枝菌根真菌(Arbuscularmycorrhizalfungi,AMF)能够促进作物对养分的吸收,适应逆境胁迫。【目的】进一步揭示AMF和根际细菌群落的跨界网络互作,挖掘与作物氮磷利用显著相关的关键微生物类群,揭示关键类群的生态网络特征。【方法】利用Illumina测序技术对3种典型农田旱地土壤(黑土、潮土和红壤)中AMF和根际细菌群落结构进行分析;构建互作网络并利用偏冗余分析、相关性分析探究了与氮磷利用相关的潜在关键类群。【结果】3种土壤中AMF与根际细菌均以正相互作用为主。不同土壤中AMF与根际细菌互作关系差异明显,在红壤中跨界互作最为密切,其中球囊霉属真菌(Glomus)与根际细菌中的放线菌(Actinobacteria)和变形菌(Proteobacteria)之间的交互作用最多。而在黑土中主要体现为根际细菌的界内互作。与氮磷利用率显著相关的关键微生物类群主要属于球囊霉属真菌、放线菌和α变形菌。【结论】典型旱地土壤中AMF与根际细菌的正相互关系对作物氮磷利用有潜在促进作用,关键类群在有机质和养分贫乏的红壤中可能起到更重要的作用。     

Divers Stereoisomers of N-Acetylhydroxyprolinol as Sugar Substitute in Oligonucleotides

Abstract

A detailed comparison of the hybridisation characteristics of oligonucleotides with 4-hydroxy-N-acetylprolinol or 3-hydroxy-N-acetylprolinol as sugar substitute, reveals dramatic differences. The 4-HO oligonucleotides are able to form stable complexes which are in general duplexes when natural nucleic acids are used as the complement, and the system has a strong preference for isochiral interaction. For the 3-HO oligonucleotides on the other hand complexes are generally weak, triple stranded, and often isochiral and heterochiral hybrids have a similar stability.     

Sociocultural factors and the genetic diversification of Amazonian Indians: A brief overview

Abstract

Within SES categories in the United States, racial and ethnic minorities generally fare less well on a variety of health‐related indicators than do majority groups. Important differences exist within subgroups, however, and at present, these differences are poorly understood. In this paper we address Hispanic subgroup (Cuban American, Mexican American, Puerto Rican, and Central/South American) differences in utilization of prenatal care. Data from the 1986 and 1987 national Linked Birth/Infant Death files are used to assess patterns of prenatal care utilization across subgroups. Using Kotelchuck's Adequacy of Prenatal Care Utilization Index, we find that when controlling for other factors, Cuban American and Puerto Rican women are more likely to obtain adequate care than are Hispanic women of Mexican or Central/South American origin. Other factors important in understanding utilization patterns include marital status, education level, birthplace, and region of the country. We conclude with a discussion of the relatively weak link between prenatal care and birth outcomes and identify important cultural factors that may be important in understanding why this relationship is not stronger.     

Host plant utilization in the comma butterfly: sources of variation and evolutionary implications

A major challenge in the study of insect-host plant interactions is to understand how the different aspects of offspring performance interact to produce a preference hierarchy in the ovipositing females. In this paper we investigate host plant preference of the polyphagous butterfly Polygonia c-album (Lepidoptera: Nymphalidae) and compare it with several aspects of the life history of its offspring (growth rate, development time, adult size, survival and female fecundity). Females and offspring were tested on four naturally used host plants (Urtica dioica, Ulmus glabra, Salix caprea, and Betula pubescens). There was substantial individual variation in host plant preference, including reversals in rank order, but the differences were largely confined to differences in the ranking of Urtica dioica and S. caprea. Different aspects of performance on these two plants gave conflicting and complementary results, implying a trade-off between short development time on U. dioica, and larger size and higher fecundity on S. caprea. As all performance components showed low individual variation the large variation in host plant preference was interpreted as due to alternative oviposition strategies on the basis of similar performance hierarchies. This indicates that the larval performance component of host-plant utilization may be more conservative to evolutionary change than the preference of ovipositing females. Possible macro-evolutionary implications of this are discussed.     

Educational inequalities in cancer incidence and mortality in Lithuania: A record linkage study

BackgroundThe aim of this study is to describe associations between incidence and mortality by major cancer sites and education in Lithuania.MethodsThe study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 1 July 2001 and 31 December 2004. Education-specific incidence and mortality rate ratios were estimated by means of multivariate Poisson regression models.ResultsWe found both the positive and inverse educational gradients in cancer incidence and mortality. The risk of developing cancer (all sites) was lower among men and women with the lowest education, whereas cancer mortality was higher among lower educated men. The higher educational level was also associated with an increased risk of prostate cancer among men and an increased risk of breast cancer among women. However, prostate cancer mortality was the highest in the lowest education group, whereas breast cancer mortality among women did not show any statistically significant differences. Lower educated men had significantly higher incidence and mortality due to lung and stomach cancers. Strikingly high incidence and mortality due to cervix cancer was observed among women with secondary and lower than secondary education.ConclusionThe results point to inequalities in early diagnosis and survival from cancer and failures ensuring equal access to medical care. Further more in-depth studies are needed in order to understand the nature and determinants of these inequalities.