综合性三级医院公益性评价的灰关联聚类分析

摘要 目的 对不同地区的7家综合性三级医院进行公益性水平的初步评价与分析。方法 运用灰关联聚类分析。 结果 7家三级医院的公益性水平总体偏低,仅各有一家医院经灰关联聚类分析归类为好与中,其余5家医院均归类为欠佳,不同地区三级医院公益性水平有一定差别。结论 灰关联聚类分析证明公立三级综合性医院公益性水平亟待加强,应从公益性的影响因素入手提高与改善公立三级医院的公益性水平。     

Social life cycle assessment: in pursuit of a framework for assessing wood-based products from bioeconomy regions in Germany

Purpose

With many policies in Germany steering towards a bioeconomy, there is a need for analytical tools that assess not only the environmental and economic implications but also the social implications of a transition to a bioeconomy. Wood is expected to become a major biomass resource in bioeconomy regions. Therefore, this paper develops a social life cycle assessment (sLCA) framework that can be applied specifically to a wood-based production system in one of Germany’s bioeconomy regions.

Methods

This paper reviews and analyses existing sLCA approaches, in terms of how applicable they are for assessing a wood-based production system in a German bioeconomy regional context. The analysis is structured according to the standard phases of environmental life cycle assessment (LCA). However, we use the term social effects rather than social impacts, to acknowledge the unknown cause–effect relationship between an organisation’s activities and its social impacts. We also consider the establishment of regional system boundaries, as well as the relationship between the social effects and the product being assessed. Additionally, an approach for the development and selection of social indicators and indices is outlined. Furthermore, we discuss data requirements and present an approach for a social life cycle impact assessment method.

Results and discussion

A new conceptual framework for a context-specific sLCA to assess wood-based products manufactured in a bioeconomy region was developed. It enables sLCA practitioners to identify “social hotspots” and “social opportunities” from a regional perspective. The location and characteristics of these social hotspots and opportunities can be analysed, in particular, for major production activities in a bioeconomy region in Germany. Therefore, according to this framework, the development of social indices and indicators, the collection of data and the approach used for characterising social effects need to relate to the geographical context of the product being assessed. The proposed framework can, thus, help to identify, monitor and evaluate the social sustainability of wood-based bioeconomy chains in a regional context.

Conclusions

This framework requires a high level of detail in the social inventory and impact assessment phase, in order to assess the regional foreground activities in a German wood-based bioeconomy region. It enables sLCA studies to identify which social hotspots and social opportunities occur and where they are located in the wood-based production system of a regional bioeconomy.

     

Barriers to Social Participation among Lonely Older Adults: The Influence of Social Fears and Identity

IntroductionLoneliness among older adults is a major public health problem that may be associated with processes of social participation and identity. This study therefore sought to examine the relationship between social participation and identity in a sample of lonely older adults living independently in London, England.MethodAn inductive qualitative approach, based on semi-structured interviews and thematic analysis, was employed.ResultsParticipants commonly spoke of barriers to social participation that have been reported elsewhere, including illness/disability, loss of contact with friends/relatives, lack of a supportive community, and lack of acceptable social opportunities. However, novel findings were also derived. In particular, participants commonly minimised the difficulties they faced alone, and described attempts to avoid social opportunities. These behaviours were linked to fears about engaging in social participation opportunities, including fears of social rejection and/or exploitation, and fears of losing valued aspects of identity.DiscussionIt is concluded that social participation amongst lonely older people will not improve through the removal of previously reported barriers alone; instead, older peoples’ beliefs, fears and identities must be addressed. Suggestions for implementing these findings within community organisations are provided.     

医务社工与志愿者在医院服务管理中作用的评价

目的 通过实证调查采集患者、医务工作者和志愿者对医务社工及志愿者工作的评价,解析医务社工及志愿者在医院服务管理中的作用。方法 采用问卷调查、文献查阅、深度访谈法,调研上海市三家三级甲等公立医院获取第一手资料。结果 调查结果显示,患者、医务人员及医务管理人员高度认可医务社工与志愿者在医院服务管理的作用。结论 医务社工和志愿者在医院服务管理中能发挥独特的作用,可以增进医患沟通,缓解或预防医患矛盾,给患者更多人文关怀和增值服务,一定程度上解决医患之间的诊治经费问题,提升服务品质、降低人力成本,应当得到全社会更多的重视。     

Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes

BackgroundTraumatic brain injury (TBI) is the leading cause of disability and mortality in children and young adults worldwide. It remains unclear, however, how TBI in childhood and adolescence is associated with adult mortality, psychiatric morbidity, and social outcomes.ConclusionsGiven our findings, which indicate potentially causal effects between TBI exposure in childhood and later impairments across a range of health and social outcomes, age-sensitive clinical guidelines should be considered and preventive strategies should be targeted at children and adolescents.     

Mormon fertility through half a century: Another test of the Americanization hypothesis

Abstract

When a family has a member affected by a rare lethal genetic disease, the normal members of the family have a reduced chance of marrying or of reaching the fertility level of the general population. This paper shows that gene frequency change is divided approximately into two parts: the change due to individual selection and that due to social pressure. It is also shown that a large progeny size in a family generally decreases the equilibrium of lethal genes because of social pressure.     

不同地区三级医院患者公益性评价比较及影响因素研究

????? 目的 了解不同地区患者对三级公立医院公益性的评价,探究公益性评价的影响因素。方法 通过问卷的形式,在东、中、西3个地区选择在三级医院就诊的患者进行调查, 使用Pearson Chi-square、非参数检验和Logistic回归方法对数据进行分析。 结果 患者对于公立医院的公益性评价存在一定的地区差异,但公益性总体评价的影响因素类似,医疗服务的适宜性和公平性是主要影响因素。结论 加强三级公立医院的公益性应该着重提高医疗服务的适宜性,提高医疗服务的公平性。     

社会资本进入公立医院政策演进分析

目的 对我国公立医院利用社会资本的有关政策进行阐述和分析。方法 基于国内公立医院发展现况,通过个案调查、访谈、文献查阅等形式,对公立医院的融资过程进行政策分析。结果 公立医院对社会资本引入的尝试,已形成了一些具有若干特点的融资模式,如银行贷款、融资租赁、慈善捐赠等。结论 我国公立医院为实现可持续发展,多渠道引入社会资本已经成为必然的发展趋势。但从整体上讲,还未形成满足各种社会资本状况的政策体系。     

Evolution And Historical Reductionism

Abstract

In response to Hoebel's criticism (1980) of the use of a dialectical model to interpret Cheyenne history, this article examines Hoebel's own views on kinship, politics, and social change. It is argued that Hoebel confuses descent with residence, and is committed to a methodology which necessarily gives inconclusive results. Most importantly, it is argued that Hoebel's theoretical perspective, characterized as “historical reductionism,” imposes a rigidly normative structure onto a society that was undergoing radical social change in the nineteenth century.     

An Overview of the Archaeology of East Texas

Abstract

This brief survey attempts to define, and to offer explanations for, the major patterns of aboriginal adaptations presently recognizable in the eastern part of Texas. It is organized from a chronological point of view, but is more concerned with the processes and conditions that lead to changes in subsistence and social systems.     

Socioeconomic position in childhood and adulthood and insulin resistance: cross sectional survey using data from British women's heart and health study

ObjectiveTo assess the associations between childhood and adulthood social class and insulin resistance.DesignCross sectional survey.Setting23 towns across England, Scotland, and Wales.Participants4286 women aged 60-79 years.ResultsBelonging to manual social classes in childhood and in adulthood was independently associated with increased insulin resistance, dyslipidaemia, and general obesity. The association between childhood social class and insulin resistance was stronger than that for adult social class. The effect, on insulin resistance and other risk factors, of belonging to a manual social class at either stage in the life course was cumulative, with no evidence of an interaction between childhood and adult social class. Women who were in manual social classes in childhood remained at increased risk of insulin resistance, dyslipidaemia, and obesity—even if they moved into non-manual social classes in adulthood—compared with women who were in non-manual social classes at both stages.ConclusionsAdverse social circumstances in childhood, as well as adulthood, are strongly and independently associated with increased risk of insulin resistance and other metabolic risk factors.

What is already known on this topic

Poor childhood social circumstances are, independently of adult social circumstances, associated with increased cardiovascular disease riskThey are associated with some components of the insulin resistance syndrome, and adverse childhood environmental factors, possibly poor nutrition, may lead to insulin resistance and to adult cardiovascular diseaseEvidence on the association between childhood social circumstances and insulin resistance in adulthood, and between childhood social circumstances and cardiovascular disease risk factors in women, is scarce

What this study adds

Belonging to manual social classes in childhood and in adulthood is independently associated with increased insulin resistance, dyslipidaemia, and obesity in older womenWomen who were in manual social classes in childhood remained at increased risk of insulin resistance, dyslipidaemia, and obesity, even if they had moved into non-manual social classes in adulthood     

Social class in childhood and general health in adulthood: questionnaire study of contribution of psychological attributes

ObjectiveTo determine the contribution of psychological attributes (personality characteristics and coping styles) to the association between social class in childhood and adult health among men and women.DesignPartly retrospective, partly cross sectional study conducted in the framework of the Dutch GLOBE study.SubjectsSample of general population from south east Netherlands consisting of 2174 men and women aged 25-74 years. Baseline self reported data from 1991 provided information on childhood and adult social class, psychological attributes, and general health.ResultsIndependent of adult social class, low childhood social class was related to self rated poor health (odds ratio 1.67 (95% confidence interval 1.02 to 2.75) for subjects whose fathers were unskilled manual workers versus subjects whose fathers were higher grade professionals). Subjects whose fathers were manual workers generally had more unfavourable personality profiles and more negative coping styles. External locus of control, neuroticism, and the absence of active problem focused coping explained about half of the association between childhood social class and self rated poor health. The findings were independent of adult social class and height.ConclusionsA higher prevalence of negative personality profiles and adverse coping styles in subjects who grew up in lower social classes explains part of the association between social class in childhood and adult health. This finding underlines the importance of psychological mechanisms in the examination of the negative effects of adverse socioeconomic conditions in childhood.

Key messages

• Regardless of adult social class, low social class in childhood is related to poor general health in adulthood
• Adverse personality profiles and negative coping styles are more common in people who grew up in lower social classes
• Psychological attributes, such as low perceived control, explain a substantial part of the direct association between childhood social class and adult health
• Psychological mechanisms may explain adverse health outcomes in adults who have a low socioeconomic background

     

The Neuroanatomical Basis of Panic Disorder and Social Phobia in Schizophrenia: A Voxel Based Morphometric Study

ObjectiveIt is known that there is a high prevalence of certain anxiety disorders among schizophrenic patients, especially panic disorder and social phobia. However, the neural underpinnings of the comorbidity of such anxiety disorders and schizophrenia remain unclear. Our study aims to determine the neuroanatomical basis of the co-occurrence of schizophrenia with panic disorder and social phobia.MethodsVoxel-based morphometry was used in order to examine brain structure and to measure between-group differences, comparing magnetic resonance images of 20 anxious patients, 20 schizophrenic patients, 20 schizophrenic patients with comorbid anxiety, and 20 healthy control subjects.ResultsCompared to the schizophrenic patients, we observed smaller grey-matter volume (GMV) decreases in the dorsolateral prefrontal cortex and precentral gyrus in the schizophrenic-anxiety group. Additionally, the schizophrenic group showed significantly reduced GMV in the dorsolateral prefrontal cortex, precentral gyrus, orbitofrontal cortex, temporal gyrus and angular/inferior parietal gyrus when compared to the control group.ConclusionsOur findings suggest that the comorbidity of schizophrenia with panic disorder and social phobia might be characterized by specific neuroanatomical and clinical alterations that may be related to maladaptive emotion regulation related to anxiety. Even thought our findings need to be replicated, our study suggests that the identification of neural abnormalities involved in anxiety, schizophrenia and schizophrenia-anxiety may lead to an improved diagnosis and management of these conditions.     

Familial Accumulation of Social Anxiety Symptoms and Maladaptive Emotion Regulation

BackgroundSocial anxiety is thought to be strongly related to maladaptive emotion regulation (ER). As social anxiety symptoms accumulate in families, we hypothesize that maladaptive ER is also more prevalent in families with anxious children. Thus, we analyze differences in emotion regulation of both child and mother in relation to social anxiety, as well as both their ER strategies in dealing with anxiety. Further, a positive relation between child and maternal ER strategies is assumed.MethodChildren (aged 9 to 13 years) with social, anxiety disorder (SAD; n = 25) and healthy controls (HC, n = 26) as well as their mothers completed several measures of social anxiety and trait ER strategies towards anxiety. As ER of children is still in development, age is considered as covariate.ResultsSAD children and their mothers reported more maladaptive ER strategies than HC dyads. Maternal maladaptive ER was related negatively to child adaptive ER which was further moderated by the child’s age.DiscussionMaladaptive ER strategies seem to contribute to the exacerbation of social anxiety in both mother and child. Mothers reporting maladaptive ER may have difficulties supporting their child in coping with social anxiety while simultaneously also experiencing heightened levels of anxiety. Deeper understanding of interactional processes between mothers and children during development can assist the comprehension of factors maintaining SAD. Implications for future research and possible consequences for interventions are discussed.     

Ecological study of social fragmentation,poverty, and suicide

ObjectivesTo investigate the association between suicide and area based measures of deprivation and social fragmentation.DesignEcological study.Setting633 parliamentary constituencies of Great Britain as defined in 1991.ResultsMortality from suicide and all other causes increased with increasing Townsend deprivation score, social fragmentation score, and abstention from voting in all age and sex groups. Suicide mortality was most strongly related to social fragmentation, whereas deaths from other causes were more closely associated with Townsend score. Constituencies with absolute increases in social fragmentation and Townsend scores between 1981 and 1991 tended to have greater increases in suicide rates over the same period. The relation between change in social fragmentation and suicide was largely independent of Townsend score, whereas the association with Townsend score was generally reduced after adjustment for social fragmentation.ConclusionsSuicide rates are more strongly associated with measures of social fragmentation than with poverty at a constituency level.

Key messages

• Place of residence may affect health, and mortality from most common diseases tends to be higher in areas characterised by low socioeconomic position
• Research dating back over 100 years suggests that social fragmentation may influencesuicide
• In the 1980s and 1990s, parliamentary constituencies with high levels of social fragmentation had high rates of suicide, independent of deprivation
• Constituencies with the greatest increases in social fragmentation between 1981 and 1991 also had the greatest increases in suicide rates over the same period
• Any targeting of suicide prevention may be more effective if aimed at socially fragmented rather than deprived areas

     

The first record for Melittobia australica Girault in New Zealand and new host records for Melittobia (Eulophidae)

Abstract

Melittobia australica Girault is a new record for New Zealand and from Vespula spp. In the Wellington district, M. australica was found in an embryo colony of the German wasp Vespula germanica (Fabricius) and in pupae of the mason wasp Pison spinolae Shuckard in 1980 and 1981 respectively. Melittobia was recorded in nests of P. morosum Smith in Canterbury, New Zealand in 1976 and 1977. The original sources of M. australica were considered.

The validity of the earliest record of Melittobia in a social wasp host is reconsidered. It is concluded Melittobia has been underated as a parasite of social wasps.     

In search of the Holy Grail: Media discourse and the new human genetics

It has widely been recognized that the media play a key role in framing debates about genetic issues. This paper provides an overview of the major areas of debate within the social scientific literature on media, public understanding of science and human genetics. It evaluates current approaches to assessing the role of the media in influencing public policy debates. It argues that an analysis of the strategies of news sources should occupy a central role in furthering understanding about the ways in which various social actors seek to influence public policy agendas. At present, within the field of human genetics, only a handful of researchers have systematically examined the strategies of news sources from the perspective of the sources themselves. While recent research has focused upon identifying the major sources and how they are used in science reporting, there remains much to be done in uncovering the processes of negotiation and contestation among social actors prior to issues gaining media coverage.     

政府补偿与监管机制改革对公立医疗机构公共卫生及公益性服务的影响分析

目的 分析上海市闵行区政府补偿与监管机制改革对公立医疗卫生机构的公共卫生和公益性服务状况的影响。方法 收集2008—2012年闵行区12家社区卫生服务中心的公共卫生服务和公益性服务,以及3家综合性医院的公益性服务的指标数据,并将部分指标与上海市同期的平均水平进行比较分析。结果 改革后,闵行区社区卫生服务中心公共卫生服务能力显著提升,服务质量保持在较高水平,服务效率也有所改进,公共卫生服务数量明显优于上海市平均水平。结论 闵行区政府补偿与监管机制改革对公立医疗卫生机构的公共卫生和公益性服务的提供有积极的影响,但未来需要关注对公益性服务的激励和补偿,尤其是补偿机制和标准更为明确和细化。     

线索有效性对社会性注意和外源性注意的影响

目的 眼睛注视、头朝向和生物运动方向等社会性线索,对人类的生存和社会交互极为重要.由于社会性线索和外周线索都具有反射性注意定向这一特点,社会性注意往往也被认为属于外源性注意.但是,外源性注意并不能完全解释所有的社会性注意现象.因此,两者是否具有相同的加工机制,尚存在争论.方法 本研究使用空间线索范式,系统考察了线索有效...     

Economic Analysis of the Legal Regimes Governing Salvage of Historic Shipwrecks

This article offers an economic analysis of the international and U.S. laws governing the recovery of archaeological data from historic shipwrecks. The framework combines values of treasure salvage and archaeological knowledge. It is suggested that U.S. salvage law, sometimes extended to international waters, gives insufficient protection to archaeological value, but that UNESCO's Convention on the Protection of the Underwater Cultural Heritage goes too far in the other direction. Two other legal regimes (government-salvager and interstate agreements) are shown to have the potential to maximize the social values of historic shipwrecks. It is also suggested that a move towards maximizing social values would be promoted if the U.S. admiralty courts tied the size of salvage awards more closely to the quality of the archaeological work performed.