台湾地区全民健保总额预算制度设计与运行效果评述

总额预算制作为医保对供方主要支付方式之一在国际上得到广泛应用,我国的上海、北京等地区也开始在不同程度上通过总额预算方式实现支付方式改革。总额预算作为一种控制医疗费用过快增长的方式既有优势也存在弊端。以我国台湾地区为例,介绍总额预算制度的运行机制和总额制定方式,并探讨总额预算制的实施效果,分析总额预算达到效果最优化的制度设计,为改革提供政策借鉴。     

The Unknown Role of Mental Health in Global Development

In this paper, the author contrasts the substantial impact of mental health problems on global disability with the limited attention and resources these problems receive. The author discusses possible reasons for the disparity: Compared to physical disorders, mental health problems are considered less important, perhaps due to lower priority of disorders that primarily cause dysfunction rather than mortality, and skepticism that mental disorders are treatable in low-resource countries. He argues that achieving improved global health and development requires addressing problems causing disability, particularly mental health problems among populations in which the common mental disorders are frequent due to deprivation, war, and disasters. The author contends that services addressing the common mental disorders could be made widely and relatively cheaply accessible if provided by non-professional workers at the community level.     

Understanding and Managing the Risks to Health and Environment from Global Atmospheric Change: A Synthesis

The global atmosphere is changing. Anthropogenic activities are increasing the concentrations of greenhouse gases and releasing synthetic compounds that deplete stratospheric ozone and increase UV-B radiation. Changes of temperature in the Northern Hemisphere during the past century strongly suggest that we are now in a period of rapid global warming relative to the past millennium. Increased concentrations of greenhouse gases are absorbing outgoing infrared radiation in the lower atmosphere, warming the troposphere and cooling the lower stratosphere. Research is beginning to indicate that losses of stratospheric ozone and increases of greenhouse gases are interdependent. Increased greenhouse gases have been implicated in the observed strengthening of stratospheric wind vortices around both poles, in turn setting the stage for further depletion of ozone and increases in UV-B radiation. Although the uncertainties are still large enough to make it difficult to assess health and ecological risks, decisions must be made. Research on indicators of risks to human health and the environment can help reduce the uncertainties in these risks and shorten the time between recognizing the risks of atmospheric change and taking concrete mitigative and adaptive actions.     

政府补偿与监管机制改革对公立医疗卫生机构科教与学科建设的影响分析

目的 分析政府补偿与监管机制改革对公立医疗卫生机构教学、科研以及学科建设的影响。方法 通过对上海市闵行区的机构调查,收集并分析2008—2012年3所公立综合性医院和12家社区卫生服务中心的医学教育、科研项目、论文发表及重点学科建设状况的相关数据。结果 闵行区公立综合性医院和社区卫生服务中心的医学教育和科研能力有所提升,重点学科建设也有所加强;但仍然存在教学能力薄弱,科研水平层次偏低,缺乏高质量的重点学科等问题。结论 政府补偿与监管机制改革在一定程度上强化了公立医疗机构的医学教育、科研能力和学科建设,但未来需进一步加大对科教和学科建设的鼓励和支持力度。     

Transforming Global Health with Mobile Technologies and Social Enterprises: Global Health and Innovation Conference

More than 2,000 people convened for the ninth annual Global Health and InnovationConference at Yale University on April 21-22, 2012. Participants discussed thelatest innovations, ideas in development, lessons learned, opportunities andchallenges in global health activities. Several themes emerged, including theimportant role of frontline workers, strengthening health systems, leveragingsocial media, and sustainable and impact-driven philanthropy. Overall, the majoroutcome of the conference was the increased awareness of the potential of mobiletechnologies and social enterprises in transforming global health. Expertswarned that donations and technological advances alone will not transform globalhealth unless there are strong functioning health infrastructures and improvedworkforce. It was noted that there is a critical need for an integrated systemsapproach to global health problems and a need for scaling up promising pilotprojects. Lack of funding, accountability, and sustainability were identified asmajor challenges in global health.     

Global health inequalities and the need for solidarity: a view from the Global South

Although the world has experienced remarkable progress in health care since the last half of the 20th century, global health inequalities still persist. In some poor countries life expectancy is between 37‐40 years lower than in rich countries; furthermore, maternal and infant mortality is high and there is lack of access to basic preventive and life‐saving medicines, as well a high prevalence of neglected diseases, HIV/AIDS, tuberculosis, and malaria. Moreover, globalization has made the world more connected than before such that health challenges today are no longer limited within national or regional boundaries, making all persons equally vulnerable. Because of this, diseases in the most affluent countries are closely connected with diseases in the poorest countries. In this paper, we argue that, because of global health inequalities, in a situation of equal vulnerability, there is need for global solidarity not only as a means of reducing health inequalities, but also as a way of putting up a united force against global health challenges. We argue for an African approach to solidarity in which the humanity of a person is not determined by his/her being human or rational capacity, but by his/her capacity to live a virtuous life. According to this view of solidarity, because no one is self‐sufficient, no individual can survive alone. If we are to collectively flourish in a world where no individual, nation or region has all the health resources or protection needed for survival, we must engage in solidarity where we remain compassionate and available to one another at all times.     

围手术期健康教育对全肺切除术后患者生存质量的影响

目的:探讨围手术期有效健康教育对患者全肺切除术后长期生活质量(QOL)的影响。方法:随机将100例全肺切除术后患者分为二组,分别采取对患者及家属有效健康教育干预和无干预措施,采用欧洲癌症治疗与研究组织癌症生存量表核心量表(EORTC QLQ-C30,简称QLQ-C30)中文版评估病人的生活质量,对术前及术后1,3,6和12个月的QLQ-C30得分与参考值进行比较。结果:1)两组患者术后长期生活质量中的功能得分无统计学差异(P0.05);2)症状方面,术后呼吸困难,疼痛明显加重;术后第6个月疲乏及经济困难明显加重;术后第12个月起,经济困难状况好转,较术前无明显差异(P0.05);3)无干预组与有效健康教育组在体力功能、角色功能、情绪功能及总体状况方面有统计学差异(P0.05);4)在术后,无干预组在疲劳和呼吸困难方面的QLQ-C30得分比有效健康教育组的低,且有统计学差异(P0.05),但是在12月之后直至病人基本恢复与有效健康教育组之间无统计学差异(P0.05)。结论:围手术期实施有效健康教育,可使全肺切除患者术后生活质量明显提高;比较两种护理措施术后生活质量,有效健康教育组较无干预组患者功能恢复较快,自觉不良症状更少。     

Global Environmental Change and Population Health: Progress and Challenges

Escalating global environmental change (GEC) over the past century has been driven largely by rapid industrialization, population growth, overconsumption of natural resources, and associated waste disposal challenges, as well as the inappropriate uses of technology. These changes are already having and will increasingly continue to have significant impacts on human health and well-being. How to tackle these issues is an important challenge to scientists, policy-makers, and the general public. Scientific consensus now exists that GEC and population health are linked, even though the details and mechanisms underlying this link remain to be both explicated and quantified. In this article we provide an overview of progress and challenges in the area of GEC and population health since the late 1980s, highlighting some of the main landmarks in this area and recommending directions for future research.     

Ethical Study on the Reform and Development of Medical and Health Services in China

At an early stage of its foundation, new China became clear about the nature of public welfare and quickly developed medical and health services, which was well received by the World Health Organization. The marketization and the reduction of input into medical and health services from the 1980s created severe adverse consequences. After the SARS' outbreak in 2003, China started to give serious consideration to its medical and health system, and to work at developing medical and health services. The new healthcare reform launched in 2009 re‐emphasizes fairness and public welfare, and China's achievements have been remarkable. Of course, there are still many problems to be solved in the reform, which also paves the way for increasing the reform in future.     

A Framework to Link International Clinical Research to the Promotion of Justice in Global Health

How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high‐income countries owed to parties from low and middle‐income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The ‘research for health justice’ framework provides direction on three aspects of international clinical research: the research target, research capacity strengthening, and post‐trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity.     

医疗保险总额预付试点三级医院患者就医感受调查

目的 调查上海市实行医疗保险总额预付的三级医院中患者的就医感受。方法 经培训的调查员应用结构式调查问卷对上海市10家实行医疗保险总额预付的三级医院的699名患者进行面对面访谈,数据分析主要采用描述性统计。结果 城保患者对门诊医生明显减少处方金额（或处方天数）的感受强于非城保患者,城保和非城保患者的住院就医感受差异无显著统计学意义。结论 医疗保险总额预付对上海三级医院患者就医感受的总体效应似偏弱,而且有限的影响主要集中于门诊而非住院环节。     

医疗卫生机构公共卫生服务协同模式的构建

医疗卫生机构公共卫生工作是传染病医疗救治和预防控制的关键环节,文章梳理了医疗卫生机构公共卫生服务能力建设需解决的问题,提出了两者协同运行模式构建方法,为完善协同运行的关键环节建设提供借签。     

高校心理健康教育的问题及对策思考

当前,高校心理健康教育基本上已进入一个快速发展之后的平台期。虽然高校心理健康教育取得了显著的成绩,但还存在着一定的问题。其根源在于学生认同度不高、全员参与性不够、课堂渗透不多和师资队伍不强,这些使高校心理健康教育工作陷于困境,严重制约高校心理健康教育深入开展。本文提出了走出高校心理健康教育困境的四项对策。     

实习护生学历与心理健康状况相关性研究

目的：了解不同学历实习护生心理健康状况及存在的心理健康问题,分析其与学历之间的关系,为实施干预提供依据。方法：采用症状自评量表（SCL-90）,对100名不同学历实习护生进行问卷调查。结果：不同学历实习护生SCL-90量表测试所得强迫症状、抑郁、焦虑、恐惧等因子分均高于常模组具体得分,不同学历SCL-90量表测试所得抑郁、焦虑、敌对、恐惧精神病性等因子分有差异。结论：强迫症状、抑郁、焦虑、敌对是不同学历实习护生最主要的心理问题,研究生、本科学历实习护生更为严重,不同学历心理问题的严重程度不同。     

JCI标准下临床健康教育模式的改进

医疗机构评审国际联合委员会的标准是世界公认的医疗服务标准,依据医疗机构评审国际联合委员会标准对健康教育模式进行改进,建立标准化健康教育工作程序、推行医师、护士、药师、康复治疗师、营养师等共同协作全员参与的健康教育模式,取得一定成效。对医疗机构评审国际联合委员会标准下的健康教育模式和体会作出总结,为临床健康教育模式提供指导。     

浅谈高校心理健康教育工作体系的构建与完善

当前,高校心理健康教育已成为构建社会主义和谐社会的重要内容,构建和谐校园的重要途径。构建高校心理健康教育工作体系对加强和改进高校心理健康教育具有十分重要的意义,必须通过重视心理教育、完善心理援助、优化心理环境、提升支持保障等方面来构建心理健康教育工作体系,通过以教育为根本、以发展为主线、以建设为重点来完善心理健康教育工作体系。     

Reintegrating Coastal Development and Public Health in Western Australia

This article presents three case studies that take a socio-ecological perspective to highlight an interconnectedness between the environment, human participation and organization, and public health, in Western Australian marine, coastal, and near-coastal places. We examine the degree to which coastal zone planning and management interact with public health practitioner, and the consequences of this interaction for biophysical surroundings and human health. The case studies demonstrate the limited roles the public health sector has played, and the indispensable expanded role it might play, in what is traditionally seen as the domain of natural resource management. A socio-ecological analysis highlighted the value of decision-making processes for coastal developments that emphasize dialogue, place, public health issues, resource distribution, as well as ecology. These adaptive capabilities offer scope for understanding the consequences of coastal planning and management actions on both the biophysical condition of the environment and human health, break the cycles of reaction, and provide an alternative framework for regulating the developmental expansion of the Western Australian coastline.David Galloway is a sustainability designer and has undertaken work for some of the pastoralists on the Ningaloo coast. The analysis of the third case study is based, in part, on information gained through these consultancies.     

Laypeople's Health Concerns and Health Beliefs in Regard to Risk Perception of Mobile Communication

The consensus scientific view is that there is an absence of convincing scientific evidence for health risks of exposures to electromagnetic fields (EMF) at levels below those recommended in international guidelines. Nevertheless, some citizens are worried about EMF emitted by mobile communication and its consequences for health. The present study explored, by means of a mail survey, health concerns and the prevalence of health beliefs related to EMF in the general population. A random sample (n = 765, response rate 41%) of the German-speaking population in Switzerland was asked to assess various health beliefs. Results suggest that health concerns are widespread but lower than health concerns in regard to other hazards. About two-thirds of the respondents believed that some people suffer from electromagnetic hypersensitivity (EHS). Health beliefs items were analyzed using the Mokken scale. This scale was related to respondents' health concerns and showed that health beliefs differed in regard to sociodemographic variables. For example, analyses showed that females, younger respondents, and respondents who believed that some people are affected by EHS endorsed significantly more health beliefs than males, older respondents, and non-EHS respondents. Results indicate that it is important for policy-makers to develop a clear understanding of the possible effects of health beliefs on health concerns and risk perception. These findings may provide guidance for the further development of information materials and strategies.     

全球变化现象及其效应

通过论述大气臭氧层的损耗、大气中氧化作用的减弱、全球气候变暖、生物多样性的减少、土地利用格局与环境质量的改变和人口的急剧增长等全球变化现象,阐明只有推行可持续发展战略才能改善环境,从而根本上遏制全球变化的加剧．文章对全球变化的若干基本问题进行了论述．