Buffeted by harsh economic winds,medical schools turn a wary eye to the future

All parts of Canada''s health care system are facing fiscal pressures these days, but they are particularly great at Canada''s medical schools. However, Dr. David Hawkins of the Association of Canadian Medical Colleges is optimistic that all 16 of Canada''s medical schools will remain open, mainly because of the huge impact they have on health care in their local communities. “We don''t just turn out students — we raise the standard of health care in a whole community,” he says.     

贫困地区医护人员精准健康扶贫政策认知的调查

目的 探讨贫困地区医护人员对精准健康扶贫政策的知晓率情况以及对知晓率影响因素分析。方法 在文献分析和专家讨论基础上设计调查问卷,开展现场调查。利用SPSS19.0软件对数据进行统计分析。结果 仅有26.0%医护人员表示对目前健康扶贫及相关政策较为了解,但有近40%的人对其当前的精准健康扶贫政策感到不满意。logistic回归分析结果显示,“所在医院是否有上级医院帮扶”“所在医院是否帮扶下级乡镇卫生院”“所在医院对长期服务基层的员工是否有优惠政策倾斜”3个因素对医护人员精准健康扶贫政策满意度水平认知有影响。结论 医护人员对精准健康扶贫政策认知度和满意度尚有提高的空间。从供给方角度出发,从医院方面出发,完善上下级帮扶政策、建立紧密型县乡村一体化健康扶贫结构;创新管理模式,为长期服务基层的员工提供优惠政策倾斜,是提高精准健康扶贫效果的可行选择。     

Implications of heterogeneous impacts of protected areas on deforestation and poverty

Protected areas are a popular policy instrument in the global fight against loss of biodiversity and ecosystem services. However, the effectiveness of protected areas in preventing deforestation, and their impacts on poverty, are not well understood. Recent studies have found that Bolivia''s protected-area system, on average, reduced deforestation and poverty. We implement several non-parametric and semi-parametric econometric estimators to characterize the heterogeneity in Bolivia''s protected-area impacts on joint deforestation and poverty outcomes across a number of socioeconomic and biophysical moderators. Like previous studies from Costa Rica and Thailand, we find that Bolivia''s protected areas are not associated with poverty traps. Our results also indicate that protection did not have a differential impact on indigenous populations. However, results from new multidimensional non-parametric estimators provide evidence that the biophysical characteristics associated with the greatest avoided deforestation are the characteristics associated with the potential for poverty exacerbation from protection. We demonstrate that these results would not be identified using the methods implemented in previous studies. Thus, this study provides valuable practical information on the impacts of Bolivia''s protected areas for conservation practitioners and demonstrates methods that are likely to be valuable to researchers interested in better understanding the heterogeneity in conservation impacts.     

基于DMSP-OLS数据和可持续生计的中国农村多维贫困空间识别

贫困是人类在21世纪发展所要长期面对的困境,消除贫困是中国全面建成小康社会的最大挑战。单纯依据经济、社会统计数据对贫困状况的测度缺乏空间视角,无法直观地分析贫困状况的空间差异、地域特征及致贫原因的生态地理背景分异机制。引入脆弱性-可持续生计框架模型,构建了可持续生计的测度指标体系,以宁夏回族自治区所辖县区为样本,借助遥感和GIS空间分析技术,建立了2002年和2013年夜间灯光指数和可持续生计指数(SLI)间的回归模型,并以青海省所有县区的数据对模型进行了验证。利用检验后的模型将持续生计指数空间化;采用空间自相关分析了县域持续生计指数的空间集聚状况。结果表明:2002年和2013年估算的SLI平均相对误差为10.84%和12.19%,精度较高。中国所有县区SLI的全局Moran's I值分别为0.636和0.579,具有较高的空间依赖性,"低-低"型贫困区域即空间贫困陷阱区集中在扎兰屯-百色一线以西。两时点上分别识别出642个、612个多维贫困县。2013年,多维贫困县区在空间上表现为东、中、西部岛状、块状、连片状3种地域类型。研究发现夜间灯光数据是一种有效的空间贫困测度数据源,可实现数据缺乏地区大尺度上的多维贫困动态监测。     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association''s activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.     

GLOBAL HEALTH IMPACT: A BASIS FOR LABELING AND LICENSING CAMPAIGNS?

Most of the world's health problems afflict poor countries and their poorest inhabitants. There are many reasons why so many people die of poverty‐related causes. One reason is that the poor cannot access many of the existing drugs and technologies they need. Another, is that little of the research and development (R&D) done on new drugs and technologies benefits the poor. There are several proposals on the table that might incentivize pharmaceutical companies to extend access to essential drugs and technologies to the global poor. 1 Still, the problem remains – the poor are suffering and dying from lack of access to essential medicines. So, it is worth considering a new alternative. This paper suggests rating pharmaceutical and biotechnology companies based on how some of their policies impact poor people's health. It argues that it might be possible to leverage a rating system to encourage companies to extend access to essential drugs and technologies to the poor.     

The health risks of new-wave vegetarianism

Many young people call themselves vegetarians because they don''t eat meat, but the eating style they are adopting is fraught with health risks. In this article, which won CMAJ''s 1996 Army Chouinard Memorial Essay Contest for Canadian journalism students, Laura Brydges Szabo looks at the "new vegetarianism" and the recommendations health care professionals are making to young people intent on following this incomplete diet. The contest encourages journalism students to write on health care topics.     

Successive Ontario governments forced to grapple with problem of health care fraud.

Albert Shu of Willowdale, Ont., is the 1995 winner of the Amy Chouinard Memorial Essay Contest. Named in memory of long time CMAJ and Canadian Journal of Surgery contributor Amy Chouinard, the competition is intended to stimulate interest in medical and health-related writing among journalism students. The winning essay, written prior to Ontario''s 1995 provincial election, examined health care fraud in the province and the impact of the photo health card that was introduced by the New Democrats party government.     

Victoria conference highlights differences in federal,provincial stands on health care issues

When Canada''s health ministers met in Victoria recently, the number of issues debated were yet another sign of the many problems facing Canada''s health care system. There were dis-agreements about the use of facility fees by private clinics, and concern about the huge impact federal cuts to transfer payments are going to have on provincial governments. British Columbia, for instance, faces 1996 federal cuts totalling $375 million — 5.8% of the province''s health care budget. As well, ministers debated the merits of a report discussing alternatives to the fee-for-service method of paying physicians. Dr. Jack Armstrong, the president, said the CMA does not favour one particular remuneration system over another, but feels strongly that doctors should have the right to choose the system they want.     

Nurse Practitioner and Physician's Assistant Clinics in Rural California: Part I: Issues

The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP''s) or physician''s assistants (PA''s). All of these have physician supervision and support. NP''s and PA''s have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported.NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician''s assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California''s Medicaid program).Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician''s assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP''s and PA''s will serve an even greater role in rural areas.     

祁连山牧区妇女社会地位及其对草地政策的认知度

牧区妇女社会地位的高低对草地生态系统健康具有重要的影响。以祁连山区的天祝藏族自治县抓喜秀龙乡为调查研究区域,随机抽取100户藏族牧户为研究对象,采用问卷、座谈和关键人物座谈等形式,对妇女在社会生产中充当的角色、日常生活中承担的家务状况、受教育程度、参与社会活动情况以及对草地政策的认知等方面进行了系统调查和分析。研究结果表明:在农村社会变革中,女性是畜牧业生产的主力军,承担着将近80%的生产管理工作,74.3%的日常家务。其在家庭经济中的决策权和农村社会中的地位也在逐渐提高,在经济方面占36.5%的支配权,拥有14.5%的决策权。但是,妇女的受教育的程度普遍较低,女性的文盲率达14.4%。因此,妇女对草地生产管理技术的接受程度较低,对草原管理方面的政策及相关的法规缺乏认识,这将会对牧区草地畜牧业的可持续发展产生潜在影响。     

Canadian Medicare: prognosis guarded.

Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making across-the-board cuts. (3) Replace blame with praise:give health care professionals and institutions credit for their contributions. (4) Learn from the successful programs and policies already in place across the country. (5) Foster horizontal and vertical integration of services. (6) Promote physician leadership by rewarding efforts to promote the efficient use of resources. (7) Monitor the effects of cutbacks: physician groups should cooperate with government in maintaining a national "report card" on services, costs and the health status of Canadians.     

Part-time hospitalization programs: the neglected field of community psychiatry.

Part-time hospitalization for persons with psychiatric disorders is underdeveloped, underutilized and often poorly understood, but should be encouraged in view of the unsatisfactory living conditions of patients discharged from hospital who still require care, the reductions in psychiatric impatient populations and numbers of beds, the increasing costs of health services and the current fiscal restraints. Day and night hospitals can provide an alternative to inpatient or outpatient treatment, rehabilitation for the long-term patient or treatment for the patient in transition from inpatient to outpatient status. The day hospital can also provide a diagnostic setting. Such programs help preserve the patient''s position in the family and the community, minimize the ill effects of hospitalization, and lower capital and operating costs of the psychiatric services. Awareness by medical and paramedical services of the value of these programs would increase their utilization. Shifting the emphasis of administrative and fiscal policies from inpatient to part-time hospitalization programs is also required.     

Health,humanitarian relief,and survival in former Yugoslavia.

Since the World Health Organisation''s effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO''s response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.     

Business leaders begin to rally in support of public health care system

There appears to be growing concern among Canada''s business leaders about the future of Canada''s health care system. At a recent meeting in Montebello, Que., that was cosponsored by the CMA and several Canadian corporations, some business representatives said Canada''s publicly funded system gives them a competitive edge in an increasingly global market.     

McGill-trained MD,experiment give June 20 shuttle flight strong Canadian flavour.

Family physician Robert Thirsk, an original member of the Canadian Space Agency''s astronaut program, will be part of the seven-member crew when the space shuttle Columbia lifts off from Florida''s Kennedy Space Centre June 20. In this special report, the 1982 McGill graduate outlines some of the physiologic and materials-science experiments the crew will conduct. Thirsk, a payload specialist and crew medical officer, thinks the findings could have a significant impact on future space missions, medicine and the biotechnology industry.     

The alluring myth of private medicine.

Canada''s medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.     

基于易地扶贫搬迁视角的喀斯特生态脆弱区生态系统服务价值的时空演变

易地扶贫搬迁是针对生活在"一方水土养不好一方人"地区贫困人口实施的一项专项扶贫工程,在助力贫困人口实现脱贫的同时,对改善生态脆弱区生态环境具有积极的促进意义。"十三五"期间贵州省易地扶贫搬迁人口约占全国总搬迁人口的1/5,是全国易地扶贫搬迁人口最多的省份,因此,研究选择贵州省县域搬迁人口最多的册亨县为研究区域。基于2009、2015、2020年3期土地利用和易地扶贫搬迁人口数据,研究选用修正当量因子法及耦合协调模型分析易地扶贫搬迁实施前后的生态系统服务价值（ESV）时空演变规律,并探讨了易地扶贫搬迁生态修复成效。结果表明：（1）搬迁后2015-2020年,册亨县ESV增长8.32亿元,增长幅度达到17.97%,比较搬迁前2010-2015年（增幅4.13%）有显著提高。（2）坡妹、冗渡、巧马、丫他、八渡、百口6个乡镇ESV增量占册亨县总增量的82.89%,ESV增量贡献最大。（3）册亨县搬迁力度越大的乡镇其ESV增加越明显,对应的耦合协调水平越高,易地扶贫搬迁与ESV增长有明显的空间相关关系。研究从生态系统服务的角度量化易地扶贫搬迁所产生的生态修复成效,有助于提高易地扶贫搬迁后续工作的科学性和空间针对性。     

中国征收碳税应对碳关税的经济分析——以美国为例

碳税和碳关税作为一种价格调整机制,长期而言会对经济系统中各主体产生较强的约束力。通过GTAP-E模型的模拟分析,得出以下结论:在目前的发展阶段,碳关税并非有效的低碳经济发展政策,尤其是美国对中国征收碳关税对降低世界碳排放量的影响有限;美国针对中国采取的碳关税政策将在一定程度上对我国出口贸易产生负向影响,尤其是对中国的高碳产业影响较大;当中美采取相同的碳税政策时,碳税的征收对中国GDP造成较大的负面影响,且中国自主采取节能减排方案不足以应对美国碳关税的负面效应;而当两者采取差异化政策时,中国主动采取节能减排行动可以有效应对美国碳关税的威胁。     

Women in medicine: practice patterns and attitudes.

Increasing numbers of women are entering medicine in Canada. In 1959 women accounted for 6% of the medical school graduates, but by 1989 they accounted for 44%. Although there has been little systematic investigation of the impact of this increase on Canada''s health care system, there are grounds for believing that female physicians bring with them distinctive values and interests, which may be reflected in the way they conduct their professional practices. We used data from a recent national survey of 2398 Canadian physicians to examine differences between women and men in their practices and their attitudes toward health care issues. Significant differences were found in the organization and management of the practices. Women preferred group over solo practice and were overrepresented in community health centres, health service organizations and centres locaux de services communautaires in Quebec. One-third of the women, as compared with half of the men, were in specialties. Even after adjusting for differences in workloads the incomes of the women were significantly lower than those of the men. Only minor differences were observed in the assessment of the health care system and alternative modes of organizing health care services. We believe that the differences were due to the double workload of women as professionals and family caregivers and the powerful socialization effects of medical education. As women overcome their minority status in the medical profession, differences between the sexes may become more apparent. Thus, the extent and effects of the progressive increase in the number of women in Canadian medicine should be assessed on an ongoing basis.