英国将大力投资分子影像设备

英国卫生部日前宣布,英国政府将于2006-2007年两年内额外拨款2000万英镑用于国家健康服务委员（NHS）建立新的分子影像设备——PET／CT,如此一来,更多的英国癌症患者会得到快速有效的早期诊断。NHS目前共有7个固定应用PET／CT扫描场所,其中6个位于伦敦和东南部地区,一个位于伯明翰,每年约进行10500次扫描,到2007-2008年,这一数字将达到40000次。     

健康老龄化视阈下我国卫生服务体系面临的挑战与机遇

阐述了健康老龄化战略的重要意义，探讨了健康老龄化战略与我国卫生体系建设的关联，并运用SWOT分析法，旨在判断与归纳健康老龄化视域下我国卫生服务体系所面临的挑战与机遇。最后，从制度建设、服务供给模式改革、人才培养等多元视角出发，探究我国卫生服务体系在新战略背景下的改革路径，以期为中国实现健康老龄化提供理论参考。     

基于健康保障责任的县级医院综合改革思路探讨

从健康保障出发,县域的医疗保障需要由县医疗服务体系承担,其中,县医疗服务体系主要由公立医院组成。县政府是透过县医疗服务体系管理公立医院,由此确定相应的投入责任和管理体制。在医疗服务体系的管理下,外加医疗保险及新农合对医院医疗费用的管理,县级医院依据外部环境和条件构造内部管理体制。当前县级医院管理体制改革中存在两个关键问题：一个是农村基层医疗卫生机构（乡镇卫生院和村卫生室）对医疗服务体系和卫生服务体系的连体问;另一个是在经济上调整医患双方利益问题,解决这两个问题将有利于推进县公立医院综合改革。     

食用农产品质量安全问题的国民心态分析——以北京市“草莓农残超标致癌”舆情事件为例

健康的国民心态是做好食用农产品质量安全工作的正能量。本文在研究北京市“草莓农残超标致癌”舆情事件的基础上,分析了当前针对食用农产品质量安全问题事件的国民心态问题,提出了食用农产品质量安全问题国民心态需求归趋及培育途径。     

健康中国建设背景下大型公立医院动态能力初探

国民的健康是拥有强大综合国力和可持续发展能力的前提和基础。健康中国建设是国家全面实现小康社会、适应社会转型期发展新常态的必然要求。医院是健康维护的主体，充分提高大型公立医院能力，获取和维持服务优势是其可持续发展的关键；而对其动态能力的研究，对确保医院在社会转型期，及时顺应改革要求和国民需求，有较强的理论意义和实践价值。     

实行全民卫生服务制度国家和地区公立医院功能研究

选取英国、香港、加拿大、印度、巴西五个国民卫生服务制度的国家或地区,梳理归纳这些国家公立医院的医院功能、区域分布、层级结构、总体数量和政府职责等。提出我国公立医院改革的建议：明确各级公立医院的功能,界定各级政府办医责任,建立良好的转诊机制。     

我国贫困地区医疗卫生服务体系建设探讨

健康扶贫是提高贫困地区人民群众的健康水平、实现健康中国的重要途径。构建和完善中国贫困地区的医疗服务体系,要重点加强医疗卫生机构标准化建设、公共卫生服务网络建设、远程医疗服务体系建设和中医药服务能力建设等方面,形成与当地经济发展和健康需求相适应的医疗卫生服务体系,保障贫困人群的健康,最终实现全民健康。     

着力推进生物产业供给侧结构性改革

<正>生物产业是当今世界正在快速孕育成长的新兴产业,是新一轮科技革命和产业变革的主要方向。适应广大人民群众对健康、安全食品等的巨大需求,加快发展壮大生物产业,是当前我国经济社会发展的重要而紧迫的任务。但受体制机制等制约,目前我国生物产业有效供给不足,创新能力不强。必须着力推进生物产业供给侧结构性改革,加强科技创新,破除生物技术在医疗、农业、化工、能源和环保等领域应用的制度藩篱,培育形成大型企业和中     

居民健康卡服务体系跨机构协同建设探讨

居民健康卡服务体系的建设横跨金融行业和医疗行业、卫生管理部门和医院、制卡机构和发卡机构,在省卫生厅的直接管理下开展。文章遵循部颁居民健康卡标准体系,对居民健康卡的制作、发行、业务受理和管理等4个环节进行了统一规划,研究了制卡机构、发卡机构、业务受理机构和管理机构如何分工建设居民健康卡服务体系,以实现居民健康卡跨地区、跨医疗机构就诊一卡通。     

多媒体与有效教学

在新一轮基础教育课程改革中，教学改革是其中一个重要组成部分。在教学过程中，大力推进信息技术与学科整合是教学改革的一个很重要的内容，因为它能逐步实现教学内容的呈现方式、学生的学习方式、教师的教学方式和师生互动的变革。充分发挥信息技术的优势，为学生的学习和发展提供了一个丰富多彩的课堂教育环境。教育的技术化趋势，成为近来教与学改革引人注目的热点。笔者试从多媒体辅助教学角度来探讨提高教学的有效性。     

Implementing and managing self-management skills training within primary care organisations: a national survey of the expert patients programme within its pilot phase

A key element of the United Kingdom (UK) health policy reform in relation to chronic disease management is the introduction of a national programme seeking to promote self-care from within the National Health Service (NHS). The mainstay of the Expert Patients Programme (EPP) is a six-week training course that provides the opportunity for anyone with a long-term condition to develop new skills to manage their condition better on a day-to-day basis. The course forms part of the NHS self-care support programme, is administered by Primary Care Trusts (PCTs) and delivered by people who have personal experience of living with a long-term condition. The NHS' official Expert Patients Programme website presently states that, "Pilot EPP courses began at 26 NHS PCT sites across England in May 2002, and by May 2004 approximately 300 PCTs had either actively implemented pilot courses or had committed to joining. The majority of PCTs are now coming to the end of the pilot phase, with many implementing plans to make EPP sustainable for the long-term." The NHS website heralds the pilot "a success." A national, postal survey of PCT EPP Leads was undertaken in order to examine both the evolvement of EPP during its pilot stage and future plans for the programme. A questionnaire was sent out to the 299 PCTs known to have committed to the EPP pilot, and an excellent 100% response rate was obtained over a 3-month period (April-July 2005). One marker of success of the Expert Patients Programme implementation is the actual running of courses by the Primary Care Trusts. This paper explores the extent to which the implementation of the pilot can indeed be viewed as a "success," primarily in terms of the number of courses run, and considers the extent to which PCTs have carried out all that they were committed to do. Findings suggest that the more time an EPP Lead dedicates to the Programme, the more likely it is that EPP has run successfully in the past, and the more likely it is that it will continue to run successfully in the future. Other factors indicating future EPP success include collaborating across PCTs to share co-ordinators, tutors, and funding.     

Conducting clinical research in the new NHS: the model of cancer. United Kingdom Coordinating Committee on Cancer Research.

The United Kingdom Coordinating Committee on Cancer Research represents the major organizations funding cancer research in the United Kingdom. The deliberations of a working party convened by the committee to evaluate recently expressed concerns that the changes in the NHS threaten research, especially clinical trials to evaluate new treatments, are reported. A survey of contributors to trials coordinated by the committee showed that half are now experiencing difficulties in continuing to participate in clinical trials. The two major problems identified were lack of time and of staff, especially for NHS staff in non-teaching hospitals. Recent changes in junior doctors'' hours and proposed reductions in the length of time for training will exacerbate this. It is possible to identify the direct and indirect excess costs of conducting research in the NHS, but currently the mechanism does not exist to designate funds specifically for this purpose. Consultation with the regional directors of research and development confirmed that the service increment for teaching and research is not the solution for this. Proposals are made to secure future clinical research in the NHS, including finance, indemnity, the licensing of new drugs, the greater use of nurse counsellors, and the value of cancer registries.     

Selective pressure can influence the resistance of Trypanosoma congolense to normal human serum

Resistance and sensitivity to normal human serum (NHS) of Trypanosoma congolense, a parasite believed to cause disease in animals only, were investigated in vivo as well as in vitro. Our results indicate that like Trypanosoma brucei, T. congolense can be grouped into three different phenotypes according to its resistance to NHS. Some strains are completely resistant to NHS, like Trypanosoma brucei gambiense and the resistant form of Trypanosoma brucei rhodesiense. Other strains show a very low degree of resistance comparable to the sensitive form of T. b. rhodesiense, and some are completely sensitive to NHS. Continuous passaging in mice in the presence or absence of NHS shows that the resistance and sensitivity of T. congolense can be reversed like in T. b. rhodesiense. Our data suggest that T. congolense might be able to infect man in regions where animals may serve as reservoirs for the infection.     

Can the NHS cope in future?

Four potential pressures are likely to determine whether the NHS will be able to cope in future: the change in population structure, changes in level of morbidity, introduction of new technologies, and increasing expectations of patients and NHS providers. New technology and changes in expectations are likely to have the biggest effect and are also the most difficult to quantify. Nevertheless, these pressures are to some extent amenable to control. If the growth in funding continues as it has in the past there is no convincing evidence that the NHS will not continue to cope.     

Role of mannose binding lectin gene variants on its protein levels and macrophage phagocytosis with live Mycobacterium tuberculosis in pulmonary tuberculosis

Mannose-binding lectin (MBL) plays an important role in innate immunity. Functional mutant homozygotes of the MBL gene affect the serum MBL levels and have been correlated with disease susceptibility. We have studied the regulatory role of variant MBL genotypes on serum MBL level and macrophage phagocytosis with live Mycobacterium tuberculosis, and the lymphoproliferative response to M. tuberculosis culture filtrate antigen in pulmonary tuberculosis (PTB) patients (n = 48) and normal healthy subjects (NHS) (n = 58). The total serum MBL level was higher in PTB patients than in NHS (P = 0.0085). Patients and NHS with AA genotype (homozygotes of MBL - common alleles) showed a very high serum MBL level, and those with OO genotype (functional mutant homozygotes of MBL - less frequent alleles) showed a very low MBL level (AA vs. OO: NHS, P = 3.3 x 10(-9); PTB, P = 3.1 x 10(-9)). A significantly lower phagocytosis was observed in NHS with AA genotype than in NHS with AO (heterozygotes) genotype (P = 0.046). In PTB patients, no such difference was observed. A negative correlation of macrophage phagocytosis with MBL level was seen in patients and NHS (P = 0.019). Antigen-induced lymphoproliferative response was significantly decreased in PTB patients with AA genotype as compared with NHS with AA genotype (P = 0.036). The present study suggests that AA genotype with its associated higher serum MBL levels plays a regulatory role in immunity to tuberculosis than functional mutant homozygotes (OO genotype) with its associated lower level of MBL.     

Funding the NHS. Is the NHS sustainable?

The survival of the NHS lies largely in the hands of government, and this article suggests steps that it should take to deal with pressures on the NHS in terms of funding, managing efficiency, and demands. Changes to the system of funding may be unfeasible, but management could be improved by research to allow greater understanding of the local effects of national policies. Alternatively health authorities could be given more freedom to manage funds, although this would have to be accompanied by stiff sanctions for those who failed. Demand could be contained by strengthening policies to ensure that new technologies are cost effective. The government could try to reduce demands arising from increased expectations by encouraging informed public debate about priorities and influencing the availability of private health care. All these efforts should be guided by the values underpinning the NHS, which should be debated and decided collectively and confirmed in a new charter for NHS''s 50th anniversary in 1998.     

Discriminant analysis of ribotype profiles of Escherichia coli for differentiating human and nonhuman sources of fecal pollution.

Estuarine waters receive fecal pollution from a variety of sources, including humans and wildlife. Escherichia coli is a ubiquitous bacterium in the intestines of warm-blooded animals and is used as an indicator of fecal pollution. However, its presence does not specifically differentiate sources of pollution. A total of 238 E. coli isolates from human sources (HS) and nonhuman sources (NHS) were collected from the Apalachicola National Estuarine Research Reserve, from associated sewage treatment plants, and directly from animals and tested for ribotype (RT) profile. HS and NHS isolates showed 41 and 61 RT profiles, respectively. At a similarity index of ca. 50%, HS and NHS isolates demonstrated four clusters, with the majority of HS and NHS isolates located in clusters C and D; isolates obtained directly from human and animal feces also could be grouped within these clusters. Discriminant analysis (DA) of RT profiles showed that 97% of the NHS isolates and 100% of the animal fecal isolates were correctly classified. The average rate of correct classification for HS and NHS isolates was 82%. We conclude that DA of RT profiles may be a useful method for identifying HS and NHS fecal pollution and may potentially facilitate management practices.     

Managed care. Origins,principles, and evolution.

Managed care has entered the lexicon of healthcare reform, but confusion and ignorance surround its meaning and purpose. It seeks to cut the costs of health care while maintaining its quality, but the evidence that it is able to achieve these aims is mixed. As well as raising awareness and understanding of the issues surrounding managed care, this series considers whether managed care is desirable for the NHS. Developed in the United States as a response to spiralling healthcare costs and dysfunctional fragmented services, managed care is not a discrete activity but a spectrum of activities carried out in a range of organisational settings. Due to its constantly changing nature, managed care is a slippery concept--but all its permutations have in common an attempt to influence and modify the behaviour and practice of doctors and other health professionals towards cost effective care. Whatever potential managed care may hold in this regard, careful appraisal of its implications is essential.     

Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

ObjectiveTo compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.MethodsThe adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators.ResultsThe per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS.ConclusionsThe widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology.

What is already known on this topic

Comparisons of healthcare systems in different countries have to be undertaken with great care but can be instructiveThe overall healthcare system in the United States is more expensive than the NHS and population health outcomes are no betterThe US healthcare system comprises many discrete and unique subsystems, including the health maintenance organisations

What this paper adds

An integrated, non-profit health maintenance organisation in California (Kaiser Permanente), with over six million members, costs about the same as the NHS but performs considerably betterKaiser''s superior performance is mainly in prompt and appropriate diagnosis and treatmentThese findings challenge the widely held view that the NHS is efficient and that its inadequacies are mainly due to underinvestment     

Identification of the Plasma Metabolomics as Early Diagnostic Markers between Biliary Atresia and Neonatal Hepatitis Syndrome

Early detection is the most effective way to improve the clinical outcome of biliary atresia (BA). Emerging metabolomics provides a powerful platform for discovering novel biomarkers and biochemical pathways to improve early diagnosis. The aim of this study is to find the potential biomarkers to distinguish BA from neonatal hepatitis syndrome (NHS) by using a metabolomics method. We comprehensively analyzed the serum metabolites in a total of 124 blood samples from patients with BA or neonatal hepatitis syndrome (NHS) and from normal individuals using advanced metabolomic approaches, and found that the levels of glutarylcarnitine (C5DC) significantly increased in the BA group while the levels of threonine (Thr) significantly rose in the NHS group comparing with the other groups. The levels of glutamic acid (Glu) in the BA group were significantly elevated compared to those in the NHS group, but still lower than the hyperbilirubinemia and normal controls. The levels of propionyl carnitine (C3), isovaleryl carnitine (C5) and glutamine (Gln) were reduced in the BA group compared to those in the NHS group, but still higher than the hyperbilirubinemia and normal controls. This study demonstrates the possibility of metabolomics as non-invasive biomarkers for the early detection of BA and also provides new insight into pathophysiologic mechanisms for BA.