湖北省公立医院成本补偿机制研究

目的 了解湖北省对公立医院的财政投入,医院收入比例及收支平衡情况。方法 根据财政投入及医院收支的相关数据,利用定性与定量分析,对比的分析方法,研究2007—2009年湖北省公立医院财政补偿情况及其收支的变化情况。结果 政府财政补助有所提高,年均增幅达到28.83%,但在医院收入中所占比例仅占7%左右,低于全国平均水平。公立医院医疗收入最高,占医院收入比例的50%左右。其次为药品收入,将近占到总收入的40%。医院收支基本保持平衡,但是大多负债率较高。结论 应该调整政府财政补偿力度与着重点,改变现有公立医院的收入结构,以保证公立医院健康稳定的发展。     

我国公立医院与社区卫生服务中心合作模式的比较与分析

通过文献评阅、专家访谈和现场调研等方法,对我国公立医院和社区卫生服务中心目前的合作模式进行了归纳,并对每种模式的成效、优缺点进行了分析。

     

香港特区公营医院运行机制评估及对内地的启示

回顾香港医疗融资的发展历程并简述香港公营医院的运营状况与开支构成比,重点分析香港公营医院的管理机构——香港医院管理局,研究其宗旨任务与目标策略相结合的管理医院管理战略,跟踪其主要经费来源的变化趋势,对其财务状况进行深入探究并进行预测。在对香港公营医院运行机制进行评估的基础上,探讨香港公营医院存在的问题以及对内地的启示,为内地医院管理机构借鉴香港逐步建立以政府投入为主体的医疗融资体系提供参考。     

Institutionalization of Life-Cycle Thinking in the Everyday Discourse of Market Actors

The widespread popularity of life-cycle assessment (LCA) is difficult to understand from the point of view of instrumental decision making by economic agents. Ehrenfeld has argued, in a 1997 issue of this journal, that it is the world-shaping potential of LCA that is more important than its use as a decision-making tool. The present study attempts to explore the institutionalization of this "LCA world view" among ordinary market actors. This is important because environmental policy relies increasingly on market-based initiatives. Cognitive and normative assumptions in authoritative LCA documents are examined as empirical data and compared with data from focus group interviews concerning products and the environment with "ordinary" manufacturers, retailers, and consumers in Finland. These assumptions are (1) the "cradle-to-grave" approach, (2) the view that all products have an environmental impact and can be improved, (3) the relativity of environmental merit, and (4) the way responsibility for environmental burdens is attributed. Relevant affinities, but also differences, are identified. It is argued that life-cycle thinking is not primarily instrumental, but rather is gaining a degree of intrinsic value. The study attempts to establish a broader institutional context in which the popularity of LCA can be understood. From the point of view of this broader context, some future challenges for the development of LCA and life-cycle thinking are suggested.     

Foraging nine-spined sticklebacks prefer to rely on public information over simpler social cues

Social animals can observe others' behavior and in the processacquire information of varying quality about a given resource.Theoretical models predict that blind copying of others' behavioris more likely when individuals are only able to observe thedecisions (here "social cues") of others rather than the cues(here "public information") on which such decisions are based.We investigated information use by nine-spined sticklebacks(Pungitius pungitius) in a two-patch foraging context. Socialcues were provided by the number of demonstrator fish presentat each patch (two versus six), which either conflicted withthe demonstrators' observed feeding rate at each patch (publicinformation) or was the only information available. Consistentwith predictions, observers preferred the patch previously associatedwith six demonstrators when social cues were the only availablesource of information but preferred the patch previously associatedwith two demonstrators ("rich" patch) when also provided withpublic information. On the bases of these experiments, we arguethat it is because these fish preferentially base decisionson public information rather than social cues that they canpotentially avoid engaging in erroneous informational cascades.Thus, the availability of public information can help socialanimals make adaptive decisions.     

Persistence of Escherichia coli O157 on farm surfaces under different environmental conditions

AIMS: To compare the persistence of Escherichia coli O157 on a variety of common faecally contaminated farmyard material surfaces (wood and steel) under different moisture and temperature regimes. METHODS AND RESULTS: Samples of field-conditioned farmyard materials (galvanized steel and wood) were cut into pieces and contaminated with fresh cattle faeces inoculated with nontoxigenic E. coli O157 (strain 3704). Thereafter, they were stored at four different environmental conditions; with temperature (5 and 20 degrees C) and moisture (moist or dry) as variables. Transfer of the pathogen to hands from the surfaces was also evaluated. Escherichia coli O157 numbers declined over time on all surfaces albeit at different rates according to the sample material and environmental conditions. Persistence was greatest on moist wood samples under cooler temperatures with large population numbers remaining after 28 days. Desiccation of surfaces resulted in a more rapid decline in E. coli O157 populations under both temperature regimes. Substantial numbers of colonies may also potentially be transferred to human hands from the surfaces during brief contact. CONCLUSIONS: When environmental conditions are favourable, E. coli O157 may persist for considerable times on a range of surfaces. However, when exposed to higher temperatures and dehydration, survival is notably decreased. Overall, bacterial persistence was significantly greater on wood samples relative to steel. SIGNIFICANCE AND IMPACT OF THE STUDY: Escherichia coli O157 is a prevalent pathogen, common in ruminant faeces. Contact with contaminated faeces may lead to human infection, resulting in possible severe illness. Although our study used only one strain of bacteria, our findings indicates that E. coli O157 has the potential to persist for long periods of time on gates, stiles and other farmyard surfaces under a range of environmental conditions. These farmyard surfaces therefore pose a potential infection pathway particularly where there is a high risk of direct human contact (e.g. child petting zoos, open farms).     

The Australian White Ibis (Threskiornis molucca) as a Reservoir of Zoonotic and Livestock Pathogens

Over the last 20 years, Australian white ibis populations (Threskiornis molucca) have expanded into urban areas, leading to increased contact between ibis, domestic animals, and humans. This has led to concern that ibis may transmit pathogens that threaten public health or food production. Here we report results from a study of ibis viral serology and bacterial culture that indicate that ibis are hosts of zoonotic and livestock pathogens such as Salmonella spp., Newcastle disease virus, avian influenza virus, and flaviviruses in Australia. We also performed a behavioral study to measure contact rates among ibis, people, and livestock that determine the potential for disease transmission.     

Do Energy Density and Dietary Fiber Influence Subsequent 5‐Year Weight Changes in Adult Men and Women?

Objective: We examined whether associations between dietary components and, in particular, energy density (ED) predicted subsequent 5‐year weight changes. Research Methods and Procedures: The present longitudinal population study was part of the Danish World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) and the 1936 cohort dietary studies. Effects of components were studied in relation to subsequent 5‐year weight changes in 862 men and 900 women, 30 to 60 years old. Linear multiple regression analyses were conducted. Results: Mean 5‐year changes in body weight (BW) were 1.2 ± 3.9 and 1.3 ± 4.6 kg for men and women, respectively. In general, neither ED nor any of the dietary components was associated with subsequent change in BW. In women, ED was positively associated with weight gain among the obese (BMI > 30 kg/m²) and inversely associated with weight gain in normal‐weight women (BMI < 25 kg/m²) (p = 0.01). However, in men there was a non‐ significant inverse trend between ED and weight gain in the obese and no significant interaction. Discussion: To our knowledge, this is the first prospective study to examine the associations between ED and subsequent changes in BW, and despite a general belief that ED is a major determinant of obesity, the present study did not generally lend support for an association. However, among certain subgroups, an energy‐dense diet may be a risk factor for weight development.     

Life Cycle Approach in the Procurement Process: The Case of Defence Materiel (9 pp)

Goal, Scope and Background Procurement in public and non-public organisations has the potential to influence product development towards more environmentally friendly products. This article focuses on public procurement with procurement in Swedish defence as a special case. In 2003, public procurement in Sweden was 28% of the GDP. In the Swedish defence sector the amount was 2% of the GDP. The total emissions from the sector were of the same order of magnitude as from waste treatment (2% of Sweden's emissions). According to an appropriation letter from the Ministry of Defence in 1998, the Swedish Armed Forces (SAF) and the Swedish Defence Materiel Administration (FMV) are required to take environmental issues into consideration during the entire process of acquiring defence materiel. Environmental aspects are considered today, but without a life-cycle perspective. - The aims of this article are to recommend suitable tools for taking environmental concerns into account, considering a product's life-cycle, in the procurement process for defence materiel in Sweden; to make suggestions for how these tools could be used in the acquisition process; and to evaluate these suggestions through interviews with actors in the acquisition process. The procurement process does not include aspects specific to Swedish defence, and it is therefore likely to be comparable to processes in other countries. Methods The method involved a study of current literature and interviews with various actors in the acquisition process. The life cycle methods considered were quantitative Life Cycle Assessments, a simplified LCA-method called the MECO method and Life Cycle Costing (LCC). Results and Discussion Methodology recommendations for quantitative LCA and simplified LCA are presented in the article, as well as suggestions on how to integrate LCA methods in the acquisition process. We identified four areas for use for LCA in the acquisition process: to learn about environmental aspects of the product; to fulfil requirements from customers; to set environmental requirements and to choose between alternatives. Therefore, tools such as LCAs are useful in several steps in the acquisition process. Conclusion From the interviews, it became clear that the actors in the acquisition process think that environmental aspects should be included early in the process. The actors are interested in using LCA methods, but there is a need for an initiative from one or several of them if the method is to be used regularly in the process. Environmental and acquisition issues are handled with very little interaction in the controlling and ordering organisation. An integration of environmental and acquisition parts in these organisations is probably needed in order to integrate environmental aspects in general and life-cycle thinking in particular. Other difficulties identified are costs and time constraints. Recommendation and Perspective In order to include the most significant aspects when procuring materiel, it is important to consider the whole life-cycle of the products. Our major recommendation is that the defence sector should work systematically through different product groups. For each product group, quantitative, traditional LCAs or simplified LCAs (in this case modified MECOs) should be performed for reference products within each product group. The results should be an identification of critical aspects in the life-cycles of the products. The studies will also form a database that can be used when making new LCAs. This knowledge should then be used when writing specifications of what to procure and setting criteria for procurement. The reports should be publicly available to allow reviews and discussions of results. To make the work more cost-effective, international co-operation should be sought. In addition, LCAs can also be performed as an integrated part of the acquisition process in specific cases.     

Patterns of bushmeat hunting and perceptions of disease risk among central African communities

There is a great need to determine the factors that influence the hunting, butchering and eating of bushmeat to better manage the important social, public health and conservation consequences of these activities. In particular, the hunting and butchering of wild animals can lead to the transmission of diseases that have potentially serious consequences for exposed people and their communities. Comprehension of these risks may lead to decreased levels of these activities. To investigate these issues, 3971 questionnaires were completed to examine the determinants of the hunting, butchering and eating of wild animals and perceptions of disease risk in 17 rural central African villages. A high proportion of individuals reported perceiving a risk of disease infection with bushmeat contact. Individuals who perceived risk were significantly less likely to butcher wild animals than those who perceived no risk. However, perception of risk was not associated with hunting and eating bushmeat (activities that, compared with butchering, involve less contact with raw blood and body fluids). This suggests that some individuals may act on perceived risk to avoid higher risk activity. These findings reinforce the notion that conservation programs in rural villages in central Africa should include health-risk education. This has the potential to reduce the levels of use of wild animals, particularly of certain endangered species (e.g. many non-human primates) that pose a particular risk to human health. However, as the use of wild game is likely to continue, people should be encouraged to undertake hunting and butchering more safely for their own and their community's health.