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基于复杂适应系统理论的我国卫生技术评估实施机制研究
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作者 曾华堂 柯夏童 +3 位作者 黄存瑞 伍丽群 杜芳 梁万年 《中国卫生经济》 北大核心 2023年第5期1-4,40,共5页
目的:探究我国卫生技术评估的实施现状和运行机制。方法:结合复杂适应系统理论,解析我国卫生技术评估实施的标识机制、积木块机制和内部模型机制。结果:从标识机制看,我国卫生技术评估的政策环境良好,但地方层面的机构体系和人才体系仍... 目的:探究我国卫生技术评估的实施现状和运行机制。方法:结合复杂适应系统理论,解析我国卫生技术评估实施的标识机制、积木块机制和内部模型机制。结果:从标识机制看,我国卫生技术评估的政策环境良好,但地方层面的机构体系和人才体系仍不成熟;从积木块机制看,不同的主体在卫生技术评估实施过程中有不同的工具,但方法指南和流程框架存在不权威、不透明的问题;从内部模型机制看,卫生技术评估的需方和供方之间的需求和预期成效沟通有限,导致研究成果不能转化为政策落实。结论:卫生技术评估是1个复杂适应系统,涉及到多方利益主体之间、主体与环境之间的交互作用,需要用系统的思维进一步重构实施机制。 展开更多
关键词 卫生技术评估 实施机制 复杂适应系统理论
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热浪定义对其健康效应评估的影响:以泰国为例 被引量:3
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作者 徐志伟 童世庐 +3 位作者 胡文彪 程健 黄存瑞 郑浩 《环境与职业医学》 CAS CSCD 北大核心 2020年第1期3-8,共6页
[背景]热浪在全球很多国家都是高致死率的自然灾害,对公众健康造成严重威胁。但目前在全球范围内,对于如何定义热浪,尚无共识。[目的]探讨热浪定义对其健康效应评估的影响,为热浪预警系统的建立提供依据。[方法]收集泰国60个省1999年1月... [背景]热浪在全球很多国家都是高致死率的自然灾害,对公众健康造成严重威胁。但目前在全球范围内,对于如何定义热浪,尚无共识。[目的]探讨热浪定义对其健康效应评估的影响,为热浪预警系统的建立提供依据。[方法]收集泰国60个省1999年1月1日—2008年12月31日的气象与各死因死亡数据。气象数据具体包括每日最高气温、最低气温、平均气温、相对湿度。各死因包括总死亡和因缺血性心脏病、肺炎、糖尿病引起的死亡,具体死因根据国际疾病伤害及死因分类标准第十版(ICD10)编码。采用准泊松非线性分布滞后模型来评估热浪对泰国人群死亡风险的短期影响,并比较热浪期间总死亡和各死因的死亡风险在不同热浪定义(强度和持续时间)下的变化。其中,热浪强度定义分别为每日平均气温的第90百分位数(P90)和P95、P97、P98;持续时间包括≥2 d、≥3 d、≥4 d。采用随机效应meta分析定量合并60个省的结果,计算热浪对泰国人群各疾病死亡的总效应值,即以相对危险度(RR)及其95%可信区间(CI)的大小衡量人群对热浪敏感性的高低。[结果]相比于非热浪期间,热浪期间人群总死亡和各死因死亡风险均升高。在低强度的热浪期间(平均气温>P90且持续≥2 d),总死亡的风险增高12.8%(95%CI:10.6%~15.1%)。热浪期间人群死亡的RR,并非完全随着热浪强度或持续时间的增加而增加。在持续≥2 d时,肺炎引起的死亡[RR(95%CI)为1.42(1.27~1.59)]和糖尿病引起的死亡[RR(95%CI)为1.34(1.17~1.52)],对以P97定义的热浪最敏感;而总死亡(RR:1.16,95%CI:1.13~1.20)和缺血性心脏病引起的死亡(RR:1.35,95%CI:1.24~1.48),对以P95定义的热浪最敏感。而以P98定义时为例,糖尿病引起的死亡风险随着热浪持续时间的增加而增加,但总死亡和肺炎引起的死亡风险随着热浪持续时间的增加而降低。[结论]本研究提示,不同强度和持续时间定义模式下的热浪,对疾病死亡风险的影响有差异。因此在热浪预警系统和其他热浪适应性政策的制定中,根据各地区人群的热浪易感性特点,量体裁衣式地使用热浪定义,可能更有利于保障人群健康。 展开更多
关键词 热浪 定义 健康效应 泰国 预警系统
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The half-degree matters for heat-related health impacts under the 1.5℃ and 2℃ warming scenarios: Evidence from ambulance data in Shenzhen, China 被引量:2
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作者 HE Yi-Ling DENG Shi-Zhou +9 位作者 HO Hung Chak WANG Hui-Bin CHEN Yang Shakoor HAJAT REN Chao ZHOU Bai-Quan CHENG Jian Wenbiao HU MA Wen-Jun huang cun-rui 《Advances in Climate Change Research》 SCIE CSCD 2021年第5期628-637,共10页
The Paris Agreement has prompted much interest in the societal and health impacts of limiting global warming to 1.5 ℃ and 2 ℃. Previous assessments of differential impacts of two targets indicate that 1.5 ℃ warming... The Paris Agreement has prompted much interest in the societal and health impacts of limiting global warming to 1.5 ℃ and 2 ℃. Previous assessments of differential impacts of two targets indicate that 1.5 ℃ warming target would substantially reduce the impact on human health compared to 2 ℃, but they mainly focused on the magnitude of temperature changes under future climate change scenarios without any consideration of greater frequency of cumulative heat exposures within a day. Here we quantified the health risks of compound daytime and nighttime hot extremes using morbidity data in a megacity of China, and also identified the time-period of heat exposure with higher risks. Then we projected future morbidity burden attributable to compound hot extremes due to the half-degree warming. We estimated that the 2 ℃ warming scenario by 2100 as opposed to 1.5 ℃ would increase annual heat-related ambulance dispatches by 31% in Shenzhen city. Substantial additional impacts were associated with occurrence of consecutive hot days and nights, with ambulance dispatches increased by 82%. Our results suggested that compound hot extremes should be considered in assessment of heat-related health impacts, particularly in the context of climate change. Minimizing the warming of climate in a more ambitious target can significantly reduce the health damage. 展开更多
关键词 Climate change Compound hot extreme Paris agreement Human health Morbidity effect
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Establishment and validation of health vulnerability and adaptation indices under extreme weather events on the basis of the 2016 flood in Anhui province,China
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作者 ZHONG Shuang CHENG Qiu +1 位作者 huang cun-rui WANG Zhe 《Advances in Climate Change Research》 SCIE CSCD 2021年第5期649-659,共11页
Climate change could intensify extreme weather events,such as flooding,which amplifies the public health threat of waterborne diseases.Thus,assessing health vulnerability and adaptation(V&A)could facilitate nation... Climate change could intensify extreme weather events,such as flooding,which amplifies the public health threat of waterborne diseases.Thus,assessing health vulnerability and adaptation(V&A)could facilitate nationally effective responses to extreme climate events.However,related studies are still negligible,and the assessment urgently needs to be validated with actual health data after extreme weather events.We established health V&A indices through literature review and factor analyses.Then,we separately mapped the spatial distribution of flood exposure,social and public health sensitivity,and adaptive capacity before the 2016 flood in Anhui province and compared it with post-flood diarrhea risks by using the geographic information system method to assess health vulnerability.Finally,we validated the indices by exploring the relationship between health V&A indices and post-flood diarrhea risks by using the quantile regression model.Results revealed that health V&A can be framed and categorized as key components of exposure,sensitivity,and adaptive capacity.The remarkable differences in the spatial distribution of health vulnerability were generally consistent with the demographic sensitivity,geographic flooding exposure,and post-flood diarrhea risks in Anhui.In addition,health V&A indices exerted significant positive impacts on infectious diarrhea post-flooding at all quantiles and were significant across different percentiles.Moreover,the impacts of flood exposure on total infectious diarrhea were high and continuous,whereas the impacts of sensitivity were not obvious in the flood's early stage(Coeff=0.643;p<0.001)but high in the flood's middle(Coeff=0.997;p<0.001)and late stages(Coeff=0.975;p<0.001).However,the impacts of adaptive capacity were heterogeneous and high in the flood's early stage(Coeff=0.665;p<0.001 at the 25th percentile)and late stage(Coeff=1.296;p<0.001 at the 75th percentile)but were insignificant at the 50th percentile.This study contributed validated three-layered health V&A indices with 30 indicators and identified that the impacts of the key components on post-flood waterborne-disease risks are heterogeneous.For instance,local public health sensitivity and adaptive capacity are insufficient to reduce these risks in the long run.This study could be used to project population health risks after extreme weather events and thereby contributes to local government planning of health adaptation. 展开更多
关键词 Climate change Climate extreme events China DIARRHEA FLOOD Health vulnerability and adaptation
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