Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients’medication adherence:a cross-sectional study in Shandong Province,China

Background:Primary health care system is a critical component of diabetes care and management.This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions(PHIs)in China,and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus(T2DM)patients.Methods:This cross-sectional study conducted in Shandong Province,eastern China(hereafter referred to as Shandong),between August and December 2017.In total,2520 community-managed T2DM patients were selected from 68 PHIs in Shandong,including 62 village-level and 6 township-level PHIs.The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs.Patients’medication adherence was assessed by four self-reported questions,and was classified as either adherent or non-adherent.Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients.Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’medication adherence.Results:A total of 1866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis.Among them,58.5%patients followed their antidiabetic treatment well.In village-level PHIs,the patient’s adherence rate was lower than in township-level PHIs(55.9%vs.61.1%,P<0.05).Among the 68 PHIs,average(2.53±0.97)glucose-lowering products(generic names)were available,which in village-level PHIs were less than in township-level PHIs(2.47 vs.3.17,P<0.05).And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients.Conclusion:Poor availability of glucose-lowering products was found in PHIs in Shandong.The availability of glucose-lowering products in PHIs was positively associated with patients’medication adherence,and could be enhanced to improve the control of diabetes in primary care settings.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.

Study on the demand for public health professional after the COVID-19 epidemic in Zhejiang Province, China: A survey based on human-machine collaboration

To understand the needs of public health institutions in Zhejiang Province,China for public health personnel,and provide basis for training public health personnel.Methods:512 public health institutions in Zhejiang Province were randomly selected from different levels and regions,and the number of ublic health professional and the demand for professional ability were investigated by questionnaire.Results:The preventive medicine personnel in public health institutions in Zhejiang Province are insufficient;There is a certain disjunction or dislocation between the abilities and needs of public health professional;The way of continuing education for public health professional is single and the opportunities are few.Conclusion:Zhejiang Province should appropriately expand the enrollment of preventive medicine majors,especially high-level preventive medicine talents,deepen the education and teaching reform of preventive medicine majors,and strengthen the continuing education and training of public health professional to meet the needs of public health services after the COVID-19 epidemic.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

文化-认知制度对体育与健康课程变革实施行为的影响——基于新制度分析的框架

基于新制度主义的分析框架,将我国体育与健康课程的变革实施放置在制度生态理论中加以解读,从而明确了体育与健康课程变革实施中出现的“有法不依、有令不行”的困境,在很大程度上受制于文化-认知制度的影响。研究深入剖析了文化-认知制度积淀的“应试图式”“身份图式”和“教学图式”对体育与健康课程实施行为的影响,提出了3个方面的优化策略,即落实和强化监督与问责的机制,实现对课改推行的有效控制;科学谋划制度安排的权力,引领和建构体育教师正确的身份认知;尊重和干预体育教师的内生性权力,促进体育教师专业能力的增强。

强基层:深圳南山区域医疗联合体的策略和效果

目的分析区域医疗联合体(以下简称“医联体”)政策指引下深圳南山区域医联体发展的探索,为其他地区医药卫生体制改革提供参考。方法通过知情人访谈、现场调研、二次资料分析、头脑风暴等方法剖析深圳南山区域医联体强基层的策略背景、实施内容和实施效果。结果统一管理所有基层医疗卫生机构,实行标准化建设,有助于更好地发展基层医疗卫生机构;实施区域学科联盟,以契约方式加强医院和基层医疗卫生机构的人员联系,具有可行性。结论强基层是医药卫生体制改革的重点,深圳南山区域医联体强基层的策略具有参考借鉴价值。

Remuneration Reforms in Public Sector： A Case of Russian Healthcare

In 2008 remuneration reform for public sector was introduced in Russia. Its main idea was to implement P4P principle well-known in business, including more flexible approach to wage setting. This paper presents an attempt to estimate an influence of the new remuneration system （NRS） on earnings level, inequalities and job motivation. The estimates are based on microdata of monitoring survey of healthcare economic problems conducted in Russia in 2009 and 2010. The extended specification of Mincer earning equation and probit-models were used. One could observe increasing wage rates and earning inequalities within healthcare institutions adopted NRS though worker＇s experience and regional economic differences remain significant wage determining factors. As it occurs, NRS is widely adopted by large regional and central hospitals while smaller health care institutions show less enthusiasm in implementing reform. Obviously, the larger institutions have more money and better educated administrative staff to introduce the new system. Those chief physicians who adopted NRS point out a positive correlation between earnings and individual input. At the same time, those committed to old principles of wage setting more often note declining job turnover. This latter result could possibly indicate negative personnel sorting, less productive workers tending to stay with employer who doesn＇t assess their performance. As concerns anticipated NRS results such as increasing motivation and quality of health services, the evidence is still ambiguous.

National Institutes of Health Funding for disease categories related to Neural Regeneration Research

The National Institutes of Health （NIH）, a part of the U.S. Department of Health and Human Services, is the nation＇s medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

Description of the National Institutes of Health

Introduction The National Institutes of Health （NIH）, a part of the U.S. Department of Health and Human Services is the nation＇s medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

INSTITUTE OF ENVIRONMENTAL HEALTH AND ENGINEERING CHINESE ACADEMY OF PREVENTIVE MEDICINE

The Institute of Environmental Health and Engineering,consisting of the previousDepartment of Environmental Health and the Department of Sanitary andEnvironmental Engineering of the Institute of Health founded in 1954,was establishedin1986.This Institute has around 220 staff in total and 11 departments,namely,theDepartment of Environmental Epidemiology;Department of EnvironmentalChemistry;Department of Environmental Toxicology;Department of EnvironmentalMicrobiology;Department of Soil Hygiene;Department of Water Treatment;

上海妇幼保健系统党员和业务骨干“双培养”工作现状与对策建议

目的调查当前上海市妇幼保健机构党员和业务骨干“双培养”工作现状,对本系统人才队伍建设提出对策建议,为打造一支政治过硬、业务精湛、作风优良的妇幼健康人才队伍打好基础。方法通过召开1场人才工作专题会,发放17张机构调查表和321份调查问卷,到3个区妇幼保健院(所)实地调研,收集17家机构工作总结等方式,了解2020—2022年上海市、区两级17家妇幼保健机构党员和业务骨干“双培养”工作情况。结果上海妇幼保健系统党员和业务骨干“双培养”工作在机制建设、思想引领和培养方式上已经取得一定成效,但在受访者中,仍有39.75%对该项工作不了解;57%的非党员业务骨干不愿意或不确定是否入党;82名非业务骨干党员认为自身与业务骨干在工作格局(27.27%)、管理能力(24.43%)、业务能力(14.2%)和人际沟通能力(11.93%)等方面存在差距。结论本市妇幼保健系统要进一步加强党员和业务骨干“双培养”工作的推进力度:一要立足“党管”、立足“精准”、立足“长远”;二要加强对业务骨干思想引领和文化引领;三要实现党员工作格局、职业素养和综合实力三方面超越,从而不断提升人才素质,夯实妇幼事业的人才基础。

Shadow Extraction and Elimination of Moving Vehicles for Tracking Vehicles

Shadow extraction and elimination is essential for intelligent transportation systems(ITS)in vehicle tracking application.The shadow is the source of error for vehicle detection,which causes misclassification of vehicles and a high false alarm rate in the research of vehicle counting,vehicle detection,vehicle tracking,and classification.Most of the existing research is on shadow extraction of moving vehicles in high intensity and on standard datasets,but the process of extracting shadows from moving vehicles in low light of real scenes is difficult.The real scenes of vehicles dataset are generated by self on the Vadodara–Mumbai highway during periods of poor illumination for shadow extraction of moving vehicles to address the above problem.This paper offers a robust shadow extraction of moving vehicles and its elimination for vehicle tracking.The method is distributed into two phases:In the first phase,we extract foreground regions using a mixture of Gaussian model,and then in the second phase,with the help of the Gamma correction,intensity ratio,negative transformation,and a combination of Gaussian filters,we locate and remove the shadow region from the foreground areas.Compared to the outcomes proposed method with outcomes of an existing method,the suggested method achieves an average true negative rate of above 90%,a shadow detection rate SDR(η%),and a shadow discrimination rate SDR(ξ%)of 80%.Hence,the suggested method is more appropriate for moving shadow detection in real scenes.

不同类型公立医疗卫生机构门诊患者满意度比较

目的 在控制门诊患者的人口学和临床特征后,比较不同类型公立医疗卫生机构的门诊患者满意度,为公立医疗卫生机构和卫生行政部门开展绩效考核提供参考信息。方法 对上海市107所公立医疗卫生机构开展门诊患者满意度问卷调查,通过多层混合线性模型分析和Snijders & Bosker法比较不同类型公立医疗卫生机构的门诊患者满意度。结果 在控制医疗卫生机构的随机效应以及其他固定效应后,公立三级综合医院和三级专科医院的门诊患者满意度相对较低,且高住院病例组合指数组医院的门诊患者总体满意度和对医生服务满意度有走低趋势。此外,公立医疗卫生机构类型可解释69.13%的机构间门诊患者总体满意度差异。结论 诸多因素可能导致公立三级医院门诊患者总体满意度相对较低,医疗卫生机构应聚焦于可控因素以提升门诊患者满意度。

2020年上海市公立医疗卫生机构门诊患者满意度调查

目的 分析2020年上海市公立医疗卫生机构的门诊患者满意度,为上海市公立医疗卫生机构改善服务质量和卫生行政部门加强服务质量的监管提供决策依据。方法 对上海市107所公立医疗卫生机构进行门诊患者满意度调查。结果 门诊患者对医疗服务满意度的总体评分平均为4.78分,但门诊患者对等候时间不满意或较不满意率相对较高。此外,机构间总体满意率差异较大。结论 2020年上海市公立医疗卫生机构门诊患者的满意度处于高水平,但部分公立医疗卫生机构应采取有效措施提高患者满意度,门诊等候时间应进一步缩短。

农村慢性病服务纵向整合的制度与激励因素研究回顾与展望

随着农村慢性病患病率的显著上升,农村县乡村的纵向整合是慢性病管理的重要趋势与发展方向。通过文献回顾、制度分析的方法,分析总结国内外农村纵向整合的制度与激励现状,从不同利益相关者角度探究针对我国农村慢性病服务纵向整合的制度完善路径。

推进乡村卫生组织一体化的障碍——基于行动者中心的制度主义分析

推进乡村卫生一体化管理是深化医药卫生体制改革中的一项重要举措。然而,全国各地在实施过程中障碍重重,进程并不顺利。对此,本文以乡村卫生组织一体化模式为例,运用行动者中心的制度主义这一理论工具,结合广东省13县(市)关键行动者的现场访谈,从政策制定者、实施者与政策目标对象的互动出发,分析相关行动者的特征、行动者格局和相互间的互动模式,剖析推进的障碍因素,揭示一体化政策实施过程的复杂性。最后,提出从政策资源、财政资金资源和组织资源投入的角度,建立乡村卫生组织一体化推进策略。

上海市公立医疗卫生机构出院患者对医疗服务的满意度及其测评方法的利弊

目的 分析上海市公立医疗卫生机构出院患者对医疗服务的满意度及满意度测评方法的利弊,为完善住院医疗服务及其满意度测评方法提供决策参考。方法 就上海市99所公立医疗卫生机构出院患者对医疗服务的满意度开展电子问卷调查。结果 2020年上海市公立医疗卫生机构出院患者对医疗服务总体满意度的平均分为4.58分,总体满意率为90.78%。出院患者对住院伙食或治疗饮食的不满意或较不满意率为6.35%。与对住院患者的调查结果相比,出院患者的调查应答率较低且存在应答对象偏倚,从中可更多了解患者的抱怨并提出改善建议。结论 上海市公立医疗卫生机构需进一步加强住院患者的伙食管理,住院患者或出院患者调查需提高可靠性。

历史制度主义视角下中国健康扶贫政策变迁与动力机制

健康扶贫政策是中国特色扶贫开发道路中积累的宝贵政策财富,健康扶贫政策的适时变迁也是巩固拓展脱贫攻坚成果和衔接乡村振兴的推动力量。以历史制度主义构建理论分析框架,中国健康扶贫政策的变迁历经了健康扶贫思想与政策萌芽、健康扶贫政策形成与发展和政策体系完善三个阶段,其变迁的动力机制表现为:宏观层面的政策环境、中观层面的路径依赖以及微观层面的行为主体互动。进入相对贫困时期后,新的时代任务将赋予健康扶贫更高的要求,中国的健康扶贫政策将朝着适应政策环境转变、强化正向路径依赖和加强行为主体互动的方向进一步演进。

Multi-Drug Resistant Acute Otitis Media amongst Children Attending Out-Patient Clinic in Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, South-East Nigeria

Objective: The study assessed microbial etiology and multi-drug resistant profile of the pathogens isolated from children diagnosed of acute otitis media (AOM) at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka. Method: Ear swab samples were collected aseptically from 40 children that visited the children out-patient clinic of the hospital. The samples were cultured within 20 minutes of collection and the isolates identified microbiologically. Antimicrobial susceptibility testing was done by Kirby-Bauer’s disc diffusion method. Results: A total of 2025 children visited the hospital during the study period and 40 (1.98%) had clinical diagnosis of acute otitis media. Ten (25%) of the 40 samples did not yield any microbial growth. Children aged ≤one year had the highest prevalence of AOM (55%). Staphylococcus aureus (34.9%) was the predominant bacteria isolate followed by Pseudomonas aeruginosa (30.2%) while Candida krusei (14%) was the predominant fungi isolate. All the bacterial isolates were resistant to ampicillin and coamoxiclav. Staphylococcus aureus isolates were marginally susceptible to gentamicin (60%) and sparfloxacin (73.3%). Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus were resistant to ceftriaxone, ciprofloxacin, streptomycin, cefuroxime, erythromycin and azithromycin. Nystatin and voriconazole had comparable effect (60%) against the fungal isolates and fluconazole was ineffective. Conclusion: The incidence of multiple antibiotic resistant bacteria associated with acute otitis media in the pediatric patient was very high. Empiric treatment of the infection in the community should be discouraged. AOM preventive strategies should be targeted on the very young children to reduce the risk of recurrence.

高职院校心理健康教育制度化研究——以盘锦职业技术学院心理健康教育实践为例

是否能确立具有明晰的职业教育特点的心理健康教育目标和重点,制定完善的心理健康教育教学纲要和课程体系,在院校内部形成统一的心理危机干预网状系统和质量评估、管理体系,将发展性教育和调适性教育有机结合,将素质教育与职业技能教育有机结合,将是高职院校开展心理健康教育工作中必须面对和解决的问题。为了更有针对性,有效地促进高职学生的身心全面发展和职业素质提升,促进高职院校心理健康教育的可持续性发展,加强高职院校心理健康教育制度化建设刻不容缓。