“陆上定居”对渔民生计的影响

广东北江上的渔民世代居住在船上,船是家也是谋生工具。2009年韶关政府推行了渔民"陆上定居"工程,将生活在韶关城区河上的渔民迁移到城市廉租房中。运用定性的方法考察渔民家庭重新安置的过程,探索陆上定居对渔民家庭生计的影响及家庭不同成员影响的代际差异。研究发现,渔民家庭整体生存状况因"陆上定居"得到较大改善,但这种影响所带来的代际差异非常明显:老年男性渔民无法适应城市的生活,依然独自从事捕鱼作业,而老年女性和子女居住在廉租房,承担了未成年人的照顾和家务活动;年轻人更快地融入了城市,工作机会和收入都改善了;而对未成年人,拥有了更好的教育条件和更大的社交圈。

Risk prediction of advanced colorectal neoplasia varies by race and neighbourhood socioeconomic status

Objective Neighbourhood deprivation increases the risk of colorectal neoplasia and contributes to racial disparities observed in this disease.Developing race-specific advanced colorectal neoplasia(ACN)prediction models that include neighbourhood socioeconomic status has the potential to improve the accuracy of prediction.Methods The study includes 1457 European Americans(EAs)and 936 African Americans(AAs)aged 50–80 years undergoing screening colonoscopy.Race-specific ACN risk prediction models were developed for EAs and AAs,respectively.Area Deprivation Index(ADI),derived from 17 variables of neighbourhood socioeconomic status,was evaluated by adding it to the ACN risk prediction models.Prediction accuracy was evaluated by concordance statistic(C-statistic)for discrimination and Hosmer-Lemeshow goodness-of-fit test for calibration.Results With fewer predictors,the EA-specific and AA-specific prediction models had better prediction accuracy in the corresponding race/ethnic subpopulation than the overall model.Compared with the overall model which had poor calibration(P_(Calibration)=0.053 in the whole population and P_(Calibration)=0.011 in AAs),the EA model had C-statistic of 0.655(95%CI 0.594 to 0.717)and P_(Calibration)=0.663;and the AA model had C-statistic of 0.637((95%CI 0.572 to 0.702)and P_(Calibration)=0.810.ADI was a significant predictor of ACN in EAs(OR=1.24((95%CI 1.03 to 1.50),P=0.029),but not in AAs(OR=1.07((95%CI 0.89 to 1.28),P=0.487).Adding ADI to the EA-specific ACN prediction model substantially improved ACN calibration accuracy of the prediction across area deprivation groups(P_(Calibration)=0.924 with ADI vs P_(Calibration)=0.140 without ADI)in EAs.Conclusions Neighbourhood socioeconomic status is an important factor to consider in ACN risk prediction modeling.Moreover,non-race-specific prediction models have poor generalisability.Race-specific prediction models incorporating neighbourhood socioeconomic factors are needed to improve ACN prediction accuracy.

Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.