基于Bootstrap-Malmquist-DEA的公立三级综合医院全要素生产率测算与动态分解

目的：测算新医改以来我国公立三级综合医院全要素生产率及其变动情况。方法：采取系统分层典型抽样方法获取2012-2018年5个省份203家公立三级综合医院投入产出指标面板数据,应用Bootstrap-Malmquist-DEA方法计算样本医院的全要素生产率,并对其构成指数进行分解研究。结果：2012-2018年全要素生产率降低0.70%,技术效率降低6.76%,技术进步6.50%,纯技术效率降低4.80%,规模效率降低2.06%。结论：新医改以来我国公立三级综合医院全要素生产率存在轻微衰退,主要原因是纯技术效率和规模效率共同下降,技术进步是促进其提升的主要动因。建议公立医院加强内部精细化管理提升管理水平,依靠技术进步进一步缩短平均住院日;政府进一步加强公立医院规模控制,加大对经济欠发达省份医疗技术投入。     

县级公立医院综合改革实施前后医院生产率变化的研究

目的:研究县级公立医院综合改革政策实施前后山东省县级公立医院生产率变化情况。方法:选取代表医院投入的人、财、物指标,代表医院产出的年门诊总量、年住院总量等产出指标,使用Deap 2.1软件,分析10个县级公立医院从2010—2013年4年间的全要素生产率变化、技术效率变化和规模效率变化。结果:在县级公立医院综合改革前后山东省县级医院全要素生产率变化不显著;试点期的技术效率平均值低于试点前(effch试点期=0.990,effch试点前=1.020,t=2.188,P=0.021);试点期的技术进步平均值要高于试点前(tech试点期=0.980,tech试点前=1.032,t=-2.075,P=0.029);试点期对试点医院和非试点医院的全要素生产率、技术效率和技术进步等比较无差异。结论:县级公立医院综合改革政策的核心措施取消药品加成,起到了切断医院的"以药补医"顽疾的作用,有效的促进了医院医疗技术的提高,对实现医生的医疗服务价值有重要意义。     

福建省县级综合性公立医院运行效率变化分析

目的:研究福建省40家县级综合性公立医院的综合效率、技术效率和规模效率变化情况,以及全要素生产率随着时间变化的情况,为提高县级综合性公立医院运营效率提供决策依据和参考。方法:收集2009—2014年福建省40家县级综合性公立医院运营相关数据,运用数据包络分析法(DEA)的CCR、BCC和Malmquist模型进行分析。结果:40家县级综合性公立医院中绝大多数处于规模递减状态,2009—2014年的全要素生产率为1.019,21家(52.5%)医院生产率有所提高,其中3家医院生产率提高是由于技术进步,3家是由于效率提高,15家是由于技术进步和效率提高共同作用。结论:福建省县级综合性公立医院效率总体不足,且不同地区医院运行效率有差异,山区医院效率有所提高,沿海地区医院效率出现下降。因此,政府在加大对县级综合性公立医院投入时,应采取差别化政策,注意合理控制医院规模,同时应加强内涵建设,重视医疗技术的提升。     

湖南省17家改革试点县级公立医院运行效率DEA的评价

目的 基于DEA-BCC模型与DEA-Malmquist指数模型,评价湖南省17家改革试点县级公立医院2012、2013年的运行效率,为卫生决策者提供数据与理论支持。 方法 选取湖南省17家县级公立医院2012年与2013年的年报数据并筛选出投入产出指标,采用DEA-BCC模型分析2012与2013年的效率与报酬状态,采用Malmquist指数模型分析2012-2013年全要素生产率变化情况。 结果 17家公立医院年均综合效率由0.805提高至0.909,纯技术效率由0.842提高至0.915,规模效率由0.956提高至0.993,DEA有效的医院由6家(35.3%)增长至8家(47.1%);17家医院全要素生产率变动均值为1.037,技术变动指数平均值为0.903,效率变动平均值为1.148,纯效率变动指数均值为1.100,规模效率变动指数均值为1.043,10所医院全要素生产率提高,占比58.8%;7所医院全要素生产率降低,占比41.2%。 结论 17家医院综合效率整体较前一年有提升,但仍有部分医院存在资源利用不充分或过剩的问题;整体呈全要素生产率提高,但技术衰退明显。医院应将重点放在技术提升与人才培养上,并适度控制发展规模。     

北京市公立医院与民营医院全要素生产率变动比较分析

目的:评价北京市2006-2015年年间公立医院和民营医院的服务效率的动态变化,并比较分析公立医院与民营医院全要素生产率在不同区域和医改前后变动的差异,为提高公立医院、民营医院的服务效率提供参考。方法:运用数据包络分析的Malmquist指数模型对北京市2006-2015年的医院的全要素生产率变动进行分析。结果:2016-2015年年间,民营医院和公立医院的全要素生产率平均每年分别在以0.92%和3.88%的速度进步,公立医院得益于技术效率和生产技术的进步,民营医院更加依赖于生产技术的进步;不同区域和医改前后的公立医院和民营医院的全要素生产率变动趋势有显著差异。结论:公立医院全要素生产率进步速度高于民营医院主要源于技术效率的进步,民营医院应继续提高管理水平,公立医院要进一步提高规模效率,达到最佳适宜规模运营。同时卫生部门要合理配置卫生资源,进一步深化医疗卫生体制改革,提高公立医院和民营医院的服务效率。     

基于DEA-Malmquist模型的海南省县级公立医院运行效率及影响因素分析

[目的]了解海南省99家县级公立医院2015-2017年间的运行效率及影响因素,更好地推进海南省县级公立医院改革。[方法]通过DEA-Malmquist指数模型分析医院的效率以及全要素生产率,运用Tobit回归分析其影响因素。[结果] 2015-2017年,有46家医院的全要素生产率提高,有52家医院的全要素生产率降低,降幅介于0%~10%之间。[结论]海南省县级公立医院的全要素生产率有待提高,需要提高技术效率和规模效率,加强医联体与城乡一体化建设,促进医院精细化管理。     

基于Malmquist指数的北京三级医院全要素生产率分析

目的测量综合三级医院全要素生产率的变化状况,为提高医院运营效率提供决策依据和参考。方法收集北京市12所三甲医院2007～2009年3年面板数据（4项投入指标,5项产出指标）,应用数据包络分析（DEA）的Malmquist模型进行分析。结果3年间样本医院全要素生产率的年平均增长率为33．7％,进一步分解发现：技术进步年均增长率为达到33．4％,技术效率、纯技术效率增长率分别为0．2％,而规模效率没有变化。结论北京地区三级综合医院全要素生产率增长较为显著,其增长贡献主要来源于技术进步,并且不存在技术衰退;为最大限度提高医院生产率,应加强医院内部管理,激发技术效率和规模效率;在医院生产率测量和效率评价研究中,宜吸收患者和公共利益维度的评价指标。     

安徽省县级综合公立医院运行效率评价

目的了解安徽省县级综合公立医院运行效率动态变化,发现同类各家医院的效率差异及其原因,以提高医院整体运行效率。方法采用RD-Malmquist指数分析29家县级医院10年来的全要素生产率(total factor productivity,TFP)及其分解项的变化趋势。结果 (1)2007—2016年29家县级医院总体TFP为1.058,其中纯技术变化(pure technological change,PTC)和规模变化因子(scale change,SCH)的年均增长率分别为2.1%、3.2%,纯效率变化(pure efficiency change,PEC)均数接近1。进一步分析发现,TFP增长主要是由技术进步所致。(2)TFP、PTC、SCH在2006—2017年期间波动幅度较大,尤其是2012和2014年。(3)93.10%的样本医院TFP大于1,且医院间效率存在一定差距,其中TFP范围为0.993～1.338,PTC为0.789～1.181,SCH为0.916～1.269。结论 90%以上的县级医院全要素生产率呈增长趋势,且其增长主要由技术进步导致,纯技术效率和规模效率发挥作用不明显;县级医院除了着力提升技术创新能力外,还应兼顾有效的管理水平,以及适宜的发展规模,从而整体提升医院的综合运行效率,缩小同级别医院之间的效率差距。     

基于DEA-Malmquist指数的某医改典型试点城市公立医院运营绩效评价

目的通过对某典型医改试点城市17家不同类型的公立医院的运营绩效进行分析,为该市提高公立医院运营绩效提出相关建议,为深化医改、促进现代化医院建设提供参考依据。方法使用DEA-Malmquist指数方法对该市17家不同类型的公立医院的运营效率进行测算分析,得出各个医院的综合技术效率、技术效率和规模效率,全要素生产率及其分解情况。结果 "十三五"期间,A市公立医院的卫生资源投入不断增加,53%(9家)的医院处于规模报酬递减状态,47%(8家)的医院处于规模报酬不变状态,2016—2019年总体效率为0.878,规模效率和技术效率分别为0.958、0.913,全要素生产率分别为0.998、1.023、0.966。结论技术效率的提升是全要素生产率提升的关键,该市公立医院需要进一步加强运营绩效管理,通过技术进步和规模调整等方式提升医院运营绩效。通过转变发展方式,防止医院规模过度扩张,推行精细化管理,实现高质量发展。     

基于数据包络分析的成都市综合公立医院运行效率分析

目的了解新形势下成都市二级以上综合公立医院相对运行效率的变化,为医院管理者以及政府部门改进效率提供决策依据。方法运用数据包络分析中的CCR、BCC模型以及malmquist指数模型分析成都市2014-2017年的医院效率。结果 2014-2017年成都市二级以上综合医院发展规模稳步提升,总体有效个数不高,技术有效个数均高于规模有效个数,三级医院全要素生产率上升,二级医院下降,技术进步效率均下降。结论建议加强医院内部资源的整合利用,提高管理水平和技术水平,增强综合医院尤其是二级综合医院的技术更新和应用能力,提高医院运行效率。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.