疾病经济风险与疾病经济负担分析

新型农村合作医疗的根本目标是通过建立大病统筹方案,重点解决或缓解农民因病致贫与因病返贫的问题。基于云南省禄丰县新型农村合作医疗调查数据,运用风险测量技术测算该人群的疾病经济风险程度,以及疾病的经济负担状况,从而更进一步明确新型农村合作医疗抗风险的重点,为更加科学合理的完善新型农村合作医疗的补偿机制提供决策依据。     

疾病经济风险与疾病经济负担分析

新型农村合作医疗的根本目标是通过建立大病统筹方案,重点解决或缓解农民因病致贫与因病返贫的问题.基于云南省禄丰县新型农村合作医疗调查数据,运用风险测量技术测算该人群的疾病经济风险程度,以及疾病的经济负担状况,从而更进一步明确新型农村合作医疗抗风险的重点,为更加科学合理的完善新型农村合作医疗的补偿机制提供决策依据.     

山西省新型农村合作医疗试点县农村疾病经济风险初步研究

目的：通过对农民疾病经济风险的分析,明确农民疾病经济风险水平和新型农村合作医疗抗疾病风险的重点.方法：采用疾病家庭经济风险度（FR）和特定人群疾病风险采用相对风险度（RR）两个指标来研究试点县农民痰病经济风险.结论：低收入家庭疾病风险强度较大,高疾病轻经济风险集中在少数家庭,不同医疗机构的疾病家庭住院经济风险差别较大,在设计合作医疗补偿方案时,使合作医疗的补偿重点向风险较大的疾病家庭转移,提高新型农村合作医疗抗疾病经济风险能力.     

医疗风险的成因和处理策略

医疗风险具有不确定性、不可预见性和危害性.因此更早、更准确的预测可能发生的医疗风险,制定完善的医疗风险规避制度,对医疗行为进行认真有效的监督,尽可能减少不必要的医疗风险是当今医院管理的重点之一.该文就我国医疗风险的特征、防范和处理进行讨论,希望对降低医疗机构医疗风险的发生和提高处理能力有所借鉴.     

贫困地区农户应对疾病的筹资及效果：基于四川省阆中市的农户调查

通过对四川省阆中市农户大病筹资行为的调查统计,分析了农户几种常见的筹资方式,对家庭经济状况不同的农户进行对比,发现各类农户中采用最频繁的两种筹资方式是亲友的赠予及亲友和金融机构的借贷.而对医疗费用贡献率最大的筹资方式是亲友和金融机构的借贷.文章对各种筹资方式进行了评价,发现当前实施的新型农村合作医疗制度和贫困医疗救助制度对大病农户的医疗费用资助明显不足.     

疾病经济风险的内涵及评价综述

通过对国内外相关研究的系统回顾和总结,在明确相关基本概念的基础上,对疾病经济风险的内涵界定进行了梳理;同时,对相关研究中广泛采用的疾病经济风险评价指标进行了归纳,为更加全面准确地评价疾病经济风险明确了方向。     

农村居民疾病经济风险与灾难性卫生支出关联性研究

综合运用疾病经济风险度和灾难性卫生支出分析农村居民疾病经济风险,结果表明,总体疾病家庭经济风险度较低,但是仍有9.49%的家庭处于高度疾病风险之中;贫困人群疾病经济风险度是非贫困人群的6.63倍;家庭疾病经济风险度与灾难性卫生支出发生率之间有相关关系,贫困人群的灾难性家庭卫生支出发生率大于非贫困人群。对此,提出了建立重大疾病补助基金、实行累进缴费制度、优化调整统筹补偿方案等建议。     

罗平县农村居民糖尿病的疾病经济风险及影响因素研究

目的 了解云南省罗平县农村居民糖尿病疾病经济风险及相关影响因素。方法 于 2021 年 7月在云南省罗平县采用多阶段分层随机抽样方法抽取年龄≥35 岁的 998 名村民进行面访调查及体检。结果 云南省罗平县农村居民糖尿病的患病率为 15. 3% ,且随着年龄增长呈现上升趋势( 趋势 χ²= 10. 776,P = 0. 001) 。患有肥胖( χ²= 4. 749,P = 0. 029) 、高血压( χ²= 5. 732,P = 0. 017) 以及有糖尿病家族史( χ²=13. 064,P < 0. 001) 的农村居民糖尿病患病率均高于未患肥胖、高血压以及没有糖尿病家族史者。糖尿病患者的人均直接、间接和疾病经济负担分别为 4 763. 46 元、177. 78 元和 4 941. 24 元,其中,男性人均直接疾病经济负担高于女性( t = 2. 124,P = 0. 034) ; 云南省罗平县农村糖尿病患者家庭灾难性卫生支出和因病致贫发生率分别为 8. 1% 和 2. 7% ; 糖尿病患者...     

新型农村合作医疗缓解疾病经济风险的效果评估

[目的]对新型农村合作医疗缓解疾病经济风险进行评估.[方法]采用入户询问的方法对样本人口进行调查,分析比较农村居民在新农合实施前后疾病经济风险的变化.[结果]家庭消费支出中医疗费占比重较大;低收入家庭支付能力依然低下;新农合降低了家庭总体疾病经济风险;住院家庭疾病经济风险增加;低年龄组人群疾病经济风险度高.[结论]农村卫生筹资应以政府为主,降低居民个人医疗卫生支出;提高新农合的覆盖率,促使新农合制度持续发展;提高筹资水平,增加对住院病人的补偿;完善医疗教助体系,降低贫困人口疾病经济风险.     

医疗保障制度抵御疾病经济风险的作用综述

通过对国内外相关研究的系统回顾和总结,对各种医疗保障制度抵御疾病经济风险的作用进行了综述.在各国不同的医疗保障制度设计中,有的对抵御疾病经济风险发挥了正面作用,有的则起到了反面作用,而我国现行的几种医疗保障制度在抵御疾病经济风险中的效果也存在一定差异.     

Mumps vaccine effectiveness and risk factors for disease in households during an outbreak in New York City

Background and objectives

Mumps outbreaks have been reported among vaccinated populations, and declining mumps vaccine effectiveness (VE) has been suggested as one possible cause. During a large mumps outbreak in New York City, we assessed: (1) VE of measles-mumps-rubella vaccine (MMR) against mumps and (2) risk factors for acquiring mumps in households.

Methods

Cases of mumps were investigated using standard methods. Additional information on disease and vaccination status of household contacts was collected. Case households completed follow-up phone interviews 78–198 days after initial investigation to ascertain additional cases. Mumps cases meeting the study case definition were included in the analysis. Risk factors for mumps were assessed, and VE was calculated using secondary household attack rates.

Results

Three hundred and eleven households with 2176 residents were included in the analysis. The median age of residents was 13 years (range <1–85), and 462 (21.2%) residents met the study mumps case definition. Among 7–17 year olds, 89.7% received one or more doses of MMR vaccine, with 76.7% receiving two doses. Young adults aged 10–14 years (OR = 2.4, CI = 1.3–4.7) and 15–19 years (OR = 2.5, CI = 1.3–5.0) were at highest risk of mumps. The overall 2-dose VE for secondary contacts aged five and older was 86.3% (CI 63.3–94.9).

Conclusions

The two-dose effectiveness of MMR vaccine against mumps was 86.3%, consistent with other published mumps VE estimates. Many factors likely contributed to this outbreak. Suboptimal MMR coverage in the affected population combined with VE may not have conferred adequate immunity to prevent transmission and may have contributed to this outbreak. Achieving high MMR coverage remains the best available strategy for prevention of mumps outbreaks.     

区域性大型活动公共卫生风险与保障对策

目的评估区域性大型活动所存在的公共卫生风险,为科学制定公共卫生保障对策提供依据。方法选取2010年江苏省第17届运动会为研究对象,采用Delphi专家咨询法、风险矩阵法以及Borda序值法等方法,并结合举办地常州市近10年各类公共卫生突发事件资料,研究区域性大型活动所存在的公共卫生风险;并对保障对策进行探讨。结果系统分析出省运会可能存在的5大类20种公共卫生风险;并进行了4种风险水平的分析,评估出高危险度风险1类1种,中等危险度风险3类5种以及低危险度风险5类14种。结论通过对区域性大型活动公共卫生存在的风险进行识别、分析、评估,找出关键控制点,可为制定针对性的公共卫生保障对策提供科学依据。     

公立医院融资风险及其管理策略探讨

描述了公立医院融资风险的概念及主要表现形式,提出融资风险的风险回避策略、损失控制策略、风险转嫁策略,并建议采取积极措施,构建公立医院融资风险管理系统、建立有效的融资风险预警机制、提高财务决策的科学化水平、建立明晰的领导任期内经济责任制,以有效防范风险的发生。     

Psychological impact of predicting individuals’ risks of illness: a systematic review

The aim of this review is to determine the frequency and circumstances under which predicting individuals’ risk of illness has adverse psychological effects. Using systematic review methodology, the literature was searched for studies that had assessed the adverse psychological outcomes of risk assessment programmes. The outcomes investigated are emotional (anxiety, depression, distress) cognitive (intrusive thoughts, perceptions of health) and behaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significant effects between and within groups in the short (one month or less) and longer term (more than one month). Where sufficient data were available, a meta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing individuals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington’s disease (10), risk of diabetes (two), risk of spinocerebellar ataxia (one) and risk of osteoporosis (two). Overall, the quality of studies assessed was limited, with only two using a randomised design to determine the psychological impact of risk assessment. Receiving a positive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psychological distress. Data were available for a quantitative synthesis of results on three outcomes, anxiety, depression and distress. Anxiety and depression were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase for those receiving positive test results. The five experimental studies that reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse psychological effects of receiving an unfavourable test result. Adverse psychological effects are a common immediate consequence of positive test results following risk assessment. Results from the few experimental studies reviewed suggest that these adverse outcomes should not be seen as inevitable.     

老年人群心血管疾病风险预测模型研究进展

风险预测模型（模型）对于老年人群心血管疾病（CVD）的一级预防具有重要意义。国内外针对老年人群构建的CVD模型共检索到15篇文献。模型的结局定义差异较大;10个模型报告时缺少方法、结果的重要信息;10个模型存在高偏倚风险;13个模型在内部验证时仅表现出中等区分度;仅有4个模型经过外部验证。老年人群CVD模型在模型算法、预测因子与结局的关联强度方面与一般人群模型存在差异,且老年人群模型的预测能力有所下降。未来仍需补充高质量的外部验证研究证据,并探索增加新的预测因子、采用竞争风险模型算法、机器学习算法、联合模型算法、改变预测时间范围等途径对模型进行优化。     

Economic and psychosocial Impact of rotavirus infection in Spain: A literature review

Severe rotavirus gastroenteritis is common in children under 5 years of age. A literature review was performed to investigate the economic and psychosocial impact of rotavirus infection in children in this age group. We retrieved 56 articles on the economic burden of the disease in Europe, 18 of them reported data from Spain; 8 articles were retrieved analysing its psychosocial impact. In Spain, rotavirus is responsible for 14% to 30% of all cases of gastroenteritis, and a quarter of these require hospitalisation. It is also associated with high use of health care resources (emergency and primary care visits). Rotavirus gastroenteritis costs the Spanish national health system EUR 28 million a year and causes productivity loss in two-thirds of parents (mean of 4 days). Taking into account these costs, it was estimated that implementing universal vaccination could prevent 76% to 95% of hospital admissions due to rotavirus gastroenteritis, as well as reduce emergency and paediatric visits, nosocomial infections, and days missed from work (77% reduction). Rotavirus gastroenteritis also has a considerable psychosocial impact on the family, although it is difficult to compare results due to the diversity of study designs and the low specificity of the measurement tools used. It also causes high stress among parents, adding to their workload and adversely affecting their quality of life.     

手术室专职教师教学压力因素及应对策略

目的探讨专职教师应对教学压力的有效策略,切实提高教学质量。方法在护理部及护士长领导下,手术室专职教师采取分层次针对性教学、强化教学对象的职业安全教育、情景模拟教学、在教学活动中总结经验,教学相长、扎根临床,业精于勤、外出学习开阔视野等策略积极应对。结果专职教师每年高质量完成多层次、多批次的教学任务约400人次。结论手术室教学策略有助于减轻专职教师教学压力及提高教学质量。     

Altered social cohesion and adverse psychological experiences with chronic food insecurity in the non-market economy and complex households of Burkina Faso

Food insecurity negatively impacts outcomes in adults and children including parenting practices, child development, educational achievement, school performance, diet, and nutritional status. Ethnographic and quantitative research suggests that food insecurity affects well-being not only through the lack food, poor diet, and hunger, but also through social and psychological consequences that are closely linked to it. These studies are limited in number, and have mostly been carried out in contexts with market economies where household access to food depends almost solely on income. This study considers the social and psychological experiences closely linked to food insecurity in northern Burkina Faso, a context marked by subsistence farming, chronic food insecurity with a strong seasonal pattern, and a complex social structure. A total of 33 men and women from ten households were interviewed in February 2001 using semi-structured interview guides. Data were analyzed following the principles of thematic analysis. Food insecurity is closely linked with consequences such as concern, worries, and anxiety that ultimately lead to weight and sleep loss. Food insecurity results in feelings of alienation (e.g., shame) and deprivation (e.g., guilt), and alters household cohesion leading to disputes and difficulties keeping children at home. Decisions made by household members to manage and cope with food insecurity are shaped by their fear of alienation and other cultural and social norms. These findings, although derived from data collected 10 years ago before the 2008 food and fuel crises, remain valid in the study context, and emphasize the importance of social and psychological consequences closely linked to food insecurity and their negative impact on the well-being at both individual and household levels in contexts of non-market economy and chronic food insecurity. Attention to these non-nutritional consequences will improve the design, implementation, and evaluation of food insecurity programs in this and similar contexts.     

Understanding the risks associated with resource allocation decisions in health: An illustration of the importance of portfolio theory

While a number of health economists have recently applied portfolio theory to the economic evaluation of health care, its importance for resource allocation and medical decision making has not been well illustrated. Portfolio theory is concerned with optimal investment strategies, based on both return and risk, and demonstrates the potential benefits from pooling different investments into a single portfolio. Portfolio theory differs from other methods that focus on risk in medicine as it focuses on the variance around the mean for a single aggregated health outcome measure. This paper demonstrates the importance of using a portfolio theory framework when evaluating a number of health interventions from the perspective of a representative individual and it expands upon the existing literature on portfolio theory in several ways. First, it highlights the importance of distinguishing between risk and uncertainty. Next, it demonstrates that portfolio theory has implications for all types of statistical analysis of multiple interventions in medicine and not only for issues of resource allocation. Through a number of included simulations, this paper also illustrates the importance of accounting for covariance (the relationship between risks) and synergies (the relationship between outcomes). Finally, possible applications and limitations to implementing portfolio theory in medical and resource decision making are discussed.