2015年湖北省卫生计生系统控烟工作第二次暗访结果分析

目的 通过暗访调查,了解湖北省卫生计生系统控烟工作进展情况,为湖北省控烟工作提供科学依据。方法 采取隐秘拍摄、填写问卷的方式对部分医疗卫生机构开展暗访,从无烟环境设置和执行情况两个指标进行分析比较。结果 湖北省卫生计生系统控烟工作总体得分较2011年上升,在百分制下,平均得分（81.22±14.89）分,但总体情况不乐观,不同地区的同一类型机构和同一地区不同类型机构得分差异显著;医疗得分较低、室内吸烟现象严重、禁烟标识设置不足、缺少室外吸烟区等方面问题严重。结论 湖北省卫生计生系统禁烟工作总体情况不容乐观,卫生计生部门作为控烟工作的主要推动者,应推动和完善控烟立法,带头起表率作用,加大控烟宣传力度,加强控烟知识和能力培训,广泛开展控烟健康教育工作。     

Effects of strong government measures against tobacco in Hong Kong

The government of Hong Kong grasped the political nettle of control of tobacco in the early 1980s, since when a comprehensive policy of legislation, education, and publicity, together with large increases in taxation on tobacco products, has been introduced. This has led to almost all of the population of Hong Kong having knowledge of the harmful effects of tobacco and of antismoking measures taken by the government. From 1982 to 1984 the number of people who smoked daily fell appreciably from 888 300 to 744 500, a reduction of 16%, while the number of teenage smokers was halved (from 22 600 to 11 200). Government commitment is crucial in programmes against tobacco in developing countries; without it antismoking efforts are unlikely to be successful.     

Patients' rights in England and the United States of America: The Patient's Charter and the New Jersey Patient Bill of Rights: a comparison.

The Patient's Charter has been in effect for nearly five years. This article considers the purpose and value of the document through a comparison with the New Jersey Patient Bill of Rights. Patient rights statements have been posted in American hospitals for more than twenty years. However, the New Jersey document and the patient rights programme it established seven years ago, have proven to be economically effective, successful in their representation of patients and enforceable, due to the adoption of state legislation and regulation to oversee the process. Several examples of how the programme works are included in the comparison, with a similar review of The Patient's Charter. In the comparison the author argues that for the programme to succeed as it has done in New Jersey, the government will need to develop legislative backing to ensure enforcement, and an efficient system for monitoring compliance. The programme will need to become credible in the eyes of the health service user. The author suggests this may be best achieved by developing an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated. A "mish-mash" of quality assurance standards and levels of care which patients can "expect" from the health service providers only serves to distract the health service user from the government's failure to commit the resources that would empower the patients rights portion of The Patient's Charter.     

Positioning North Carolina for leadership in injury control: a call to action

For most types of injury and violence, mortality and morbidity rates in North Carolina are worse than those of the nation. The costs in lives and dollars are enormous. The state has not provided the necessary resources for tackling the problem, devoting barely $6 per death to preventive efforts and failing to ensure that the public health workforce is adequately trained. At the same time, North Carolina has numerous excellent academic and community-based resources that can enable further capacity development. This article suggests the following 6 key steps for moving the state forward to prevent injury: making a serious financial commitment, training practitioners, supporting safety-promotion initiatives, creating a stronger culture of safety, addressing disparities, and improving data systems.     

Women and tobacco: with the master settlement agreement, we've come a long way, baby!

This commentary provides a brief overview of the impact tobacco has on the health of women. Tobacco control activities that reduce the number of young people who start smoking, reduce exposure to environmental tobacco smoke, and increase the ability of Americans to successfully quit have the capacity to markedly reduce the toll of tobacco. The efforts can be greatly enhanced by the unprecedented opportunity the master settlement agreement (MSA) between the state attorneys general and the tobacco industry presents for directing resources to those policies and programs that are most effective in stemming tobacco use. The relentless increase in tobacco marketing reaching teens and ethnic minority women makes ever more urgent our concerted efforts to confront those policy initiatives that can ensure the MSA is adhered to fully.     

Yes, minister, Canadians need strong tobacco-control legislation now!

At a meeting with federal health minister Diane Marleau on Nov. 16, 1995, the CMA and other health organizations were told that the minister plans to propose comprehensive measures to limit the manufacture, sale and marketing of tobacco products. On Dec. 11, 1995, the minister announced a "Blueprint on Tobacco Control," which outlined the scope of her plan to introduce tobacco legislation in the spring. On the basis of adamant support for tobacco control from all levels of the organization, the CMA urges the minister to move quickly. It also advocates regulating tobacco as a hazardous product in the meantime. Physicians can take a wide variety of actions to intervene with patients and add their voice to antitobacco lobbying efforts in 1996.     

Mental Health Act 1983

After reviewing the history of mental health legislation in England, Hamilton discusses some provisions of the new Mental Health Act that went into effect in September 1983. Among the issues pertaining to involuntary commitment covered by the act are the terminology and definition of mental illness; criteria for emergency admission, admission for assessment, and length of detention; patients' rights; mental health review tribunals; and consent to treatment. Two of the more controversial provisions are the reinstitution of a mental health commission with protective functions for detained patients, and a mandatory second opinion for certain forms of treatment.     

"Below the Line": The tobacco industry and youth smoking

Background

This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people.

Method

A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement.

Results

The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents.

Conclusion

The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.     

互联网医疗与跨境医疗结合的法律风险：以粤港澳大湾区为例

粤港澳大湾区的建立为三地医疗卫生事业的协同发展提供了新的契机。三地医疗协同发展面临跨径跨境医疗中的各种障碍。在“互联网+”背景下发展起来的互联网医疗作为远程医疗的形式之一,在优化医疗资源,方便社会公众就医及获取保健信息方面有着相当的优势。将互联网医疗与跨境医疗相结合发展尽管能够发挥两者优势,但面临一定的法律风险。本文基于我国立法现状,以粤港澳大湾区为对象,就跨境医疗与互联网医疗相结合的法律风险做出一定的探讨。提出可借鉴欧盟经验,签订具有统一适用效力的协议,以保障患者、医生、第三方医疗平台的合法权益。     

吸烟对健康的危害及控烟策略

烟草严重威胁中国民众的身体健康，必须采取科学有效的措施对吸烟进行预防与控制。本文探讨了吸烟对健康的危害及控烟策略，研究吸烟在中国的流行状况及影响因素，并提出控烟策略和措施。有效的控烟运动有赖于政府积极主导控烟规划，社会政治、经济和文化等各个领域积极构建控烟支持环境，从而切实减少烟草对我国公民健康的危害。     

全科医生参与社会控烟的伦理责任

2016年,世界卫生组织（WHO）在其发布的关于世界烟草使用情况的报告中指出,每年大约有600万人死于吸烟诱发的疾病,危害居民身心健康的同时,也给社会造成了严重的经济负担。作为社区居民健康的“守门人”,全科医生在推动社会控烟事业进步的过程中应扮演重要的角色。本文基于全科医生职业使命的伦理考量,提出全科医生在社会控烟事业中应承担的伦理责任：第一,全科医生应该在行为上树立榜样,自身坚决杜绝烟草;第二,全科医生应尽力规劝其患者戒烟,同时在社区中倡导建立无烟环境;第三,全科医生应在整个医疗体系内积极宣传无烟化的理念,将戒烟辅助纳入常规诊疗服务流程。此外,全科医生还应该致力于促进政府对烟草控制框架公约的履行,推动全社会控烟事业的进步。     

Health in the workplace

General good health and the prevention of specific "non-occupational" disease, in addition to protection against occupational disease and injury, are already part of the aim and function of occupational health services. They are justified, if at all, mostly on the grounds of intangible benefits the virtue of which is not questioned. Concern over health costs and financial constraints are forcing industry to justify health expenditure. Yet, the health programmes can be justified, and industry has some obligation to adopt them.     

烟草危害与公共健康的伦理研究

烟草危害是当今世界的一个严重的公共健康问题.降低烟草危害和保护公共健康已经成为重要的伦理学课题.本文首先例举一些事实说明烟草对于公共健康的危害,进而从伦理角度分析这一危害,并且讨论了降低烟草危害的道德责任问题.     

Tobacco and the Third World: the growing threat

Over the past 2 decades, the Third World has become the site for growing tobacco production and consumption. Between 1960-75, tobacco production increased 5-fold in Africa, 46-fold in Latin America, but only 13-fold in Europe. Of the world's 10 top tobacco producers, 5 are in developing countries. Similarly, consumption of cigarettes is increasing twice as fast in developing as in developed countries. In some parts of India, Latin America, and the Philippines, over 70% of people smoke. This pattern can be expected to reproduce an epidemic of smoking-related diseases in the Third World before the end of the century, including lung cancer and coronary heart disease. Smoking also can be expected to affect stillbirth and infant mortality rates. For many Third World countries, tobacco is a valuable cash crop and an important source of foreign exchange. Fertile lands are used to expand tobacco cultivation rather than to produce food for local populations. The Third World tobacco industry is dominated by Wester tobacco companies based in the US, UK, and South Africa. Much of their profit comes from tobacco exports to developing countries and from their subsidiaries there, especially in light of increased awareness in developed countries of the hazards of smoking. Western governments should pressure international tobacco companies to reduce and eventually stop exports to the Third World. Third World Governments should be urged not to depend on tobacco growth and to substitute it for food crops. Health Departments should undertake surveys to determine the prevalence of smoking and, on the basis of study results, introduce appropriate health education measures. Physicians should recommend to governments legislative measures to control smoking. Finally, there should be a ban on advertising, health warnings on cigarette packets, a ban on smoking in public places, and restrictions on the sale of cigarettes to children.     

地方医学院校与社区卫生服务的互动研究

地方医学院校因与社区的特殊地缘关系,联系密切、互相影响、互相依托。社区为地方医学院校发展提供基础性资源,服务社区则是地方医学院校的职责所在。通过立法与体制改革、共建系统化人才培养体系、推进卫生服务的深度合作、完善志愿者服务体系、构建网络化资源共享平台等策略形成良性互动,能促进二者互利共赢。     

An analysis of physician antitrust exemption legislation: adjusting the balance of power.

Current antitrust law restricts physicians from joining together to collectively negotiate. However, such activities may be approved by state laws under the so-called state action immunity doctrine and by federal legislation under an explicit antitrust exemption. In 1999, Texas became the first state to pass physician antitrust exemption legislation allowing physicians, under certain defined circumstances, to collectively negotiate fees with health plans. Last year, similar legislation was introduced in the US Congress, in 18 state legislatures, and in the District of Columbia. This legislation was passed only in the District of Columbia where its implementation was blocked by the city's financial control board. Nonetheless, legislation permitting physicians to collectively negotiate fees with managed care plans has been introduced in 10 state legislatures this year, and there is continued interest in introducing similar legislation in the US Congress. This analysis examines the basic features of this legislation and its potential impact on the balance of power between physicians and managed care plans.     

基于国际经验的中国健康产业发展战略与策略

健康产业从广义说，是指以健康建设为中心，以健康理念为前提，以人的健康为最终目的，与人类健康直接和间接相关的所有产业和部门的集合。从狭义说，健康产业是指与健康直接且高度相关的，提供以维护、改善和增进人的健康为直接或最终用途的各种产品、服务的行业和部门的集合。近年来，随着全球经济的飞速发展，人们生活品质和健康保健的重视程度也日渐提高，健康产业也已经成为世界上许多国家特别是欧美发达国家和广大新兴市场国家有效应对金融危机冲击、增强经济发展活力、满足多样化需求、加快抢占全球健康产业分工的新制高点的战略选择。国际上而言，美国的健康产业起源于1963年，是美国近十年来增速最快的产业，占国内生产总值占比逐年上升。从我国情况而言，本文概述了我国健康产业的政治背景、社会背景和经济背景的情况以及健康产业发展相对滞后、配套服务难以满足生产发展需求、健康产业中医药制造整体层次水准不高、医疗卫生服务发展不均衡和养老产业规模发展不完善的现状。本文基于以上情况对今后中国健康产业的发展战略和目标提出了应该由国家政策支持，助推健康产业的发展的政策建议。具体从提升全国健康意识、实现医疗资源均衡化和发展针对不同人群的多元化健康产业体系这3方面具体开展和落实。      

Big tobacco "pull out all stops" for a landmark example: The Burswood Casino case

Background

With the aid of internal tobacco industry documents, this paper provides a chronology of events documenting the role of the Philip Morris tobacco company in the 1993 litigation case against the Burswood International Resort Casino (BIRC). The paper also examines the implications of this case for the regulation of second hand smoke exposure.

Method

A systematic keyword search and analysis of internal tobacco industry documents was conducted using documents available on the World Wide Web through the Master Settlement Agreement.

Results

The industry documents provide comprehensive evidence that the Philip Morris tobacco company provided assistance to the BIRC in its defence against action by the Western Australian government. The Philip Morris tobacco company, along with others, sought to publicise and promote the outcome as a ‘landmark example’ to lobby against the implementation of indoor smoking bans.

Conclusion

Philip Morris'' investment in the BIRC defence demonstrated the industry''s recognition of the potential significance of the case beyond Western Australia. Involvement in the BIRC case assisted the wider tobacco industry by helping to prolong smoking at casinos and other Australian hospitality venues. The findings contribute to our understanding of the history of tobacco industry strategies implemented in Western Australia and internationally to slow tobacco control progress, and the preparedness of the tobacco industry to exploit favourable developments originating anywhere in the world.     

我国台北和长春的社区式长期照顾服务比较研究

随着老龄化程度的不断加剧,老年人长期照顾问题已经成为世界性的卫生保健和社会问题,以社区为基础的长期照顾服务已经成为长期照顾服务体系的重要组成部分。本文分别从保险类型、服务内容、服务方式、费用承担、服务对象、人力资源与质量控制等方面,对我国台北与长春的社区式长期照顾服务进行比较分析,并以此为基础,提出对我国大陆地区开展长期照顾服务的建议,包括不断完善长期照顾政策法规、加强质量监控、明确服务对象、完善保险制度、实现合作与服务多元化、促进长期照顾服务队伍专业化。另外,在人力资源短缺、互联网普及的时代,“互联网+长期照顾”不仅有利于减少人力资源需求,而且有利于扩大服务范围,提高服务质量,是未来重要的发展方向之一。     

Tensions in setting health care priorities for South Africa's children.

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities.