壮族的民间信仰与民俗医疗

壮族的传统医药文化非常丰富,民间至今依然盛行与宗教信仰密切相关的“神药两解”的民俗医疗方法。笔者在田野调查中发现,壮族乡村的病人在积极寻求药物治疗的同时,还借助麽公、囊妹、道士等神职人员施行各种仪式来治病,且往往能取得意想不到的效果。本文拟从田野资料出发,借鉴医学人类学的相关理论,以目前壮族农村盛行的巫术与祝由疗法为例,来探讨壮族的民间信仰与民俗医疗的关系。     

一个“成功"游牧民定居工程背后的资源困境

游牧民定居工程被视为改变牧区靠天养牧、加速牧区现代化和城镇化的重要举措而广泛实施。 游牧民定居工程迅速且深刻地改变着草原牧区的自然、社会及经济形态,同时也改变了人与自然资源之间的互动关系及作用时空尺度。 在“成功冶的定居点,牧民生活水平大幅提高,且对天然草场的利用减少;但是,对比相邻的村庄发现,其“成功冶的关键在于有足够的外部资源输入,包括草场、农田和地下水等。 而从区域的生态环境来看,这种“成功冶模式并不符合当地干旱地区的生态特征,有可能造成更大范围内的生态破坏。 因此,游牧民定居工程应该从区域生态特征出发,对类似“成功冶模板的推广更加谨慎。     

论生态环境损害赔偿诉讼与环境公益诉讼之衔接

在现行司法实践中,我国对生态环境损害之救济采取的是生态环境损害赔偿诉讼与环境公益诉讼并行的"双轨制"模式.通过分析典型案件可以发现,现行立法未能为化解生态环境损害赔偿诉讼与环境公益诉讼之间的制度"碰撞"提供明确的规范指南,导致"两诉"之间时常会陷入管辖冲突与衔接困境.生态环境损害赔偿诉讼的模糊属性以及相关立法规定的缺失,是导致"两诉"衔接陷入困境之根由.为此,应当在准确识别生态环境损害赔偿诉讼性质之前提下,通过立法对"两诉"之间的顺位规则、索赔主体机制等核心规范予以明确.具体而言,未来我国应当明确生态环境损害赔偿诉讼优于环境公益诉讼的顺位规则,并建立"行政机关—环保组织—检察机关"三位一体且逐层递进的索赔主体结构,最大程度发挥"两诉"之制度合力.     

政府支出对医疗服务健康公平影响的比较和启示

医疗服务公平和人民的健康是各国卫生系统向其国家居民提供医疗服务所应实现的两个重要目标。但以英美日为例的发达国家根据世界卫生统计年鉴中的医疗服务公平性排名确有明显差距，因此，高收入和高政府医疗卫生支出与医疗卫生服务公平和健康公平性并没有必然关系。本文通过比较分析美日英国的政府间医疗卫生支出责任划分的结构发现高政府医疗卫生支出比例是提高医疗服务筹资公平性的前提，中央承担社会医疗保险责任是实现医疗服务筹资公平性的保证，政府特别是中央政府出资的长期护理有助于提高国民健康水平，地方政府的参与更有助于提高一国医疗系统机构数量特别是医院的数量。     

中国基本医疗保险的实际参保率及其分布特征:基于多源数据的分析

全民覆盖是基本医疗保险降低国民医疗费用负担的前提条件。中国基本医疗保险是否实现了全民覆盖仍存在争议。本文利用多源调查数据,分析了我国基本医疗保险实际参保率及其分布特征。不同来源的数据基本证实,2015-2016年,中国仍有超过10%的国民没有参加任何一项基本医疗保险制度。其中,城镇居民、非农户口和没有户口的居民、东北地区、年轻人、儿童、未就业人群、低收入人群、在校学生以及流动人口基本医疗保险实际参保率更低。城乡居民实行自愿参保,因管理部门分割、信息系统不统一导致的重复参保以及因财政补贴制度导致的户籍地参保等制度设计,是导致基本医疗保险未能实现全民覆盖的根源。要实现基本医疗保险全民覆盖,解决国民医疗后顾之忧,未来我国基本医疗保险应实行强制参保、以家庭为单元参保、常住地参保,建立全国统一的基本医疗保险信息系统,并鼓励发展补充性医疗保障制度。     

Alarmed: sensory approaches to improving medical alarm systems

Medical alarms sound incessantly, loudly, and dissonantly, contributing to an already noisy ICU and OR soundscape, and ultimately harming both patients and staff. Sometimes triggered in error, the sheer number of alarms distracts health care professionals and results in sensory overload that contributes to hospital staff’s alarm fatigue. In turn, staff become increasingly likely to ignore alarms instead of acting on them. Furthermore, the patients’ sensitivity to alarms disturbs their hospital stay, raises their stress levels, and impedes their recovery process, with sometimes lasting effects. This article considers the sensory effects of hospital alarms and possibilities for redesigning future alarm systems, with the goal of eventually creating a more calming, less stressful, and safer hospital soundscape environment for all.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下，发现就医惯性的存在；并运用集中指数分解法发现，卫生服务的利用存在不公平，偏向于富人，而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

Healthy Barbs: Activism Confronts Mortality

Barbara Brenner, JD, was the Executive Director of Breast Cancer Action (BCA) from 1995–2010. Before that, she was a longtime activist in the anti-war movement and an attorney who, for most of her career, practiced public policy law. After she was diagnosed with breast cancer in 1993 at the age of 41, she took the helm of BCA. Under her leadership, the organization moved into a position of national advocacy—demanding research on the causes and prevention of breast cancer, including the role of industrial pollutants. Barbara started the “Think Before You Pink” campaign, encouraging people to question whether companies that display pink ribbons actually produce products that harm women's health or generate any funds to fight breast cancer. Her blog, “Healthy Barbs,” challenged readers to critique routine healthcare practices and policies. Barbara received numerous awards, including a Jefferson Award for Public Service in 2007, the Smith College Medal in 2012, and the ACLU-Northern California's Lola Hanzel Courageous Advocacy Award in 2012. Barbara had a recurrence of breast cancer in 1996. She died of complications associated with amyotrophic lateral sclerosis, ALS, on May 10, 2013.     

新农合对四川藏区的减贫效应分析

The New Rural Cooperative Medi-cal System ( hereafter NRCMS) in Tibetan areas of Sichuan was started in Wenchuan in 2005 , and by 2008 covered all of the province’s Tibetan areas. This paper studies the effects of the NRCMS on im-proving the health of and alleviating poverty for farmers and herdsmen in Tibetan area of Sichuan. Most parts of the Tibetan areas of Sichuan are located in high altitude districts. Thirty two coun-ties of these areas are classified as “National Pov-erty Counties”. Poverty and disease go hand in hand in these regions. Kashin-Beck disease and hydatid disease are the major endemics in the pas-toral and agro-pastoral areas of Sichuan. Endemic, infectious and chronic diseases are widespread in Sichuan’s Tibetan areas. More than 70% of pa-tients are workers from 20 to 60 years old. Disea-ses are more prevalent in women than in men. Kashin-Beck disease and hydatid disease are cur-rently incurable. Patients suffer from health prob-lems, which leads to a decrease in their income and the heavy burden of medical expenses. The new rural cooperative medical system alleviates the negative effects of farmers’ falling into, or back in-to poverty due to disease. However, the existing medical compensation mechanism is not sufficient to solve the problem. The greatest impact of NRCMS on the farmers and herdsmen in Sichuan’s Tibetan areas is that the system has gradually changed local people’s medi-cal behavior, as well as their underlying ideas a-bout medicine: they begin to believe in hospitals. In particular, more pregnant women are choosing to give birth in hospitals, which reduces the rate of infant mortality and postpartum diseases, and im-proves the health of women. Since the full coverage of the NRCMS in 2008 , the number of people participating in the system has reached the overall average level of Si-chuan province. By analyzing the data before and after the implementation of this system, and meas-uring the impact of the system on people’s health, it can be found that the NRCMS’s role in serving the vulnerable population, such as the elderly and infant children, is more marked. Since the implementation of the NRCMS, all administrative villages in Sichuan Tibetan areas have established village clinics, which solved the problem of a shortage of medicines and doctors in those areas. Farmers and herdsmen have conven-ient access to medical treatment, enhancing the ac-cessibility of medical service. After the implemen-tation of the NRCMS, the health of the elderly population in rural areas has improved. Infant mor-tality rates have dramatically fallen. The implementation of the NRCMS improved the medical service capacity of township hospitals and village clinics. And the NRCMS has brought the township hospitals and village clinics into its scope of compensation, which greatly promotes the utilization of primary medical services in Tibetan areas. The poverty reduction effect of the NRCMS can be analyzed from two aspects:Firstly, the im-
provement in health leads to increased income, be-cause good health can promote labor productivity. Meanwhile, the increase in income will in turn im-prove the overall level of health. Secondly, the in-patient and outpatient compensation rate is raised year by year, which reduces the medical fees of farmers, and prevents them from falling back into poverty.