医患关系性质的理论和实证分析——以北京市医生和患者的调查数据为例

通过理论分析及医患双方调查,揭示医患之间复杂关系的本质特征和内在规律,为医疗卫生体制改革和制度建设提供帮助。研究表明,医患关系是多种社会关系的复合体,其健康发展的基础是相互信任,回归这种淳朴的社会信任关系是和谐医患关系建立并延续的根本。     

构建和谐高校医患关系,发挥医护人员育人作用

一、引言医患关系是医务人员与病人在医疗过程中产生的特定医治关系,是医疗人际关系中的关键。现代医学的高度发展,更将这一概念加以扩充,"医"已由单纯行医团体扩展为参与医疗活动的医院的全体职工;"患"也由单纯求医者扩展为与相关的每一种社会关系。医患关系,简单讲是     

海外华人“拾伙夫妻”现象的社会学分析

海外华人“搭伙夫妻”现象不仅是当前媒体关注的一个热点，更是一个值得深入研究的社会问题。所谓“搭伙夫妻”，是指夫妻双方或其中一方已结婚，由于与配偶无法团聚，临时与他人结成像家庭般的伴侣关系而居家度日。从孤单寂寞方面的心理原因、异性渴望方面的生理原因、物质条件方面的经济原因、社会压力方面的社会原因等方面入手分析了其产生的原因。探讨了会产生诸如影响婚姻的瓦解、家庭的和睦、滋生家庭问题和导致犯罪行为、导致华人优良传统和伦理道德的滑坡等方面的社会负面影响，并指出应该如何正确看待这一现象，以期引起社会的进一步关注和讨论。     

中国西部少数民族地区人口的贫困原因及其政策启示

中国的少数民族人口主要分布在生态环境恶劣、经济社会发展落后的西部地区,这些地区同时也是贫困人口分布最多的区域。本文首先从地域、人口增长以及国家扶贫战绩几方面分析了西部少数民族地区人口与贫困在地域上的重合性,进而从区域发展、社会公平和政策效果以及贫困人口的人文因素等方面分析了造成少数民族地区人口贫困的原因,认为虽然造成区域性少数民族贫困状况的主要原因来自于区域发展的滞后,但在摆脱贫困的难易方面,政府提供的脱贫服务和民族人口的人文制约因素则起着更为重大的作用。     

理性与非理性的家庭生育行为

人口控制的关键是对家庭生育行为的控制。家庭生育行为控制除了受社会、经济、文化、节育技术等因素的支配和影响外,同时也取决于家庭夫妇双方对计划生育政策的接受程度,对各种生育因素影响作用的反映弹性和行为态度。在接受程度、反     

从招郎到“两头住”:招赘婚姻变迁研究

通过对湘北夏村的数据统计和个案访谈,研究发现夏村的招赘婚姻在2000年以后迅速衰落,新型的"两头住"婚姻模式大量出现。"两头住"婚姻模式具有提高赘婿地位、兼顾双方父母、代际关系柔和、家庭关系和谐等特点。在村落社会中,国家计划生育政策、女性婚姻自主权、子代和父代的理性考量等因素共同促成了招赘婚姻的以上变化。文章最后对学界观点进行简要讨论和回应,期待对招赘婚姻变迁有一个更为深刻的理解。     

气候变化对干旱区家庭生计脆弱性影响的空间分析——以新疆于田绿洲为例

文章通过对干旱区社会经济结构、社会网络等调查,探讨气候变化导致干旱区家庭生计脆弱性的原因。借助空间回归模型,以新疆于田绿洲为研究区域,2000、2005、2010年为时间段,同时考虑社会经济结构和空间扩散因素,综合检验气候变化条件下,社会经济结构、地理位置差异、族群及相邻效应等因素对干旱区家庭生计脆弱性空间变化可能造成的影响。结果发现,家庭年均纯收入、家庭抚养比率、女性户主的家庭比例、仅以农业生产为主要经济来源的家庭比例等社会经济因素及空间相邻关系是影响干旱区生计脆弱度空间扩散的最主要原因。族群因素方面,维吾尔族对干旱区气候变化和环境演变更为适应。而不同的地理位置,如乡村和城市、绿洲和荒漠等则表现出不同的生计脆弱度空间聚集状态。     

人口性别结构的比较研究

性别比是影响人类婚姻、生育的基本因素,与人口再生产、人口分布及其它人口结构均有直接关系,过高或偏低都可能导致一系列社会问题。我国人口性别结构经过解放后30多年的社会、经济等因素的影响,发生了很大变化。笔者主要就解放后尤其是1982年到1987年全国和各地区人口性别结构的特点和变化及其成因进行简单的比较分析。     

西部农村留守妇女家庭压力及其影响因素分析

本文采用西部地区24个行政村千余名农村妇女的调查数据,探讨了农村留守妇女的家庭压力及影响因素。研究发现,留守确实增强了农村妇女的家庭压力,留守妇女承受的精神压力、经济压力、抚养赡养压力都要大于非留守妇女;留守妇女的年龄、家庭特征、当初择偶时对般配的重视程度、夫妻异质性、与外出丈夫的沟通状况、社会支持等因素对其家庭压力有不同程度的影响。提出建立夫妻间良好的沟通机制和构建社会支持网络的建议。     

中国家庭代际功能关系及其新变动

家庭代际功能关系是由义务和责任履行、权利享有、需求交换和情感沟通所组成的体系.社会转型之下,亲代对子代的教育义务增大,子代赡养亲代义务减轻;高龄和生活不能自理父母对子女尚有照料依赖.随着独生子女一代的长大,女儿在代际功能关系中的作用提高,甚至具有不可替代性;人口预期寿命提高,直系成员存世代数增加,4代存世家庭大幅度上升,可能加大子代的照料负担.整体看子代“回馈”亲代的功能下降,直接影响育龄夫妇的生育行为.子代代际功能关系履行降低有社会福利制度的替代、客观条件制约的作用,也有主观意识弱化的因素,还有约束性制度环境欠缺的问题.政府和社会组织应推动适应现代社会要求的新的代际功能关系的建立.     

中国大陆全民医保与台湾地区全民健保福利性之比较

中国大陆的全民医疗保险与台湾地区的全民健康保险在制度覆盖对象、基金给付范围和给付程度、基金实现效率及效果等体现制度福利强度的方面都有明显的差别,这与两地的经济实力、健保观念、健保管理经验和政治环境差异有关。借鉴台湾地区健保经验,大陆欲增强全民医保的福利效果,应把医疗保险发展成统一的全民健康保险,实行门诊和大病统筹保障;加快培育私营医疗服务机构,增加定点医疗机构并让民众自由就诊;建立以病人为中心的医院品质评价机制,引导医院改进服务设施,提高人本服务水平;加快基金按服务质量和病种付费的步伐,加速推行总额预算制;减少对公立医院的非建设性投入,加大对民众医保的投入。     

Quality Assessment of the Oncology Health Service in a Public Hospital

Quality assessment is a crucial issue in the strategic management of the public health sector. The objective of this study is to investigate the patients’ perception of the health system quality and explore the relationships between doctors and long-term cancer patients. The data under study have been collected during a survey conducted with long-term cancer patients who follow an oncological therapy in a Public Hospital. In the study, exploratory factorial analysis is developed and two structural equation models are proposed. The first model describes the service quality as perceived by the patients, which is influenced by four important factors, namely tangible aspects, reliability, empathy (doctor–patient human relations) and hospital organization. The second model describes the relationship between doctors and long-term cancer patients, which is influenced by three factors, that is reliability, empathy and hospital organization. The discussion highlights the contribution that the results of the study may make to the investigation of the possible strategies for improving health care service quality.

     

家庭电子健康档案——公民健康权利的重要载体，人口与健康科学数据的重要来源

一、“人”是健康的核心、科研的落脚点 健康是人类发展所必须关注的一个永恒的基本的主题,但绝不仅仅是单纯的医学问题。长期以来,随着诊疗技术的不断发展,健康领域越来越为医院、医务工作者和医学科研人员所主导,患者的地位越来越被动,“未病”者的生存与健康状况更是难以得到及时、有效和持续的制度性监测、研究和干预,导致突发公共卫生事件频发,社会危害严重。     

The hospitals and population growth: The voluntary general hospitals, mortality and local populations in the English provinces in the eighteenth and nineteenth centuries part 2

Summary In the second part of this article the number and nature of hospital cases treated in the light of physical, medical and surgical limitations are examined. Each hospital's records of treatment are summarised and discussed. Whether or not the hospitals were able to tackle successfully some of the major diseases and causes of death and thereby exert a positive influence in reducing mortality rates is then considered. Two main conclusions are drawn. First, that the hospitals had a positive role to play within their patient catchment areas, but that this was insufficient to affect national mortality trends decisively. Secondly, the hospitals' influence was of greater importance before the mid-nineteenth century. Despite advances in medical knowledge and techniques, population pressure, overcrowding and the growing incidence of serious cases in hospitals coupled with outbreaks of 'hospital diseases' meant that the results of hospital treatment may have become less impressive. But even then, mortality levels in the hospitals were low and the hospitals did not merit their reputation of being 'gateways to death' or as institutions 'which positively did harm'.     

“You’re a ‘high-risk’ customer”: A qualitative study of women’s experiences of receiving information from health professionals regarding health problems or complications in pregnancy

BackgroundExperiencing complications in pregnancy is stressful for women and can impact on fetal and maternal outcomes. Supportive encounters with health professionals can reduce the worry women experience. Further research is needed to understand women’s perspectives on communicating with their healthcare providers about their concerns.AimThis study explored women’s experiences of receiving information about pregnancy complications from healthcare providers and their interactions with multiple professionals and services during pregnancy.MethodsThis was a qualitative interpretive study. Semi-structured interviews were conducted with 20 women experiencing pregnancy complications recruited from antenatal services at two hospitals in Sydney. Inductive thematic analysis was used to analyse the data.FindingsWomen had a range of reactions to their diagnoses, including concern for their baby, for themselves and for their labour. Most women reported that communication with healthcare providers was distressing, they were not listened to and staff used insensitive, abrupt language. Women were also distressed by delays in education, receiving contradictory information and having to repeatedly share their stories with different health professionals. In some cases, this damaged the therapeutic relationship and reduced trust towards healthcare providers. Midwives were generally preferred over doctors because they had a more woman-centred approach.ConclusionTo improve women’s experiences of care for pregnancy complications, it is critical to improve the communication skills of maternity service providers. Women’s need for information, resources and support can best be provided by continuity of care with a named health professional, for example, a midwife working within an integrated multidisciplinary antenatal service model.     

论社会医疗保险中的道德风险及其制度消解

道德风险源于人的机会主义倾向,在社会医疗保险领域中积弊已久,主要表现为需求方的过度消费和供给方的诱导需求,其原因在于第三方支付效应、价格补偿效应和医疗伦理的异化。只有医、患、保三方进行制度创新才能对其有效消解。     

Technical information via print

The amount that the staff of family planning clinics learn through technical publications is discussed in this article on the Philippine Population Center Foundation's Study of the flow of scientific information. The main questions raised include to what extent doctors, nurses and midwives learn from publications sent to their clinics, or from colleagues who have read the journals. If the latter is true, do the staff members teach one another or merely refer each other to the technical information available? 99 copies of "Population Reports" were sent out to various clinics throughout the Philippines. A 3rd of the issues were on the pill, a 3rd were on the IUD, and a 3rd were on the condom. 6 weeks after the information was sent out, tests on all 3 contraception methods were given to all staff members who were part of the survey. Ideally clinic staffs would perform best on the tests of the method on which they had received information. Tables giving breakdowns on the individual areas tested show that while clinics which had been sent information on the IUD scored best on the IUD test, clinics which had been sent pill and condom information did not do better on their respective tests than the others. Nurses and midwives from clinics with good interpersonal relations scored higher on the tests on which they had been sent information. Results also showed that the more involved a professional was with a contraceptive, the more he/she read about it. While encouragement and referral occurred between colleagues, teaching did not. A 2nd study was then run on how levels of interpersonal communication could be determined. A multiple regression analysis showed that the best predictors of intraclinic communication were age difference among clinic staff, similarity in clinic staff's length of family planning service, family planning caseload, similarity of clinic staff's reading of professional literature, average length of service of staff members in the medical profession, and average age of clinic staff.     

The outbreak of coronavirus disease in China: Risk perceptions,knowledge, and information sources among prenatal and postnatal women

BackgroundThe COVID-19 pandemic has created anxiety among members of the public, including all women over the childbirth continuum, who are considered to be at a greater risk of contracting most infectious diseases. Understanding the perspectives of health care consumers on COVID-19 will play a crucial role in the development of effective risk communication strategies. This study aimed to examine COVID-19-related risk perceptions, knowledge, and information sources among prenatal and postnatal Chinese women during the initial phase of the COVID-19 pandemic.MethodsA cross-sectional survey design was adopted, and a four-section online questionnaire was used to collect data. Using a social media platform, the online survey was administered to 161 participants during the outbreak of COVID-19 in Nanjing, China, in February 2020.ResultsThe participants perceived their risk of contracting and dying from COVID-19 to be lower than their risk of contracting influenza, however many of them were worried that they might contract COVID-19. The participants demonstrated adequate knowledge about COVID-19. The three major sources from which they obtained information about COVID-19 were doctors, nurses/midwives, and the television, and they placed a high level of confidence in these sources. There was no significant relationship between the perceived risk of contracting COVID-19 and knowledge about this disease.ConclusionThe present findings offer valuable insights to healthcare professionals, including midwives, who serve on the frontline and provide care to pregnant women. Although the participants were adequately knowledgeable about COVID-19, they had misunderstood some of the recommendations of the World Health Organisation.     

The role of a provincial hospital: The Norfolk and Norwich hospital, 1771–1880

Up to the mid-1950's most economic and social historians accepted that improved medical measures, notably the expansion of hospital facilities, made a significant contribution to population growth in the late eighteenth and early nineteenth centuries by helping to reduce mortality rates. In an article which first appeared in 1955, T. McKeown and R. G. Brown criticized what had become the ‘traditional’ view. Though the number of hospitals increased, and though there were advances in medical education and knowledge, such developments, McKeown and Brown suggested, were of little value to the population until reflected in improvements in the standards of treatment available. ‘In assessing the contribution of hospitals to the reduction of mortality’, they argued, ‘we are less concerned with the number of beds than with the results of treatment of the patients who occupied them’.     

老年人社区医养融合养老模式选择意愿影响因素分析--基于ISM-AHP方法

老年人社区医养融合养老模式选择意愿受众多因素的影响,这些因素涉及范围广且关系复杂。为厘清各影响因素之间的层次关系和影响程度,本文从身体特征、家庭特征、认知特征和环境特征四个方面构建了影响因素指标体系。首先采用解释性结构模型分析得到由表层直接影响因素、中层间接影响因素和深层根本影响因素组成的3级多层递阶有向图,然后应用层次分析法对各因素指标的影响力进行排序,建立指标综合权重体系。结果表明：表层直接影响因素包括ADL、医疗支出能力、健康自评等8个,中层间接影响因素包括慢性疾病数量、社会关注度、医疗保障水平等8个,深层根本影响因素包括家庭收入水平、政府支持力度和发展阶段3个。其中,家庭收入水平、ADL、医疗保障水平、慢性疾病数量、政府支持力度等是老年人社区医养融合养老模式选择意愿的主要影响因素。