平教会定县实验中的农村卫生工作之考察

中华平民教育促进会定县实验区在二十世纪三十年代创立了一套由村保健员、乡保健所、县保健院组成的三级卫生保健网,并在学校卫生、妇婴保健、传染病预防和疾病治疗等方面做出了显著的成绩,在当时产生了广泛的影响,对我们今天来说仍值得借鉴。     

Pathways between education and health: a causal modelling approach

Summary.  The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways.     

于根元先生的语言规划观

于根元先生的语言规划观主要体现在“语言规范观”“语言主体多样观”“语言服务观”三个方面。在语言规划研究方面,于先生提出了许多具有鲜明特色的重要命题,如语言规范的参照项是交际值、检验规范的成效是对语言生活的影响、语言规范制定时应重视语言的可预测性、规范就是服务等,这些命题如今看来,依然具有学习借鉴的理论意义和实践价值。     

“健康丝绸之路”构建的“政府—社会”复合路径

借鉴社会运动理论,可探索一种融合了政府自上而下和社会自下而上进程的“政府—社会”复合路径,以构建“健康丝绸之路”。社会运动理论的三种视角可为这种复合路径的具体实施与需要关注的环节带来重要启发：首先,当前新冠肺炎疫情的跨国传播暴露了全球公共卫生治理体系存在的严重不足,凸显出构建补充型国际卫生合作模式的必要性与紧迫性;其次,推进“健康丝绸之路”的构建,需要政府和社会层面的协作,将“一带一路”沿线国家的资源充分调动起来,形成优势互补与资源共享。与此同时,要推进健康话语体系的完善,如倡导和促进“人类卫生健康共同体”理念的传播,通过话语和心理共鸣等民心相通的途径,促使国际社会采取联合行动以共同应对全球公共卫生危机。     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

On the limiting properties of social indicators

Characteristics of the population and economic measures that constitute traditional social indicators are compared with more recent “quality of life” measures to demonstrate that social indicators are always value statements at the policy level. The possibility of alternative perspectives is illustrated. It is suggested that an awareness of the assumptions implicit in any given indicator is as important as the data they provide.