老龄健康的经济学研究现状、问题与对策

通过文献回顾发现,目前老龄健康研究最大的问题是研究结论的不一致,甚至相互矛盾,其根本原因在于未能正确处理内生性、生态学谬误等问题。建议通过工具变量法解决联立性偏误、随机分配法解决自选择偏误、Heckman二阶段法解决样本选择偏误、面板数据解决变量遗漏、利用滞后期数据解决反向因果关系问题,利用HLM模型解决生态学谬误。     

Changing attitudes to risk at older ages: The role of health and other life events

This paper investigates risk attitudes at older ages in 14 European countries. Older individuals report lower willingness to take risks in all countries. Using panel data we are able to show that this relationship between financial risk attitudes and age is not due to cohort effects or selective mortality. We also show that key mechanisms driving this change with age are health changes and other life events – in our preferred specification around half of the overall evolution of risk attitudes with age can be explained by health shocks, retirement, and widowhood or marital change that occur increasingly frequently as individuals age. These life-events are a particularly important explanation of the evolution of risk attitudes for women.     

政府购买服务与社区卫生服务机构的发展

在当代中国的城镇与乡村,社区卫生服务机构能否发展为民众的健康守门人,这是中国医疗服务体系改革与发展的重要议题之一。近年来,各级政府投入了大量公共资源,社区卫生服务机构的服务能力显著提升,但医师人均诊疗服务量基本上原地踏步,住院服务量却在萎缩。要达成"强基层"的目标,最为关键的是要"建机制",即建立一种政府购买服务的新机制,取代当前流行的行政化体制,以调动基层医疗机构的积极性。新机制的核心就是推进医保付费改革,以按人头付费为主导的新付费方式取代通行的按项目付费主导制。     

A mixed-methods evaluation using effectiveness perception surveys,social network analysis,and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson’s correlations. CHC members’ positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas.     

Communicating about infectious disease threats: Insights from public health information officers

The public health communication challenges that arise in times of infectious disease threats (IDTs) were examined using the Risk Amplification through Media Spread (RAMS) Framework and in-depth phone interviews with 40 national, state, and local public health information officers (PIOs). Interviewees shared their experiences and insights related to how IDTs are communicated to the public, including the different types of traditional and social media used, how they develop and assess IDT messages, and their perceptions regarding the IDT risk amplification process. Theoretical and practical implications for health public relations and public health communication are discussed.     

Contracting out of basic health facilities in Pakistan: Are the lessons generalizable?

Amid growing support within international development agencies for the privatization of health facilities in developing countries, contracting out of the Basic Health Units (BHUs) in Pakistan has been presented as a success. This article argues for caution in generalizing results from this model. It shows that the model improved service delivery because the organization taking over the BHUs was itself a government‐owned QUANGO (Quasi‐Autonomous NGO); similar concessions would not have been granted to a private provider. Further, the article shows that, given the strong resistance that the model continues to receive from administrators within the state system, development agencies must consider whether models that try to sidestep the bureaucracy instead of working towards installing good practice within the state system, can be viewed as a success.     

Exceeding parents' expectations in Ear-Nose-Throat outpatient facilities: the development and analysis of a questionnaire

The study attempts to develop an outpatient service quality scale by investigating the key dimensions which assess parental satisfaction and provides a recommendation on an improved health service delivery system. The survey was conducted in an Ear-Nose-Throat outpatient clinic of a Greek public pediatric hospital. A total of 127 parents in outpatient waiting areas were chosen; 74.8% of the sampled parents were under 40, and 78% were mothers. A factor analysis was performed; while a Fischer's exact test and multinomial logistic regression analysis was conducted. All Cronbach's α exceeded 0.70 and all factor loadings exceeded 0.50. Twenty-three items were retained through the scale development process and seven factors were formed that appear to be statistically valid and clinically meaningful: access and convenience, doctor's attention, customization, reliability, assurance, satisfaction and loyalty. Findings were discussed in relation to parents’ overall satisfaction and intention of reusing and recommending outpatient clinic. Satisfaction was found to be positively affected by access and convenience and doctors’ attention. Staff attitude and the telephone procedure of scheduling the child's examination found positively correlated to the likelihood of recommending services to friends and relatives. Time and communication in the waiting room influenced parents’ satisfaction. Overall, results reveal the measures that need to be taken in order to improve outpatient service quality.     

Framing breast cancer: Building an agenda through online advocacy and fundraising

Using qualitative content analysis, this study employs agenda building and framing to examine e-mail messages from Susan G. Komen for the Cure and the Komen Advocacy Alliance to determine strategies for communicating about breast cancer and inspiring involvement in nonprofit advocacy and fundraising efforts. Three types of messages, nine frames, and various tactics emerged among 50 messages sent during 1 year. Theoretical implications and practical applications for public relations and fundraising professionals are discussed.     

Primary versus secondary prevention messages: College students' perceptions of effectiveness by marijuana user status

Abstract

Objective: With medical and recreational marijuana legislation expanding throughout the country, the need to educate high-risk populations is evident. The purpose of this study was to assess college students’ perceptions of health communication messages comparing primary and secondary prevention messages concerning marijuana. Participants: Participants (n?=?487) included college students, ages 18–25, enrolled in a Midwestern University. Methods: Participants assessed messages based on likeability, creativity, believability, persuasiveness, relevance, and usefulness using an online questionnaire that also included open-end comments. Results: Rasch analyses indicate that nonmarijuana users rated primary prevention messages higher than secondary prevention messages, whereas marijuana users ranked secondary prevention messages more favorably than primary prevention messages. Conclusion: Interventions designed to address marijuana use among college students may be more effective if tailored toward user status. Specifically, primary prevention materials should be designed for abstainers, while secondary prevention messages that focus on harm reduction strategies should be used with marijuana users.     

Examining fear and stress as mediators between disorder perceptions and personal health, depression, and anxiety

Research examining the effect of neighborhoods on personal health has often focused on neighborhood disorder, or visual cues in neighborhoods perceived as personally threatening or noxious. Neighborhood disorderliness is thought to elevate individuals’ fear of crime, thereby negatively impacting personal and mental health. Unfortunately, the pathways between disorder, fear of crime, and health have yet to be established. This study examines the pathways between neighborhood disorder, fear of crime, and three health outcomes. Using the Community, Crime and Health Survey, this study employs structural equation modeling to examine how general (being afraid of walking alone) and offense-specific fear of crime (being afraid of specific crimes) mediate the relationship between individuals’ disorder perceptions and self-rated health, depression and anxiety. Results show that fear of crime does mediate the relationship between disorder perceptions, self-rated health and depression, though the mediating pathways are weak. This study suggests that the disorder-fear of crime-health nexus should be re-examined theoretically.