从职业病防治看我国集体合同制度的不足与完善

职业病防治法的规定已经较落后,应当对其进行修改,扩大职业病的范围,同时为集体合同约定职业病条款预留空间。改革职业病的管理体制,积极完善工会组织,充分利用行业集体合同、区域集体合同和专项集体合同等现有机制,通过集体协商,引导劳动者和用人单位通过集体合同解决职业病防治问题,无论对于合同双方主体还是对于整个社会都是有益的。     

A latent process model for dementia and psychometric tests

We jointly model longitudinal values of a psychometric test and diagnosis of dementia. The model is based on a continuous-time latent process representing cognitive ability. The link between the latent process and the observations is modeled in two phases. Intermediate variables are noisy observations of the latent process; scores of the psychometric test and diagnosis of dementia are obtained by categorizing these intermediate variables. We propose maximum likelihood inference for this model and we propose algorithms for performing this task. We estimated the parameters of such a model using the data of the 5 year follow-up of the PAQUID study. In particular this analysis yielded interesting results about the effect of educational level on both latent cognitive ability and specific performance in the mini mental test examination. The predictive ability of the model is illustrated by predicting diagnosis of dementia at the 8 year follow-up of the PAQUID study based on the information from the first 5 years.     

强化干预代谢综合征改变心脑血管事件发生风险的纵向随访研究：社区人群心脑血管事件前瞻性研究系列之四

目的了解药物综合干预代谢综合征（MS）是否可以改变发生心脑血管事件的风险。方法采用随机整群抽样南宁市两个社区的1215人符合纳入标准为本次综合干预治疗的研究对象,随机分为强化干预组和对照组。强化干预组人群按照是否患有MS及其相关疾病、疾病前状态（包括高血压、血压前期、肥胖、超重、糖尿病、糖耐量减退、血脂异常）等分别采取不同的强化治疗方案进行干预;对照组人员维持志愿就诊和志愿服药的正常医疗状态,每年随访1次,按WHO—MONICA方案心血管病事件（CVD）的诊断标准登记本年度发生的CVD和死亡事件。结果前瞻性随访研究43．5个月后：①经比较对照组中MS亚组与非MS亚组,MS患者发生心脑血管事件比非MS显著增高（P=-0．02）;②经比较干预组中MS亚组与非MS亚组,干预后MS心脑血管事件下降明显,MS患者发生心脑血管事件与非MS相比无差异（P〉0．05）;③经比较干预和对照两组MS亚组之间心脑血管事件的发生率,干预组为2．7％,对照组为10．1％,差异显著（P=0．03,OR值=4．01,95％CL：1．07—15．10）;两组非MS亚组之间心脑血管事件的发生率分别为2.3％和4．2％,无显著性差异（P=0．12）。结论药物综合干预代谢综合征（MS）可以改变发生心脑血管事件的风险,与对照相比干预后风险降低了约4倍。     

神经分子生物学的发展

分子生物学的崛起改变了神经科学研究的进程。本文回顾了神经分子生物学40年的发展里程,分析了脑的1O年工程研究和焦点。展望了未来30年该领域发展趋势。     

论《沉沦》的“病态叙事”

试图通过对《沉沦》中郁达夫有意识无意识的“病态叙事”,来发掘小说的深刻内蕴;指出在郁达夫的作品中,主人公大都是“有病”的人,作者采取了“病态叙事”这种方式来展现和表达自己的内心痛苦,从而揭示五四一代先进知识分子普遍的痛苦和绝望。     

性病隐喻与两性身体叙事——中国现代文学中的“性病”意象探析

性病是中国现代文学中最典型的疾病意象之一,对性病的关注涉及对妓女生活的想象,而性别文化身份的差异在对妓女的叙事上体现为两种不同的身体叙事方式。男性主体的中心意识使文学创作更多地表现为人民伦理的宏大叙事,体现着“民族一国家”的“大意义”;女性的历史边缘处境使女性书写更多地呈现为自由伦理的私人叙事,作为一种“小意义”而存在着。对于文学作品中出现的性病,宏大叙事侧重于把女性身体编织进政治、道德、历史的意义圈,强调女性身体的公共性;私人叙事强调性病之于女性的私人经验,呈现女性身体的私人性。     

Bayesian hierarchical joint modeling using skew-normal/independent distributions

The multiple longitudinal outcomes collected in many clinical trials are often analyzed by multilevel item response theory (MLIRT) models. The normality assumption for the continuous outcomes in the MLIRT models can be violated due to skewness and/or outliers. Moreover, patients’ follow-up may be stopped by some terminal events (e.g., death or dropout), which are dependent on the multiple longitudinal outcomes. We proposed a joint modeling framework based on the MLIRT model to account for three data features: skewness, outliers, and dependent censoring. Our method development was motivated by a clinical study for Parkinson’s disease.     

The Cost of Compensating Asbestos Victims Under the Occupational Disease Compensation Act of 1983

The potentially huge financial liability due to asbestos product suits and the resulting filings for reorganization in bankruptcy by Manville, UNR Industries, Inc., and Amatex, has become a major public policy concern. In response to the problem several bills have been introduced in the Congress to provide compensation for asbestos (and other occupational disease) victims. This paper estimates the cost of compensating asbestos victims under the provisions of the "Occupational Disease Compensation Act of 1983," introduced by Congressman George Miller. Utilizing fatality projections from studies by Enterline, Selikoff, and Walker, and assumptions regarding likely claims filing and success rates, duration and degree of disability, and medical expenses, first year costs for this legislation are estimated to range from a low of $131 million to a high of $ billion. Present value cost estimates at a 2% real discount rate range from $3 billion to $56 billion. The paper also estimates the impact of possible modifications to the compensation provisions of the legislation. Reducing medical payments by the amount received from medicare would lower costs by 3-4%. Providing survivors with a 3-year lump sum benefit rather than a 5-year lump sum payment would save 20-25% as would offsetting the 5-year lump sum by expected social security old age and disability benefits. Combining all of these changes would reduce costs by almost 50%.     

HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

试论德国的医疗保险体制改革

德国是世界上最早实施社会医疗保障的国家。德国的医疗保险体系以社会医疗保险为主,商业医疗保险为辅。德国的医疗保险体系具有优质、高效、公平、覆盖面广等优点,但近年来也难以摆脱资源浪费,经费入不敷出等问题的困扰。德国于20世纪90年代和21世纪初持续进行医疗保险体制改革,采取了取消部分医疗补贴,提高某些医疗服务的自费比例,扩大有偿医疗服务范围,并组建了由政府机构,保险公司和医保医院共同构成的独立机构,对疾病认证,治疗程序和医疗服务质量进行统一规定和管理。本文对德国医疗保险体制改革进行了系统介绍和评估,对构建和完善具有中国特色的医疗保险体制具有参考借鉴价值。