Development and Consideration of Global Policies for Managing the Future Risks of Poliovirus Outbreaks: Insights and Lessons Learned Through Modeling

The success of the Global Polio Eradication Initiative promises to bring large benefits, including sustained improvements in quality of life (i.e., cases of paralytic disease and deaths avoided) and costs saved from cessation of vaccination. Obtaining and maintaining these benefits requires that policymakers manage the transition from the current massive use of oral poliovirus vaccine (OPV) to a world without OPV and free of the risks of potential future reintroductions of live polioviruses. This article describes the analytical journey that began in 2001 with a retrospective case study on polio risk management and led to development of dynamic integrated risk, economic, and decision analysis tools to inform global policies for managing the risks of polio. This analytical journey has provided several key insights and lessons learned that will be useful to future analysts involved in similar complex decision-making processes.     

Discovering Spatio-Temporal Models of the Spread of West Nile Virus

Emerging infectious diseases are characterized by complex interactions among disease agents, vectors, wildlife, humans, and the environment. Since the appearance of West Nile virus (WNV) in New York City in 1999, it has infected over 8,000 people in the United States, resulting in several hundred deaths in 46 contiguous states. The virus is transmitted by mosquitoes and maintained in various bird reservoir hosts. Its unexpected introduction, high morbidity, and rapid spread have left public health agencies facing severe time constraints in a theory-poor environment, dependent largely on observational data collected by independent survey efforts and much uncertainty. Current knowledge may be expressed as a priori constraints on models learned from data. Accordingly, we applied a Bayesian probabilistic relational approach to generate spatially and temporally linked models from heterogeneous data sources. Using data collected from multiple independent sources in Maryland, we discovered the integrated context in which infected birds are plausible indicators for positive mosquito pools and human cases for 2001 and 2002.     

Using repeated-prevalence data in multi-state modeling of renal replacement therapy

Multi-state models help predict future numbers of patients requiring specific treatments but these models require exhaustive incidence data. Deriving reliable predictions from repeated-prevalence data would be helpful. A new method to model the number of patients that switch between therapeutic modalities using repeated-prevalence data is presented and illustrated. The parameters and goodness of fit obtained with the new method and repeated-prevalence data were compared to those obtained with the classical method and incidence data. The multi-state model parameters’ confidence intervals obtained with annually collected repeated-prevalence data were wider than those obtained with incidence data and six out of nine pairs of confidence intervals did not overlap. However, most parameters were of the same order of magnitude and the predicted patient distributions among various renal replacement therapies were similar regardless of the type of data used. In the absence of incidence data, a multi-state model can still be successfully built with annually collected repeated-prevalence data to predict the numbers of patients requiring specific treatments. This modeling technique can be extended to other chronic diseases.     

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。     

Minamata Disease and Environmental Governance

Abstract: This article aims to clarify the conditions necessary for environmental governance through a case study of one of the most tragic examples of environmental destruction, the Minamata disease. The Minamata disease is methyl‐mercury poisoning resulting from the ingestion of contaminated fish and shellfish. The first incident of the Minamata disease occurred in the mid‐1950s, in Kumamoto Prefecture. In spite of the grave lesson that the pollution in Kumamoto provided, Japanese society went on to experience a second occurrence of Minamata disease in the mid‐1960s, in Niigata Prefecture. Conflicts between victims, the companies responsible for contamination, and the central and prefectural governments have continued for the past 50 years. As a whole, the history of the two incidences of Minamata disease shows a lack of environmental governance in Japanese society. Effective environmental governance is the ability to produce adequate solutions to a variety of environmental problems. In order to resolve an environmental problem such as Minamata disease adequately, four tasks must be achieved. These are the discovery of the cause, the prevention of suffering, recovery from suffering and the learning of a lesson. What factors are crucial to the achievement of these tasks? Through an analysis of the history of Minamata disease, I would like to point out three fundamental factors that have a decisive influence on the solution of an environmental problem. They are the existence of an effective and just juridical system, a mature public sphere, and the quality of individual actors who are concerned with an environmental problem. The following conditions are important to the fostering of environmental governance on a more concrete level: sensitivity of the society and the ability to set an agenda, autonomy of the research process and of any research groups, organization of the antipollution movement, an adequately designed system for compensation, and various measures which help to counter socially amplified suffering.     

Quantitative Risk Assessment of FMD Virus Transmission via Water

Foot-and-mouth disease (FMD) is a viral disease of domesticated and wild cloven-hoofed animals. FMD virus is known to spread by direct contact between infected and susceptible animals, by animal products such as meat and milk, by the airborne route, and mechanical transfer on people, wild animals, birds, and by vehicles. During the outbreak of 2001 in the Netherlands, milk from dairy cattle was illegally discharged into the sewerage as a consequence of transport prohibition. This may lead to contaminated discharges of biologically treated and raw sewage in surface water that is given to cattle to drink. The objective of the present study was to assess the probability of infecting dairy cows that were drinking FMD virus contaminated surface water due to illegal discharges of contaminated milk. So, the following data were collected from literature: FMD virus inactivation in aqueous environments, FMD virus concentrations in milk, dilution in sewage water, virus removal by sewage treatment, dilution in surface water, water consumption of cows, size of a herd in a meadow, and dose-response data for ingested FMD virus by cattle. In the case of 1.6 x 10(2) FMD virus per milliliter in milk and discharge of treated sewage in surface water, the probability of infecting a herd of cows was estimated to be 3.3 x 10(-7) to 8.5 x 10(-5), dependent on dilution in the receiving surface water. In the case of discharge of raw sewage, all probabilities of infection were 100 times higher. In the case of little dilution in small rivers, the high level of 8.5 x 10(-3) is reached. For 10(4) times higher FMD virus concentrations in milk, the probabilities of infecting a herd of cows are high in the case of discharge of treated sewage (3.3 x 10(-3) to 5.7 x 10(-1)) and very high in the case of discharge of raw sewage (0.28-1.0). It can be concluded that illegal and uncontrolled discharges of contaminated milk into the sewerage system may lead to high risks to other cattle farms at 6-50 km distance of the location of discharge within one day. This clearly underlines current measures that prohibit such discharges, and also asks for strict control. This risk assessment clearly demonstrated the potential significance of FMD virus transmission via water, and the results will be useful on an international scale, and could also serve as a basis for other FMD risk-assessment models.     

The effect of information on health risk valuations

This article examines the effect of familiarity with chronic lung disease on people's willingness to pay to reduce their risk of contracting chronic bronchitis, and on their willingness to increase their risk of auto death to reduce chronic bronchitis risk. We find that persons who have a relative with chronic lung disease are willing to give up more income to reduce their risk of chronic bronchitis than persons with no first-hand knowledge of the disease; however, their willingness to increase their risk of auto death to reduce their risk of chronic bronchitis is no different, on average, than persons with no first-hand knowledge of lung disease. This suggests that responses to risk-risk tradeoffs may be more stable than responses to risk-income choices.This research was sponsored by Resources for the Future and by the U.S. Environmental Protection Agency, Office of Policy Planning and Evaluation, Alan Carlin and Joel Scheraga, project officers. We thank Robert Mitchell for his help in conducting focus groups, and Caroline Harnett and Sari Radin for research assistance. Stan Presser, Sue Dowden, and Tim Triplett of the University of Maryland's Survey Research Center administered the survey. We especially thank Stan Presser for his suggestion that we sample relatives of people with chronic lung disease. We also thank Kip Viscusi, Wes Magat, and Joel Huber for making available their computer programs and data, and Ajay Kalra for programming help. Paul Portney and John Mullahy provided useful comments on an earlier draff of the article, as did two referees.     

Importance of active listening in treating workers with musculoskeletal disorders

Female assembly workers reporting constant neck and shoulder pain, despite ergonomically acceptable working conditions, were interviewed. As a starting point in the interviews, the patients were asked to describe their general situation at work. Their reports were fed back and discussed with company management in a wider group meeting and resulted in an improvement in their attitudes to those workers. A climate of confidence and well-being was created, which the women experienced as genuine. The workers' report of pains improved dramatically and absence due to musculoskeletal disorders was reduced by more than 90% during the following year.     

妨害传染病防治罪的立法缺陷及其补救

对妨害传染病防治罪存在的立法问题作出评述,提出该罪的可罚范围有待拓宽、行为方式有待明确、与刑法其他罪名需要进一步衔接及统一、刑罚设置上有待进一步完善。     

论清代女词人赵我佩的“病、瘦”言说

清代女词人赵我佩存词173首,收于《碧桃仙馆词》中。赵氏体至孱弱,工愁善病,其词多言"病、瘦",直抒胸臆,清丽婉约。赵氏"病、瘦"词是一种自我表达的方式,不但记录了赵氏受苦受难的身体感受,也记录了赵氏受苦受难的心灵感受。她通过疾病所导致的苦难和情感上的残缺,唤醒自己及同时代的女性长期以来对疾病苦痛煎熬及夫妻离居造成的情感缺失的麻木,找寻迷失的自己,并关注自己的生存环境和生存状态。可以说赵氏词以独特的"病、瘦"言说参与到中国文学现代化的进程中来,为后世读者竖起了一座"病、瘦"词的丰碑。