论新型农村合作医疗制度的城乡统筹——以杭州为例

2003年新型农村合作医疗制度试点实施以来,杭州试图让农民和城镇非从业人员根据自身实际情况灵活选择不同的医疗保险项目、定点医院,并逐步提高筹资水平,报销和补偿水平。通过分析杭州新农合实施过程、运作逻辑,从制度供给的公平性、可及性和合理性出发,认为新型农村合作医疗制度可以实现有差别统一的城乡统筹。     

血栓弹力图在PCI术后患者抗血小板治疗中的应用研究

目的:研究血栓弹力图在经皮冠状动脉介入治疗(PCI)患者中,使用血栓弹力图所测定的血小板抑制率的波动及临床疗效作用。方法:选取我院2012年1月份至2013年12月份收治的200例冠心病PCI治疗患者,应用血栓弹力图分析仪测定其二磷酸腺苷(ADP)途径诱导的血小板抑制率数据,根据抑制率差异分为3组,抑制率70%的为合格组,抑制率30%的为不合格组,入选不合格组再次分为2组,1组保持常规剂量治疗不变,另一组为大剂量治疗组。结果:随访半年的记录,记录一般情况及严重心脏不良事件发生情况。结果:随访的6个月中,共发生不良事件28例,其中合格组10例(9.6%),常规治疗组11例(22.4%),大剂量治疗组7例(14.9%),3组中不良事件发生率比常规治疗组大于大剂量治疗组,大剂量治疗组大于合格组,统计学上有明显差异(P0.05)。结论:血栓弹力图在PCI患者抗血小板治疗中应用具有一定的指导意义。     

Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model

We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n = 68) were compared to individuals assigned to a usual care condition (n = 61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.     

Using agency data for evidence-based programming: a university-agency collaboration

Agencies providing residential treatment are encouraged, or even mandated, to collect outcomes data and to implement evidence based practices, yet little guidance has been provided on how to do so using agency administrative data that are collected on an ongoing basis. We examined data on Child and Adolescent Functional Assessment Scale (CAFAS) scores for 1608 admissions to a residential treatment center from 2002 through 2008. CAFAS scores were measured every 90 days, providing multiple CAFAS scores for each individual. Results demonstrated that on average residents improved in functioning over time. Sensitive to the evolving needs of residents who had been entering the program, the treatment center made significant program changes in 2006 to attempt to better serve residents through a broad array of specialized programming. Compared to the overall results, the analysis suggested that residents who entered the program since October 2006 appeared to have made larger improvements in their CAFAS scores. Results were derived by employing multilevel models appropriate for estimating growth trajectories with repeated measures data. Conversations with agency staff suggested that using administrative data, and advanced statistical models, were extremely helpful for organizational decision making and evidence-based programming.     

Organizational characteristics that foster early adoption of cultural and linguistic competence in outpatient substance abuse treatment in the United States

Recent years have seen an increased interest in developing culturally and linguistically responsive systems of care in substance abuse treatment in the United States. This study examines the extent to which external and internal organizational pressures contributed to the degree of adoption of culturally and linguistically responsive practices in the nation's outpatient substance abuse treatment system early in the period of development of this system of care. Findings show that a higher degree of adoption of culturally competent practices was most likely in treatment programs with high dependence on external funding and regulation. Internally, programs with a larger number of professionals were associated with the lowest degree of adoption, while managers’ cultural sensitivity contributed significantly to a high degree of adoption of these responsive practices. Considering the passage of recent legislation enforcing the use of cultural and linguistic competence in health care, implications of these baseline findings on early adoption patterns are discussed for future research and health care policy evaluation.     

The dilemmas for black social work professionals: Therapeutic implications

This paper explores the nature of social work and therapeutic practive from the perspective of black practitioners in Britain today. Black practitioners carry their histories of hurt, loss and reunion, migration and racism with them, and this lends a particular meaning to the idea of 'therapeutic' for them. The writer articulates some of the complexities and tensions of black professional social work identity through a number of vignettes based on her own experience and biography. The paper was presented as a keynote address at the Therapeutic Social Work Today conference at the Tavistock Clinic in 2001.     

Empowered and self-managing users in methadone treatment?

Empowerment is a keyword in treatment. Users should have the means and possibilities to influence their treatment and become self-managing. Drawing on ethnographic fieldwork in a Danish methadone treatment project, we find that the practices of users and staff are often not carried out in accordance with governmental intentions. We identify a gap between the official notions of treatment and practices. We analyse the notions and practices of empowerment by applying two analytical perspectives. First, we apply a constructionist perspective in which empowerment is analysed as wanting to set users ‘free’ but also as ways to govern. We elaborate the analysis by applying a more practice-oriented focus. Drawing on this perspective, we analyse the ways in which staff and users constantly produce, construct and negotiate institutional practices that differ from the governmental intentions for treatment.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Characteristics and Outcomes of College-Age Adults Enrolled in Private Residential Treatment: Implications for Practice

Substance use among college-age adults is of interest due to high levels of use and low levels of treatment access and engagement relative to other adults. Data collected from 1,972 clients in residential services were analyzed to investigate differences in use patterns, treatment outcomes, and other life area problems. Participants completed an Addiction Severity Index (ASI) and the University of Rhode Island Change Assessment (URICA) at baseline, and an ASI and Treatment Services Review at 1-month and 6-month postdischarge interviews. Almost a quarter (24.1%) of participants were college age (18–25 years old). They were more likely to be White and male, and less likely to complete treatment although they had a longer average length of stay. College-age adults improved on all outcome measures, and posttreatment service use shows significant difference between college-age and older participants. Implications for practice are discussed.     

A reduced form of the Workplace Bullying Scale – the EAPA-T-R: A useful instrument for daily diary and experience sampling studies

The need for more longitudinal studies (i.e. daily diary and experience sampling studies) focused on counterproductive work behaviours such as bullying requires shorter scales that at the same time do not compromise their content validity. Our main objective is to develop and validate a reduced version of the Workplace Bullying Scale (Escala de Abuso Psicológico Aplicado en el Lugar de Trabajo): the EAPA-T-R. Two studies (Study 1: 1506 and Study 2: 932 employees, respectively) were conducted to evaluate its psychometric properties and to ensure the external validity of the EAPA-T-R. Correlation and regression analyses were performed to reduce the current 12-item scale to a more parsimonious 4-item scale. Moreover, the psychometric properties of potential models were compared. Subsequently, the new scale was assessed using confirmatory factor analysis. Likewise, statistically significant relationships were found between the EAPA-T-R and other dimensions evaluated, such as job characteristics, transformational leadership, engagement, job satisfaction, and subjective performance. Moreover, bullying mediated the relationship between transformational leadership and burnout. To sum up, the EAPA-T-R showed good reliability and validity across studies, supporting its use in future research. The benefits of this short scale for daily diary and experience sampling studies and when using large surveys are discussed.