影响北京市居民就诊满意的因素分析

了解北京市居民对医院评价的影响因素是提高医疗服务整体水平和质量的前提。本文以累积Logistic模型为主要方法 ,研究影响北京市居民就诊满意的因素。将各因素按照医疗消费行为特点归为供方因素和需方因素两个方面 ,通过不同的模型找出具有显著作用的变量 ,同时测度其效应的相对大小。研究发现 ,就诊费用是影响居民就诊满意供方因素中最显著的一个 ,而需方因素效应在不同模型中表现不大一样     

Pre-employment antecedents of health resources, job factors and health risk behaviour in men and women

The role of individual factors in youth as predictors of adult health resources, job factors and health risk behaviour was studied in men and women. The studied health risk behaviours were smoking, use of alcohol and sedentary behaviour. Sense of coherence (SOC) was the used measure of adult health resources. The pre-employment data had been collected from a sample of 1084 subjects representative of Finnish youth at the mean age of 12 years. For this follow-up study, 345 women and 361 men, working in Finland, responded to a questionnaire at the mean age of 36 years. In the analyses of structural relationships, individual factors in youth were related to adult variables for both sexes, although only two consistent relationships were found for women: outgoing, social activities in youth predicted adult smoking and use of alcohol. Of the job factors, low job demands were related to smoking and lack of support at work was related to sedentary behaviour in women. The strong relationships of SOC with perceptions of social support and influence at work for both sexes characterized its role in health-promoting experiences at work, and supported its importance as a general health resource.     

The psychosocial work environment of district nurses in Sweden

Data were collected from a stratified sample of district nurses in the greater Stockholm area on four occasions during one year using questionnaire techniques (to assess psychosocial working conditions and social networks, and self-reported health sums); as well as physiological measurement techniques. Three groups of district nurses were compared: group A, those working independently in the 'traditional' role but outside primary health care centres; group B, those working independently in the 'traditional' role but in primary health care centres; and group C, those working in the model role as part of primary health care teams. The study focused on the effects of these different work environments on the district nurse's psychological and somatic health, and their physiological state.

The data suggested that district nurses in the primary care teams (group C) had a lower objective work load than those working in the more traditional role. Despite this, they reported a less favourable balance (ratio) of work demands to decision latitude. They reported more 'problems' and 'conflicts' at work than did the other district nurses. However, such 'problems' were diminishing during the study period, which could mean that successive adaptation to the 'new' situation was occurring. The 'conflicts', on the other hand, remained. This may indicate that despite this adaptation, the district nurses in the primary care teams were struggling with their new work roles. It points to the need for organizational support during this important change process. The district nurses in group B (traditional role but in a primary health care centre) had the highest objective work load and showed physiological reactions in terms of elevated plasma cortisol levels in the morning, high systolic blood pressure and sleep disturbances.     

Helping Older People in Residential Care Remain Full Citizens

New Labour’s project of modernization has involved thepromotion of interlocking ideas about active citizenship andnew modes of democratic engagement combining to produce whathas described as ‘participative governance’. Concernsabout legitimacy, a ‘democratic deficit’ and theneed to shift power and responsibility to the ‘citizen’have led to the emergence of a range of new deliberative foraand democratic processes. This has led to debates about howto ensure that social diversity can be represented in the decision-makingprocess. A challenge has been how to engage with the issuesof an ageing population and represent older people in all theirdiversity. In recent years, there have been growing calls toextend advocacy rights to older people living in residentialcare. Mostly, this has been to ensure that as consumers, theyhave a fuller say in how their service is run. Older care homeresidents are service users but, as persons, should not be reducedto this role only; they are also citizens in the broadest senseand should not be cut adrift from debates at the national, localand community levels on issues that concern them. This paperexamines how the moves to bring older people into deliberativedemocratic processes have tended to focus on those in their‘Third Age’. Those in institutional settings, beingin the ‘Fourth Age’, occupy a much more marginalposition. This effective disenfranchisement is yet another reasonwhy, for many, the move into residential care—a difficulttransition for a variety of reasons—becomes regarded asthe ‘last refuge’. It contributes to the sense ofloss of identity, lowering of self-esteem and a reduced senseof personhood. This article accepts that there should be moreeffective involvement of care home residents in decision makingabout their personal care. However, there are dangers in adoptinga too narrowly consumerist approach. This can reinforce a reductionistview of care home residents simply as ‘service users’—aform of ‘othering’ in itself. As citizens and membersof a wider community, they should be included in consultationsabout any community and wider political debates that affectthem. Such a proposal implies a widening and deepening of advocacyservices available to this group. As most older people in residentialcare are there following the intervention of a social care professional,then ensuring that they have access to advocacy must surelybe a key task. This paper argues that this is frustrated bythe lack of suitable services. Without a significant investmentby the Government in independent advocacy services, not onlyis the social work task with one of social care’s coreclient groups rendered impossible, but the Government cannotdeliver on its own agenda of empowerment, active citizenshipand inclusion.     

Older People and Permanent Care: Whose Decision?

This paper looks at decision making when older people enterpermanent care, and focuses on power issues. The recent pastis reviewed and related to aspects of the current picture. Dementiaand capacity are a specific focus. The complexities of the workfor practitioners, together with their sometimes difficult workingenvironments, engender a climate which can be counter productiveto protecting the self-determination of older people.     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

企业必须善待职工

企业善待职工是我国社会主义制度决定的.近几年来,某些企业损害职工利益,给社会带来不安定因素,这是值得引起重视的重要问题.作者认为企业应该尊重职工、善待职工,建立企业管理人员与普通职工平等的、亲密的兄弟关系.本文从四个方面分析善待职工的重要意义,并针对现状提出了较为切实可行的善待职工的六条对策建议.作者选题具有现实和长远意义,论点正确,分析中肯,值得企业管理部门参考.     

Childcare involvement, job characteristics, gender and work attitudes as predictors of emotional exhaustion and sickness absence

Reports in the literature vary regarding the existence of gender differences in relation to burnout and sickness absence. To investigate this, the present study was aimed at investigating the role of several gender-relevant variables, particularly childcare obligations, job characteristics, and work attitudes in emotional exhaustion and sickness absence in 404 male and female nurses in an institution for people with learning difficulties. Questionnaires were administered reflecting demographic and job characteristics, work and non-work attitudes, and emotional exhaustion (as measured by the Emotional Exhaustion Scale of the Maslach Burnout Inventory). Female nurses were expected to report higher levels of emotional exhaustion and to be absent through sickness more often than men. Also, childcare investment, job characteristics, and (non) work attitudes were expected—via emotional exhaustion—to predict gender differences in sickness absence. It was found that women did not have higher sickness absence rates, and although a gender difference appeared in emotional exhaustion it was in the opposite direction from that predicted. For both genders, emotional exhaustion had a significant positive effect on sickness absence, and especially childcare investment and number of work hours appeared to contribute to both outcomes. These results are of interest because, despite current stereotypes, sickness absence was not higher in women, and neither were women more at risk for emotional exhaustion. In particular, load—workload as well as care load—appeared to predict emotional exhaustion and thus sickness absence.     

Obtaining cancer risk factor prevalence estimates in small areas: combining data from two surveys

Summary.  Cancer surveillance research requires accurate estimates of risk factors at the small area level. These risk factors are often obtained from surveys such as the National Health Interview Survey (NHIS) or the Behavioral Risk Factors Surveillance System (BRFSS). The NHIS is a nationally representative, face-to-face survey with a high response rate; however, it cannot produce state or substate estimates of risk factor prevalence because the sample sizes are too small and small area identifiers are unavailable to the public. The BRFSS is a state level telephone survey that excludes non-telephone households and has a lower response rate, but it does provide reasonable sample sizes in all states and many counties and has publicly available small area identifiers (counties). We propose a novel extension of dual-frame estimation using propensity scores that allows the complementary strengths of each survey to compensate for the weakness of the other. We apply this method to obtain 1999–2000 county level estimates of adult male smoking prevalence and mammogram usage rates among females who were 40 years old and older. We consider evidence that these NHIS-adjusted estimates reduce the effects of selection bias and non-telephone coverage in the BRFSS. Data from the Current Population Survey Tobacco Use Supplement are also used to evaluate the performance of this approach. A hybrid estimator that selects one of the two estimators on the basis of the mean-square error is also considered.     

在公平与效率之间:对北京市养老资源的空间分析

基于网络采集的养老机构数据和第六次全国人口普查数据，以公共设施区位理论为框架，使用空间分析方法，本文对北京市养老资源的分布模式进行了研究。研究发现，在乡镇/街道层面，整体上公办养老资源分布相对均衡，呈现正的空间依赖，民办养老资源则局部呈现负的空间相关性特征。空间回归分析表明，尽管两者布局均受到辖域内服务对象绝对数量这一因素的影响，但民办养老资源分布对老年人口密度这一指标更为敏感。不同类型的养老资源分散与集聚的空间模式，体现了公共设施供给问题上效率与公平原则之间的对比关系，这是行政与市场力量形塑的结果。