美国“以患者为中心的医疗之家”创新模式及其启示

发展基本卫生保健服务作为解决各国医疗问题的基本途径,是实现人人享有平等医疗的关键。“以患者为中心的医疗之家”是近年来美国基本卫生保健的改革创新模式,其以患者的需求为中心,提供全面、持续和便捷的医疗服务,在控制医疗费用、提高服务质量和患者满意度方面取得了良好的效果。借鉴该创新模式经验,结合我国现状,可以从服务理念、内容、提供主体、组织方式、资金来源和支付方式方面探索构建适合我国的基本卫生保健服务模式,夯实我国医疗卫生体系基础,推动新医改进程,提高人民健康水平。     

国际犯罪与国际刑法

论述了打击与预防国际犯罪的客观需要促进了国际刑法的产生与发展,而国际刑法作为规制国际犯罪的法律,又反之为国际犯罪的遏制提供了法律依据和保障。因此,可以说,国际犯罪与国际刑法之间的关系是相互依存、相生相伴的。     

Nativity and citizenship status affect Latinos’ health insurance coverage under the ACA

ABSTRACT

The 2010 Patient Protection and Affordable Care Act (ACA) aimed to increase health insurance access for the over 47 million uninsured people in the U.S.A., among whom ethnoracial minorities had the highest uninsured rates before the ACA. Studies have shown that Latinos have had the greatest improvements in health coverage under the ACA, but many may be at a significant disadvantage, specifically due to their nativity and immigration status, as the ACA explicitly excludes unauthorised immigrants from most of its provisions. Using the 2015 Latino National Health and Immigration Survey, a nationally representative sample of Latinos (n?=?1493), we find that variation in health insurance access among Latinos can be traced to immigration status. This study finds no differences among U.S.-born versus foreign-born Latinos in the likelihood of being uninsured in 2015. However, among foreign-born Latinos, unauthorised immigrants are five times more likely than naturalised citizens to be uninsured and less likely to visit a primary care provider or clinic, even after controlling for other factors including language, income and education.     

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.     

Reasons for women's non-participation in follow-up screening after gestational diabetes

BackgroundDue to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the women's future health. The women's experiences of treatment and care during their pregnancies may affect participation.AimThis study aimed at understanding the women's experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening.MethodsA qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews.FindingsThe women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences.ConclusionThe women wished to be reminded of screening to increase their sense of safety. The women's experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the women's need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the women's individual needs and preferences for treatment and care offers potential for improvement.     

The Role of Clinical and Process Quality in Achieving Patient Satisfaction in Hospitals

Managers constantly struggle with where to allocate their resources and efforts in managing the complex service delivery system called a hospital. In the broadest sense, their decisions and actions focus on two important aspects of health care—clinical or technical medical care that emphasizes “what” the patient receives and process performance that emphasizes “how” health care services are delivered to patients. Here, we investigate the role of leadership, clinical quality, and process quality on patient satisfaction. A causal model is hypothesized and evaluated using structural equation modeling for a sample of 202 U.S. hospitals. Statistical results support the idea that leadership is a good exogenous construct and that clinical and process quality are good intermediate outcomes in determining patient satisfaction. Statistical results also suggest that hospital leadership has more influence on process quality than on clinical quality, which is predominantly the doctors' domain. Other results are discussed, such as that hospital managers must be mindful of the fact that process quality is at least as important as clinical quality in predicting patient satisfaction. The article concludes by proposing areas for future research.     

三月三——中国的情人节的倡导与考释

我国夏历三月三上巳节,是中国古代典型意义上的情人节。笔者在神话学、民俗学、社会学等多角度对上巳节的源起及流变,上巳节的祭高禖求子嗣、祓禊驱灾、会男女等节日内容和我国目前该节日的现状及心理认同感进行分析研究的基础上,首倡三月三为我国自己的情人节。     

“革命文学”的倡导者瞿秋白

上世纪二三十年代,瞿秋白在理论上倡导革命文学,并有“实绩”,是革命文学的倡导者、奠基者之一。这一时期,瞿秋白的文艺观既是无产阶级文艺理论的先声,也是二三十年代革命文学理论不可缺少的重要组成部分,并对革命文学运动产生了直接或间接的影响。     

医疗社会工作视角下和谐医护资源网络的构建

在现行医疗体制不断改革和完善的过程中,开展医疗社会工作,重新审视医患双方的角色,以医疗社会工作者为中介,构建"医疗机构—家庭—单位—社区—慈善公益组织"五位一体的医护资源网络,缓解医患矛盾,维系医疗秩序和谐稳定,促进医患双方合作互助共同捍卫生命的价值与尊严。