重大公共卫生事件中应如何作为:来自医学人类学哈佛学派的启示

聚焦人类学者在针对重大公共卫生事件的跨学科研究中应该有何作为这一议题,通过借鉴来自医学人类学哈佛学派的民族志洞见和研究经验,为当下2019新型冠状病毒疫情危机中所进行的田野观察和分析,以期获得灵感和启示,并探索有可行性和操作性的研究策略和方法。     

对我国普通高校学生心理健康问题的调研

运用反映人类心理健康状况的CES-D、SAS和SCL-90自评量表的测试结果表明,我国普通高校学生的心理健康状况不容乐观,20.4%的大学生有轻度心理障碍,8.6%的学生有中度心理障碍,3.2%的学生患有心理疾病,这应当引起学校教育的高度重视和全社会的广泛关注。     

A Risk-Based Method for Modeling Traffic Fatalities

We describe a risk-based analytical framework for estimating traffic fatalities that combines the probability of a crash and the probability of fatality in the event of a crash. As an illustrative application, we use the methodology to explore the role of vehicle mix and vehicle prevalence on long-run fatality trends for a range of transportation growth scenarios that may be relevant to developing societies. We assume crash rates between different road users are proportional to their roadway use and estimate case fatality ratios (CFRs) for the different vehicle-vehicle and vehicle-pedestrian combinations. We find that in the absence of road safety interventions, the historical trend of initially rising and then falling fatalities observed in industrialized nations occurred only if motorization was through car ownership. In all other cases studied (scenarios dominated by scooter use, bus use, and mixed use), traffic fatalities rose monotonically. Fatalities per vehicle had a falling trend similar to that observed in historical data from industrialized nations. Regional adaptations of the model validated with local data can be used to evaluate the impacts of transportation planning and safety interventions, such as helmets, seat belts, and enforcement of traffic laws, on traffic fatalities.     

Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

福州市社区空巢老年人健康状况调查

目的了解空巢老年人的健康现状及其影响因素,为老龄工作提供科学依据。方法2002年4~5月进行入户调查,采用分层整群抽取福州市鼓楼、台江、仓山三个区60岁及以上的社区老年人,共得到有效样本1767例,其中空巢老人696名。空巢老人躯体健康、生活自理能力(ADL)、经济状况、精神健康、社会健康5个维度的健康状况及其影响因素的调查是本次研究的主要内容。结果福州市社区空巢老年人占老年人总体比例的39%,其中男性多于女性;由logistic检验得出空巢老年人健康状况受年龄、性别、原职业、是否赞成非家庭养老方式、锻炼程度等因素的影响。结论倡导空巢老年人形成良好的生活饮食习惯与自我保健意识,加强对空巢老年人慢性病的防治,丰富老年人的精神生活、社会生活,提高对空巢老年人经济支持,完善社区为老服务,从而改善空巢老年人的健康状况。     

生态运动与绿色主义福利思想：生态健康科学与新型公共卫生框架

人与自然、社会与自然关系既是经典的理论议题,又是紧迫重大的现实政策问题.本文从生态运动入手,系统介绍作为生态运动理论基础的绿色福利主义,并以生态健康科学为基本理论视角,简要探讨新型现代公共卫生政策框架及其革命性的现实、理论与政策涵义.