How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Translating cross-lagged effects into incidence rates and risk ratios: The case of psychosocial safety climate and depression

Longitudinal studies are the gold standard of empirical work and stress research whenever experiments are not plausible. Frequently, scales are used to assess risk factors and their consequences, and cross-lagged effects are estimated to determine possible risks. Methods to translate cross-lagged effects into risk ratios to facilitate risk assessment do not yet exist, which creates a divide between psychological and epidemiological work stress research. The aim of the present paper is to demonstrate how cross-lagged effects can be used to assess the risk ratio of different levels of psychosocial safety climate (PSC) in organisations, an important psychosocial risk for the development of depression. We used available longitudinal evidence from the Australian Workplace Barometer (N?=?1905) to estimate cross-lagged effects of PSC on depression. We applied continuous time modelling to obtain time-scalable cross effects. These were further investigated in a 4-year Monte Carlo simulation, which translated them into 4-year incident rates. Incident rates were determined by relying on clinically relevant 2-year periods of depression. We suggest a critical value of PSC?=?26 (corresponding to ?1.4 SD), which is indicative of more than 100% increased incidents of persistent depressive disorder in 4-year periods compared to average levels of PSC across 4 years.     

Frontier spaces of vulnerability: Regional change,urbanization, drought and fire hazard in Santarém,Pará, Brazil

Fire hazard is a mounting concern in tropical rainforests of the Brazilian Amazon and has raised awareness within the science community of the links between agricultural fire use, drought and accidental fire. As a result, fire is being addressed as a crisis event with mitigation focused on those who light fires, particularly smallholder agriculturalists. Little attention is paid to the historical and ongoing ways in which Amazon landscapes and peoples have been made more susceptible to fire. Frontier regions of the Brazilian Amazon serve a variety of functions within the larger Brazilian society, including as extractive reserves for economic development, as social safety valves to reduce population pressures, and as areas to support urban regional integration. Each of these functions has impacted frontier environments in ways that create more flammable landscapes and/or shape the vulnerability of people to fire hazard. This paper uses a case study inthe Brazilian Lower Amazon to understand how vulnerability to fire hazard develops. It argues that if fire mitigation remains centered on fire as a crisis event, an understanding of what constitutes frontier spaces of vulnerability, both in landscape and in populations, will be limited.     

Book Reviews

Books reviewed:
M Hollander and D Wolfe, Nonparametric Statistical Methods
T Leonard and J.S.J Hsu, Bayesian Methods     

Modelling daily multivariate pollutant data at multiple sites

Summary. This paper considers the spatiotemporal modelling of four pollutants measured daily at eight monitoring sites in London over a 4-year period. Such multiple-pollutant data sets measured over time at multiple sites within a region of interest are typical. Here, the modelling was carried out to provide the exposure for a study investigating the health effects of air pollution. Alternative objectives include the design problem of the positioning of a new monitoring site, or for regulatory purposes to determine whether environmental standards are being met. In general, analyses are hampered by missing data due, for example, to a particular pollutant not being measured at a site, a monitor being inactive by design (e.g. a 6-day monitoring schedule) or because of an unreliable or faulty monitor. Data of this type are modelled here within a dynamic linear modelling framework, in which the dependences across time, space and pollutants are exploited. Throughout the approach is Bayesian, with implementation via Markov chain Monte Carlo sampling.     

论证券市场化解委托代理风险的作用机制

本文首先探讨了证券市场化解股份有限公司代理人道德风险问题的作用机制 ,并进一步详尽地分析了该机制发挥作用需要具备的条件 ,包括 :证券市场存在、证券市场具有完善的信息交流功能、证券市场有效性较高等。文章继而对照上述条件分析了我国证券市场的现状。最后提出了改进的对策     

分形理论在计算机辅助图案造型中的应用研究

本文简单介绍了分形理论的概念和特征，着重阐述了分形理论在图案艺术设计方面的应用和方法。研究设计了计算机辅助图案艺术设计系统的功能和构成。     

对品牌不当延伸的思考

文章界定了品牌延伸的内涵,分析了品牌延伸的动力机制,阐述了品牌不当延伸的主要危害,如引起消费者的不良联想、破坏原有品牌形象、降低消费者对品牌的忠诚度及失去老顾客、使原有品牌价值流失等。就如何正确开展品牌延伸提出了围绕核心价值开展品牌延伸、遵循品牌延伸"近亲繁殖有益"原则、根据产品的不同分类来实行多品牌命名等观点。     

Discrete time modelling of disease incidence time series by using Markov chain Monte Carlo methods

Summary.  A stochastic discrete time version of the susceptible–infected–recovered model for infectious diseases is developed. Disease is transmitted within and between communities when infected and susceptible individuals interact. Markov chain Monte Carlo methods are used to make inference about these unobserved populations and the unknown parameters of interest. The algorithm is designed specifically for modelling time series of reported measles cases although it can be adapted for other infectious diseases with permanent immunity. The application to observed measles incidence series motivates extensions to incorporate age structure as well as spatial epidemic coupling between communities.     

试论企业经营中的委托——代理关系与激励机制设计

企业经营中的委托—代理关系和激励机制问题显然是存在若干冲突理论和观点 的复杂课题，本文通过一个简单的数理模型对这一问题进行了理论上的阐释，同时也给出了现 阶段解决问题的一般思路。