临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议。     

临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议.     

激励发展中国家的卫生研究——再思考与研讨新策略时代正在兴起

发展中国家需要更清晰地明确其卫生研究面临的优先项目,即国家应共同分担全球性研究项目,增强激励和纳入研究轨道的国家能力,把循证决策人微言轻政策决策的基础,加强国家与国际合作问题是卫生研究中的中心议题。     

刍议医生“道德人”与“经济人”的角色平衡

医生是以"道德人"为基础同时兼具"经济人"属性的特殊职业群体,而既往医改中由于存在政府决策的个人主义、政策对医生激励与约束机制不相称、政策对医生权利与义务规定失衡等问题使医生角色定位产生矛盾。从根本上解决医生角色定位问题是医改成功的关键。通过调整政府本位的卫生政策制定观念、卫生政策提出机制、卫生政策制定机制等促使医生"道德人"与"经济人"的角色平衡,以期对我国医疗卫生政策制定中如何对医生角色进行定位提供一定的理论参考。     

卫生政策走向与公共健康及其伦理思考

政府通过决策决定卫生政策,卫生政策对于公共健康具有导向和引领作用。卫生政策走向直接影响公共健康,决定公共健康的发展方向。卫生政策与公共健康的关系是因果关系,前者决定后者。卫生政策需要有伦理学基础和伦理学专家的伦理论证,坚持公正、公平、公益的原则。     

卫生政策走向与公共健康及其伦理思考

政府通过决策决定卫生政策,卫生政策对于公共健康具有导向和引领作用.卫生政策走向直接影响公共健康,决定公共健康的发展方向.卫生政策与公共健康的关系是因果关系,前者决定后者.卫生政策需要有伦理学基础和伦理学专家的伦理论证,坚持公正、公平、公益的原则.     

肿瘤临床决策中的卫生经济学评价及其意义

肿瘤治疗的综合性决定了其临床决策的复杂性。卫生经济学评价是一种通过平衡成本与效果,从多维度权衡疗效、生命质量及资源费用以指导临床决策的方法。与国外相比,中国卫生经济学应用尚存在较大发展空间。笔者认为随着相关理念进步、人才培养,卫生政策和临床指南的制定,卫生经济学评价定会成为肿瘤临床决策的重要工具。     

美国的《医学决策》杂志

美国医学决策学会早在1981年,就办了一本<医学决策>杂志,并且已经出到第25卷.现在我们手头上有它的2004年1～6期、2005年1～4期的主要论文目录.让我们看看美国的临床医生在医学决策方面关心些什么问题吧!纵观这10期杂志的内容选题,我们可以看出,他们对医学决策的研究、视野和题材都是比较广泛的,涉及决策的自身研究、决策制度和体制、医疗效果的预测和评估、不同治疗项目的比较、诊疗费用的研究、科研的设计与论文资料的处理、图像判断、医学的伦理与法律的评估、对研究成果的可靠性、治疗样本的剖析、卫生政策的决策等.     

医学整合与卫生系统改革

从国际和我国卫生改革导向与发展趋势的角度,分析医学整合与卫生改革的关系.认为卫生系统改革的目标与政策导向印证了医学整合的实践与路径;医学整合的理论框架与发展实践为卫生改革与发展提供了可能;医学整合的目的与方向和卫生系统改革与政策导向协同一致,才能相互促进、共同发展.     

美国的《医学决策》杂志

美国医学决策学会早在1981年,就办了一本《医学决策》杂志,并且已经出到第25卷。现在我们手头上有它的2004年1~6期2、005年1~4期的主要论文目录。让我们看看美国的临床医生在医学决策方面关心些什么问题吧!纵观这10期杂志的内容选题,我们可以看出,他们对医学决策的研究、视野和题材都是比较广泛的,涉及决策的自身研究、决策制度和体制、医疗效果的预测和评估、不同治疗项目的比较、诊疗费用的研究、科研的设计与论文资料的处理、图像判断、医学的伦理与法律的评估、对研究成果的可靠性、治疗样本的剖析、卫生政策的决策等。例如,对医学决策…     

Health promotion from the perspective of social cognitive theory

Abstract

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing the habits of individuals. Further progress in this field requires building new structures for health promotion, new systems for risk reduction and greater emphasis on health policy initiatives. People's beliefs in their collective efficacy to accomplish social change, therefore, play a key role in the policy and public health approach to health promotion and disease prevention.     

ISLAMIC VERDICTS IN HEALTH POLICY DISCOURSE: PORCINE‐BASED VACCINES AS A CASE STUDY

In this article, I apply a policy‐oriented applied Islamic bioethics lens to two verdicts on the permissibility of using vaccines with porcine components. I begin by reviewing the decrees and then proceed to describe how they were used by health policy stakeholders. Subsequently, My analysis will highlight aspects of the verdict's ethico‐legal arguments in order to illustrate salient legal concepts that must be accounted for when using Islamic verdicts as the basis for health policy. I will conclude with several suggestions for facilitating a more judicious use of verdicts in policy‐relevant discourse. My analysis is meant to contribute to the dialogue between science and religion, and aims to further efforts at developing health policies that value health while accommodating religious values. In the encounter between the Islamic tradition and global public health, a multidisciplinary dialogue, where Islamic legists become aware of the health policy implications of their ethico‐legal pronouncements, and where health policy actors gain a literate understanding of Islamic ethico‐legal theory, will lead to verdicts that better meet the needs of patients, health workers, and religious leaders.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

流动人口生殖健康服务质量评价的相关理论研究

开展城市流动人口的生殖健康服务质量评价研究对于促进我国流动人口生殖健康状况持续改进和公平地享有生殖健康服务具有重要意义。从生殖健康的相关基本理论,我国生殖健康服务的政策支持,卫生服务质量评价的经典理论,系统思想及系统论,流动人口的特征等几个方面进行了流动人口生殖健康服务评价的理论基础系统论述。     

The Social Determinants of Health: Why Should We Care?

A growing body of empirical research examines the effects of the so-called “social determinants of health” (SDH) on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the (un)fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

Policy Frames, Metaphorical Reasoning, and Support for Public Policies

This article evaluates the predictive value of a new theory for understanding public support for alternative solutions to policy problems, which we call policy metaphors. A policy metaphor represents a particular form of cognitive framing that makes use of commonly understood social institutions and judgments about their effectiveness to form "archetypes" against which proposed solutions to new policy problems are compared. We test the extent to which both understanding of and preference for particular policy frames predicts the nature and strength of policy choices by a representative sample of the American public. After controlling for factors that past research has shown to be important in understanding public opinion, including general partisan and ideological attitudes, self-interest, political values, and emotions, the cognitive frames specified by the general theory of policy metaphors are shown to strongly predict public support for hypothetical solutions to three different policy problems. These frames also predict support for President Clinton's 1993–94 health care reforms after controlling for those same conventional predictors. Most importantly, we demonstrate that these cognitive frames help constrain the beliefs of even the least politically aware members of the general public. Discussion centers on the implications of this new approach for understanding public opinion.     

社会资本理论及其在卫生领域的应用

在文献复习的基础上,首先介绍了社会资本的基本理论一定义、类型和研究层次,然后总结分析了国内外卫生领域就社会资本与健康、卫生服务利用以及卫生筹资的关系所开展的研究,最后指出在卫生领域应用社会资本理论时应明确界定社会资本的概念,科学完整地测量它,并科学看待它对健康和卫生服务的影响。     

Front-line services,complexity, research and policy

The evidence-based culture of modern mental health policy and service delivery is being extended through funded efforts to accelerate implementation of research findings in practice settings. In this paper, we argue that this linear model of research and policy-making is profoundly ill adapted to the nature of practice realities and real-world policy-making processes. Both need to be re-conceptualised using the theoretical and practical resources deriving from modern complexity theory. A short case study illustrates the nature of ‘complexity’, the reframing of the notion of ‘evidence’ it implies and the different relationship between research, practice and policy that flows from this more attuned model of mental health and therapeutic processes.