降低剖宫产率维护母婴利益

剖宫产作为一种生产方式,其比率居高不下,已经引起医学界和卫生管理部门的重视.分析其原因,开展相应的对策研究,已成为当务之急.通过健康教育使产妇走出认识误区;加强医务人员职业道德建设;加强医疗卫生法制建设;完善医疗卫生管理体制;建立和谐的医患关系是降低剖宫产比率,维护母婴利益的重要保证.     

公民的基本医疗卫生权利与义务内容浅探

介绍了基本医疗卫生权利与义务的用语规范、政策内涵与法律渊源,分析了其主体及其与法律法规的关系,提出公民基本医疗卫生权利的研究应该且必须从法理学入手;立足于新医改背景和基本医疗卫生法框架,且加快立法步伐,这是全面落实医药卫生体制改革和完善社会主义法律体系的出发点。建议从法理学入手加强基本医疗卫生权利理论研究;以新医改实践为基础构建基本医疗卫生法框架,以完善社会主义法律体系为目标加快基本医疗卫生立法步伐。     

行为决策中的比率偏差

比率偏差是指小概率事件以不同比率形式呈现时,人们倾向于认为以较小数字呈现的事件更不可能发生.这种现象在医疗卫生领域和职业生涯决策中有重要的应用价值.目前关于比率偏差产生的解释主要包括标准理论与认知经验自我理论.比率偏差的影响因素主要包括元认知技能、计算能力、认知视角和任务性质等.未来的研究需要从比率偏差现象的产生、心理机制及应用方面进行深入研究.     

广西医疗卫生资源配置的公平性研究

利用洛伦兹曲线和基尼系数,分析广西医疗卫生资源配置的公平性;其中人口分布的基尼系数为0.10～0.35,地理分布为0.10～0.55,县域配置的公平性优于城区、人口分布优于地理分布、卫生人力资源分布的公平性较差.应加强医疗卫生资源的投入,调整资源的内部结构,提高医疗卫生资源人口和地理分布上的公平性.     

医生如何应对孕妇的无指征剖宫产要求?——基于裁判文书的实证分析

从医学科学来说,医生应拒绝孕妇提出的无指征剖宫产要求。然而,司法判决统计数据表明,拒绝比同意剖宫产败诉率更高,医院赔偿金额也更多;从临床实践来看,由于剖宫产手术的医学指征难以准确把握,拒绝孕妇剖宫产请求后配套措施难以满足,更容易产生不良后果;从法律上来看,孕妇才是其最佳利益的判断者,医生的治疗特权并不适用于孕妇的剖宫产请求。因此,无论是基于合法性还是现实性考虑,医生都应该同意孕妇提出的无指征剖宫产请求。     

加拿大安大略省卫生保健体系改革评析:整合的经验

建立整合型医疗卫生服务体系既是顺应全球医疗卫生事业发展的趋势,也是我国医疗卫生体制改革的重要内容。梳理加拿大安大略省卫生保健体系改革所显示的整合内涵、整合方式、整合评价,总结其特点,包括始终强调病人优先、健康公平;坚持各司其职、共同治理;鼓励民众参与、公开透明;保障绩效,推进可持续发展。从保障民众享有公平的医疗保健权利、梳理卫生体系管理者与医疗服务提供者的关系、建立多元主体共同治理三方面,提出对我国建立整合型医疗卫生服务体系的启示意义。     

医疗人工智能的伦理风险及应对策略

医疗人工智能的迅猛发展带给医疗卫生领域更多发展契机的同时,也带来了一系列伦理风险和挑战。从人的道德主体性地位、责任认定、隐私权保护和医生主体性地位四个方面探讨了医疗人工智能带来的伦理风险。提出要实现医疗人工智能健康、有序地发展,需要采取重构责任伦理,强化特殊监管;加强隐私和数据保护,保障公众安全;坚定医生主体地位,优化诊疗质量等应对策略,以趋利避害,更好地促进人类健康和医疗卫生水平的提高。     

从失配到适配：农村医疗卫生服务可及性的逻辑转换

医疗卫生服务可及性作为实现供需匹配的重要手段,其实现目标既要有利于实现更高质量的医疗卫生服务均等化,又要有助于增进农民对医疗卫生服务满意度。基于公共管理的视角,可及性是一个评价医疗卫生服务供给与需求的适合度的概念,应包括可获得性、可接近性、可适应性和可承受性等内容。供需失配是农村医疗卫生服务可及性存在的基本症结,而财政失衡与资源错配是形成农村医疗卫生服务供需失配的主要原因。基于问题导向和目标导向,从医疗资源配置、服务供需精准对接、服务质量反馈、医疗卫生支出补偿等方面提升医疗卫生服务可及性,是实现农村医疗卫生服务从失配到适配逻辑转换的根本路径。     

市场、价值取向、政府之于医疗卫生

分析了现代医疗卫生服务的消费品属性并将其划分为3大部分,由此形成的不同供给渠道,决定了医疗卫生服务的市场运作方式的必然性,但必须坚持始终如一的正确的价值取向——社会公众利益最大化的医疗卫生服务的基本目标。强势的政府主导是医疗卫生改革与发展的关键,提出了当前政府主导作用的具体意见和建议。     

医学生服务社区农村意向的调查与思考

医学生服务社区农村，是加强社区农村卫生服务体系队伍建设的必要条件。通过对不同专业（方向）高年级医学生服务社区农村就业意向的调查和相关资料分析，对我国社区农村医疗卫生服务人才培养模式进行了探讨，为建立健全中国式社区农村医疗卫生服务人才培养体系提供参考。     

《周易》家人卦的家道要旨

《周易》家人卦的家道理论体系,由立家之道、安家之道和兴家之道构成,且三位一体而又层层递进。立家之道,源于“阴阳变易”之化生原理,宏于“阴顺阳威”;付之践行,始于“闲邪未蒙”,功在“厉威勿纵”,誉于“顺德利贞”。安家之道,据于“允执厥中”的象位原理,适于“中正合宜”;履之于家,固于“持守正道”,毅于“谨遵中德”,成于各安角色。兴家之道,基于“民安国泰”的系统法则,旨在“家齐国治”;行之于家,寓于“王假有家”,系于交感互爱,遵于唯变所适。整个家道理论体系是一个系统有机统一的整体,极具系统性与辩证性。     

以“法德共治”多重机制塑造市场主体的德性人格

诚信是市场经济的健康发展的基本前提之一。在社会实践的具体过程中 ,诚信必须人格化 ,转化为德性人格 ,这样才会行之有效。德性人格不仅是协定“契约”的普遍准则 ,而且还更应该是市场主体的内在素质。德性人格的形成 ,唯一可靠的现实途径 ,就是在法德共治条件下 ,形成德性人格生长的多重机制。     

Motivation to manage among college business students: A reassessment

The present study reassesses trends in motivation to manage among college business students (N = 216). Motivation to manage scores are compared with J. B. Miner's (Personnel Psychology, 1974, 27, 605–613) results for three periods since the early 1960s, across two types of universities—public and private, and between males and females. Results indicate that the downward trend in motivation to manage scores appears to be reversing; business students at the private university scored higher on motivation to manage than those at the public university, and males scored higher than females. Implications for vocational research are discussed.     

辩证认识处理烧伤创面

人体是对立统一的有机整体,烧伤后皮肤局部形态结构和功能发生改变,进而引发局部与全身病理生理变化,烧伤创面处理贯穿于烧伤治疗的全过程。辩证认识和正确处理烧伤创面,提高烧伤治愈率;并将皮肤组织工程、整形外科等先进的技术手段和方法应用于烧伤创面的修复治疗,降低烧伤患者晚期畸形发生率,最大程度地让患者重返社会,恢复正常的生活和工作,这是现代烧伤治疗的目标。     

The Performance of Environmental Science in Research Teams

Scientists' practices rely not only on the discursive production of science but also on routine interactions whereby scientists manage their teams and their publics. The metaphor of the theatre helps explain how researchers perform impressions to different audiences. This metaphor can also help analyse how scientists and researchers cooperate in performance teams in order to manage credibility impressions. How are research teams constructed and maintained? How do team members respond to the challenges of coordinating the team and elaborating a common vision given their differences in aims and understandings? From 2005 to 2007 a scientific team worked together in the city of Tuzla, Bosnia and Herzegovina, to develop land remediation measures for coal waste disposal sites. The team was organised around a common front developed through ongoing negotiation and bargaining. Scientists employed different strategies to maintain the team through the development of the project, such as reciprocity, unanimity and bargaining. To accommodate individual views, the common front emphasised the presentation of results and the process of research over its specific content and impact.     

经络实质的思辨

通过对古人认识经络方法的综合分析,结合现代有关研究,论证了经络是古人在总结对人体生命现象多方面客观认识的基础上,经过古代哲学抽象所形成的理论路线图,而非一种独立的客观实体.肯定了腧穴-脏腑相关性的存在,否定了循经感传即经络的假说,并强调了研究人体体表-脏腑相关性的重要性.     

Transition Discontinuities and the Biographical Shaping of Early Work Careers

Because of the restructuring of work and deregulation of the labor market school-to-work transitions have been predicted to become destandardized. These structural changes will finally also erode Germany's renowned dual system of apprenticeship training. From an economic-structural point of view it is likely that young persons' social integration and biographical plans can no longer rely on this occupation-driven transition arrangement. Based on a quantitative and qualitative longitudinal study with young adults in two German labor-market regions, this exploratory study shows that the dual system not only trains for certain occupations, but also socializes for the contingencies of the labor market. The results are interpreted in the new conceptual framework of self-socialization, which links individual agency with social contexts across the life course in terms of a biography-environment fit. Applied to transition discontinuities and shifting contexts of career development, processes of self-socialization are reflected in different modes of biographical agency in the shaping of early employment careers. Self-initiated and enforced discontinuous employment and occupational change are mediated by various constellations of occupational contexts and modes of biographical agency. The study suggests that for young adults the dual system still provides skills and orientations for coping with career discontinuity.     

The interface between counselling and neuropsychological assessment of patients with AIDS/HIV

Manifestations of central nervous system dysfunction in adults and children with AIDS/HIV are common. The contribution of counselling in relation to these patients is described. This includes: contributing to the assessment of patients, addressing ‘dreaded issues' while patients are still well, helping patients to find solultions and manage problems, engaging the support of friends and the family in managing patients, ‘translating’ the results for the patient from formal assessments, discussing treatment options and helping parents and prospective parents to manage behaviour problems in their children. Counsellors also have a special role in advising and consulting colleagues about the management of these patients. Counselling in a clinical setting is, however, inextricably bound to limitations in the medical care of this patient group.     

Children and the Commons Dilemma1

The management of a commons dilemma analog by same-age, same-sex groups of children from age 3 to age 16 was examined. The effectiveness of commons dilemma management by the groups was greater than expected. Effectiveness increased with age and from one period to another. There were no sex differences, but a significant age x sex interaction indicated that girls manage the commons better in the younger groups and boys manage it better in the older groups.     

Benign and disruptive disturbances of the supervisory field1

Inspired by Baranger, Baranger and Mom’s notion of psychoanalytic bastion, we describe an unconscious collusion between analytic supervisors and supervisees. This collusion’s purpose is to avoid the anxiety inherent in the psychoanalytic field and that enters unprocessed into the supervisory field. The supervisor/supervisee dyad’s emotional experience can be fleeting, with moderate intensity, but can slow down the process. This can happen sometimes in any supervisory situation. Or it can become permanent and with greater intensity and bring the entire process to a standstill and to a disruption of the supervisory field. We call the first situation a ‘benign disturbance of the supervisory field’, the second a ‘disruptive disturbance of the supervisory field’. We illustrate both disturbances using supervisory material. Our purpose is to show how to detect these disturbances, understand them, and manage them.