试论卫生应急“机制”建设中不容忽视的几个问题

卫生应急工作要迈上科学发展轨道,应多关注从"机制"建设上找寻亟待解决的问题。本文拟从突发公共卫生事件特点及应急机制建设重要性入手,探究卫生应急机制建设过程中尚存的"拦路虎",找寻卫生应急机制建设应对之策,即:关口前移,建立应急预案动态更新机制;瞄准实战,建立突发疫情应对处置机制;筑牢"后墙",建立突发事件储备保障机制;紧盯"重心",建立医院危机攻关应急机制。     

Families and households of the poor: The 19th-century Slovenian gostači

The present study examines the position of day laborers, a social category still awaiting comparative study by family historians. In 19th-century Slovenian sources these laborers, called gosta?i, were a very mobile group that did not own property; they could be married or single and could be involved in various occasional jobs, agricultural or industrial, skilled or unskilled. By comparing two communities (one agrarian, the other centered on iron production), the study shows that the living and working arrangements of gosta?i were profoundly affected by the economy and by natural resources. They therefore developed different residential patterns, though in neither case did their families constitute a part of the owner's sub-household in the Laslettian sense. The study concludes that in the 19th century this poor social group should not be treated as a homogenous workforce but as flexible and dynamic.     

Progress and challenges of consolidating the African state: “consolidation indicators” and the African Charter on Democracy,Elections and Governance

Since independence, there have been some improvements in political development in African states in respect to the prevalence of democracy, recognition of the rule of law, reduction in unconstitutional changes of governments, regular, transparent, free and fair elections, and a conducive environment for doing business. This article proposes a range of “consolidating indicators” that can be used to measure the consolidation of the African State in light of the African Charter on Democracy, Elections and Governance (ACDEG). Consolidation indicators examined include the level of internal integration/disintegration of the state, the degree and nature of peace, the nature of democracy and elections and of governance systems, levels of capacity, the social fabric of the state as well as issues concerning women and youth. The use of consolidation indicators is a new effort to address issues of contingency and preventive planning, with the aim of having more peaceful and progressive African states. Characterising African states, based on various consolidation indicators, is an important and relevant endeavour, especially because the concept of the “consolidation of the African State” is under-researched, with a paucity of a clear assessment. The discussion highlights the importance of the ACDEG and notes the increasing recognition by African states of the importance of democratic values and practices to the continent. Understanding the progress and challenges of consolidating the African State will help policy makers to strengthen the implementation of ACDEG, in pushing African states towards realising the African Union (AU) Africa Agenda 2063. This article takes an Afrocentric approach by discussing the positive role of regional and continental institutions in promoting and strengthening democracy and governance in Africa.     

新时代国家治理视野中的人民法庭及其功能塑造

人民法庭作为国家司法权在基层社会的表征,在不同时期发挥着不同功能。新时代人民法庭是乡村社会"在法治轨道上推进国家治理体系和治理能力现代化"的重要参与者,承担着通过乡村法治推进国家法治秩序生成的职责,应当着眼于乡村社会结构变迁、"自治、法治、德治相结合"的乡村治理体系以及制度规范引领下的乡村治理逻辑,重新审视人民法庭的设立依据,并赋予法律适用、乡村规范型塑、价值判断和法治文化培育等功能,打造以人民法庭为中心的乡村法治权威,建立现代乡村法治秩序。     

中医医疗机构不良执业行为及防范措施调查分析

为了解和掌握东城区中医医疗机构的执业现状,探讨如何规范中医医疗机构的执业行为,为下一步制定中医药发展综合改革政策提供参考,东城区卫生监督所编制了《东城区中医医疗机构依法执业调查表》,对东城区103家中医医疗机构进行了问卷调查。调查结果显示：参与调查的东城区103家中医医疗机构有34家存在使用异地执业医师、设立网站未经审核、医疗废物暂时贮存时间超过2天等不良执业行为。经数据分析,中医医院不良执业行为的发生率比诊所高且具有统计学意义。针对上述问题笔者提出应针对中医医疗机构实施分级管理,加强对中医医疗机构依法执业的培训,卫生监督部门应加大执法力度,建立官方权威中医宣传平台等防范措施,以促进中医医疗机构依法执业及中医行业的健康发展。     

2012-2013年北京市海淀区放射卫生量化分级监督管理情况对比分析

找出北京市海淀区内开展放射诊疗工作的医疗机构在放射卫生管理中存在的问题,并为下一阶段海淀区卫生监督所的监督管理重点指明方向。方法：采用普查的方法,于2012年和2013年,用自制的《北京市海淀区医疗机构放射卫生量化分级表》对辖区内已取得《放射诊疗许可证》且开展放射诊疗活动的医疗机构进行量化评级。结果：（1）2012年和2013年分别调查了269和257家医疗机构。与2012年相比,2013年A级单位所占比例由30.1%提高到了72.0%;C级和D级单位数和构成比都有了很大程度的下降,差异具有统计学意义。（2）一级以下医疗机构中A级单位增加的比例和三级医疗机构C级单位减少的比例最大。一级及以下级别的医疗机构中的C、D级单位数占全部医疗机构的比例最大。（3）2012年量化分级情况中,卫生管理、放射人员证和工作场所三个大项合格率较低,合格率分别为56.5%、61.0%和64.7%;而2013年这三项的合格率均得到较大提高,分别为81.3%、81.0%和83.7%。（4）除个人剂量检测管理和建设项目管理的合格率分别为71.6%和70.8%外,2013年其他八项管理项目的合格率均达到80%以上。结论：三级和一级以下医疗机构实行量化分级监督管理最有成效;2013年海淀区放射卫生合格率反映出个人剂量检测和建设项目管理为下一年的监督管理重点。     

非医师行医的法律思考

非医师行医,卫生监督机构依照《执业医师法》和《医疗机构管理条例》进行监管,但在法律法规适用上存在着差异,导致执法结果不同,影响了打击非法行医行为的社会效果。因此,应加快修改法律法规,使之切合实际。国家卫生计生委应加强卫生法律法规的解释,统一操作规程。卫生监督机构应与司法机关建立沟通协调机制,统一认识,形成打击非法行医行为的合力。     

Innovation in the public sphere: reimagining law and economics to solve the National Institutes of Health publishing controversy

The National Institutes of Health (NIH) are responsible for the largest proportion of biological science funding in the United States. To protect the public interest in access to publicly funded scientific research, the NIH amended terms and conditions in funding agreements after 2009, requiring funded Principal Investigators to deposit published copies of research in PubMed, an Open Access repository. Principal Investigators have partially complied with this depository requirement, and the NIH have signaled an intent to enforce grant agreement terms and conditions by stopping funding deposits and engaging in legal action.The global economic value of accessible knowledge offers a unique opportunity for courts to evaluate the impact of enforcing ‘openness’ contract terms and conditions within domestic and international economies for public and economic benefit. Through judicial enforcement of Open Access terms and conditions, the United States can increase economic efficiency for university libraries, academic participants, and public consumers, while accelerating global innovation, improving financial returns on science funding investments, and advancing more efficient scientific publishing models.     

Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the government's health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.     

Climate resilient planning in Bangladesh: a review of progress and early experiences of moving from planning to implementation

Bangladesh is one of the first least developed countries (LDCs) to develop a long-term climate change strategy, the Bangladesh Climate Change Strategy and Action Plan (BCCSAP). Two funds were set up after developing the BCCSAP, one using government resources (BCCTF) and the other using donor resources (BCCRF). This paper uses the “building blocks” framework to analyse changes that occur when progressing from planning to finance and implementation by comparing the BCCRF and BCCTF. This analysis reveals how governance enablers are influenced by political economy dynamics that steer funding decisions and implementation outcomes, and provides lessons for countries pursuing climate resilience.