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find Author "王雪莹" 2 results
  • Analysis of fairness and trends in the allocation of medical and health resources in Shanghai from 1995 to 2018

    ObjectiveTo evaluate the equity of health care resource allocation in Shanghai and the changing trends from 1995 to 2018.MethodsBeing based on the Gini coefficient and the Theil index, the equity of health care resource allocation in Shanghai from 1995 to 2018 was comprehensively evaluated from the perspective of "demographic equity" and "geographic equity", and the Mann-Kendall non-parametric test was used to predict the trends of changes.ResultsThe Gini coefficient of the distribution of medical and health resources by population in Shanghai from 1995 to 2018 was 0.225 9 to 0.411 9, and the configuration was in a normal or optimal state with an increasing trend. The Gini coefficient distributed by geographic area was 0.892 4 to 0.979 3, which was in a disadvantaged state and a decreasing trend. The overall Theil index ranged from 0.010 9 to 0.058 1, which was a more equitable configuration, but with a decreasing trend. In addition, both the Gini coefficient and the Theil index showed that equity improvements were mainly influenced by the number of health facilities and beds, with health facilities contributing the most to equity, while the disparity in health technician staffs was the main reason for the decline in equity. Inequities in the allocation of health facilities and the number of beds originated mainly within regions, while inequities in the allocation of health technicians originated mainly between regions.ConclusionsThe allocation of health care resources in Shanghai is more equitable and the equity has been on the rise in recent years. However, at the present stage, there is still a contradiction between equitable allocation by population and inequitable allocation by geographic area, and in the future, there is a contradiction between the tendency of inequitable allocation by population and the tendency of equitable allocation by geographic area. Optimizing the allocation of health technicians is the key to improving equity, and addressing regional differences in allocation is an effective way to optimize the allocation of health technicians.

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  • 育龄期女性癫痫患者丙戊酸的选择策略

    鉴于丙戊酸(Valproate, VPA)宫内暴露的致畸风险及其对胎儿生长发育的影响, 2014年10月隶属于欧洲药品管理局(European Medicines Agency, EMA)的相互认证和分布处理协调小组(Coordination Group for Mutual Recognition and Decentralised Procedures-Human, CMDh)建议加强对女性使用VPA的限制, 随后国际抗癫痫联盟欧洲事务委员会(Commission on European Affairs of the International League Against Epilepsy, CEA-ILAE)及欧洲神经病学学会(European Academy of Neurology, EAN)组成的工作小组在《Epilepsia》上撰文, 旨在对育龄期女性使用VPA做出指导。撰文时, 工作小组充分考虑了使用VPA与其它替代药物的致畸风险、控制癫痫发作的重要性、癫痫发作对患者及胎儿的危害、VPA及其它抗癫痫药物对癫痫控制效力等因素。最终的建议包括以下7点:①育龄期女性应尽量避免使用VPA; ②应在医生及患者(必要时患者代理人)共同商议后决定治疗方案, 依据癫痫类型及发作形式选择合理的治疗方案时, 应仔细进行风险-获益评估; ③对于最适合VPA治疗的发作类型及综合征, 应该充分向患者及家属解释VPA及其它替代药物的获益和潜在风险; ④VPA不应作为局灶性癫痫的一线治疗药物; ⑤VPA或许可以作为治疗某些癫痫综合征的一线用药, 如特发性(遗传性)全面性癫痫伴有强直阵挛发作; ⑥VPA或许可作为生育可能性极小的女性癫痫患者的一线用药, 如合并严重的智力或身体残疾; ⑦应持续随访服用VPA的育龄期女性患者, 以确定最佳治疗方案

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