沥青混凝土桥面铺装早期病害原因分析

针对沥青混凝土桥面铺装的早期病害及其原因进行了分析与研究,提出了用有限元分析需要注意的一些问题,指出了今后主要的研究方向。     

The management of acid-related disorders: the burden of disease and the need for effective treatment

Summary

A large and increasing number of people suffer from acid-related disorders such as dyspepsia, gastro-oesophageal reflux disease (GORD), and peptic ulcer disease. In 1994 alone, about 2 million patients consulted their family doctor for an acid-related disorder. Treatment of these patients represents a high cost to the NHS in terms of medications, consultations, referrals and treatment of complications. UK government statistics also indicate that there is a huge economic burden associated with acid-related disorders in terms of lost productivity.

Effective management of acid-related disorders is required to ensure that the available resources are used efficiently and to the benefit of the NHS, society and the patient.

Proton pump inhibitors are the most effective and predictable therapy available for acid-related disorders and many clinical studies have demonstrated their superior efficacy over H2-receptor antagonists in the management of these conditions. These therapeutic advantages translate into economic gains. Several economic studies have shown that it is more cost-effective to treat GORD and peptic ulcer disease with the proton pump inhibitor omeprazole than with H2-receptor antagonists.     

Modelling the cost-effectiveness of nevirapine triple combination therapy and dual combination therapy for the treatment of HIV disease in the United Kingdom

Summary

Recent advances in HIV antiretroviral therapy together with limited budgets have forced payers to look for evidence that new combinations provide good value for money. Using a public financing perspective, two Markov models are employed to evaluate the first-year outcomes and costs and the long-term cost-effectiveness of adding nevirapine (NVP) to dual combination therapy with zidovudine (ZDV) and didanosine (ddI) in the United Kingdom.

First-year medical care savings are estimated to be £2,122 (103.8% of NVP cost). In the longer term, NVP/ZDV/ddI therapy yields £6,186 per life year saved (costs discounted at 6%). The model is moderately sensitive only to duration of therapy effects and the therapy initiation time. These model estimates suggest that policy makers may expect to observe superior initial health outcomes and substantial medical cost savings during the first year of therapy, as well as acceptable long-term cost-effectiveness, when NVP/ZDV/ddI is used in place of dual therapy.     

关于疾控中心疫苗财务管理的问题与对策探讨

目前我国医疗水平趋于日益提高的状态,与此同时社会广大群体也逐渐意识到疾控工作的重要性,对疾控工作的重视度越来越大。疫苗,区别于一般的药品,是一种特殊的商品,由于其特殊性,在其采购、使用等任何一个环节出现问题都将会产生不可估量的严重后果,为此国务院设立了专门的条例(《疫苗流通和预防接种管理条例》)来对疫苗的管理进行规范。在对疫苗进行管理的过程中,各级疾控中心在其中占据了非常重要的角色,其是疫苗流通过程中重要的组成部分,在疫苗管理中有非常重要的作用。本文分析了疾控中心疫苗管理的基本情况以及疫苗管理中所存在的问题,并结合自己的工作经验,针对所存在的问题总结阐述了完善措施,以此来提高疾控中心疫苗财务管理的水平。     

Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson’s disease in the UK and Germany

Abstract

Background:

Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting ～5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).

Methods:

A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3–5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider’s perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.

Results:

UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).

Conclusions:

From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.     

Huntington's disease,critical illness insurance and life insurance

We describe briefly a model of Huntington's disease (HD), a highly penetrant, dominantly inherited, fatal neurological disorder. Although it is a single-gene disorder, mutations are variable in their effects, depending on the number of times that the CAG trinucleotide is repeated in a certain region of the HD gene. The model covers: (a) rates of onset, depending on CAG repeat length as well as age; (b) post-onset rates of mortality; and (c) the distribution of CAG repeat lengths in the population. Using these, we study the critical illness and life insurance markets. We calculate premiums based on genetic test results that disclose the CAG repeat length, or more simply on a family history of HD. These vary widely with age and policy term; some are exceptionally high, but in a large number of cases cover could be offered within normal underwriting limits. We then consider the possible costs of adverse selection, in terms of increased premiums, under various possible moratoria on the use of genetic information, including family history. These are uniformly very small, because of the rarity of HD, but do show that the costs would be much larger in relative terms if family history could not be used in underwriting. We point out some difficulties involved in applying a moratorium that recognises simply a dichotomy between ‘carriers’ and ‘non-carriers’ of any mutation in a gene when these mutations are, in fact, very variable in their effects. These complexities suggest that restrictions on the disclosure, rather than on the use, of genetic information, if it became established as a principle, could deprive insurers of information needed for risk management even if not used in underwriting.     

浅谈植物病虫害的防治要点

本文就植物病虫害防治要点进行初步探讨。     

文学与疾病题材关系简论

以疾病为题材的文学作品揭示了文学与疾病的种种联系,它们把疾病组合进个人-疾病-社会这个特殊的三角形中。从心理学角度看,对读者可起到交流和治疗作用;从接受美学角度看,可成为健康人的学习资料和生活指南。     

Cost analysis of a disease management programme for adult Medicaid clients with schizophrenia

Summary

This investigation assessed changes in direct medical costs, from the perspective of a public payer, associated with a comprehensive, field-based disease management programme for adult Medicaid clients with schizophrenia in the US State of Colorado.

A propensity score-matching algorithm was employed in this retrospective analysis owing to the inherent non-randomisation of enrollees. Of the 126 clients initially enrolled, 73 (58%) remained within the programme continuously for 6–12 months.

These participants were associated with 30% lower overall per member per month medical costs (p<0.001), although no differences were noted for overall pharmacy costs. Provision of the disease management programme was through an external vendor and cost $31,250 per month regardless of the number enrolled.

Future research should seek to assess long-term clinical, humanistic and economic outcomes in this population and to develop methods that increase programme participation.     

沥青混凝土路面病害防治的施工管理措施

对于沥青混凝土地面而言,裂缝、水破坏、松散、泛油、推移等都是其最常见的病害现象,可以说是公路施工过程中质量方面的通病,不但影响了车辆通行的速度及安全,也对我们所有施工技术人员提出了严峻的考验和挑战,本文系统的介绍了沥青混凝土路面病害的形成原因和在施工管理过程中的如何采取相应的有效措施,希望可以供所有同仁参考。