Direct Benefit Transfer Scheme for Tuberculosis Patients – Performance Challenges observed by the Providers and Patients

Introduction: Government of India launched an Aadhar-linked Direct Benefit Transfer (DBT) scheme from 1st April, 2018. Under this scheme, all notified TB patients would receive Rs 500 per month (~US$7) throughout the course of their treatment for nutritional support. Aim and Objectives: To determine the challenges faced by the health providers and patients in the implementation of Direct Benefit Transfer scheme. Methods: This was a mixed method cross-sectional study conducted on all public and private TB patients notified during the year 2019 under RNTCP (now NTEP) in district Amritsar, Punjab. Quantitative data about the availability and validation of bank accounts was obtained from the Nikshay portal after having permission from the District TB Officer. Qualitative data was obtained from the focus group discussion and in-depth interviews with the involved staff members (17) and patients (20) registered in Tuberculin units of Amritsar. Results: From the Nikshay reports, it was observed that there was significant difference between the public and private sector and between rural and urban areas. Focus group discussion was done with the TB Health Visitor (TBHV) and Senior TB supervisors (STS) and asked about the hurdles they faced. Items were identified and tabulated. In-depth interviews were conducted on 20 patients, 10 each from public and private sector respectively. Data collected was transcribed and arranged as per the themes or questions and then the information was recorded under those sub-headings. Conclusion: The major challenges observed by the providers were lack of support from the private sector, lack of awareness among people, technical issues and more work burden. Patients mostly mentioned about confidentiality issues, lack of awareness, social stigma of the disease, less amount and long and complex process.

Research on the doctors′ willingness of working at primary institutions and the economic incentive effect from the perspective of mental account / 中华医院管理杂志

Objective:To understand the incentive effect and influencing factors of the current economic incentive policy for medical alliances in Longhua District of Shenzhen(the alliance for short) on doctors′ willingness to work at primary medical institutions(the primary for short) from the perspective of mental account, and to explore the economic incentive effect of different economic incentive distribution methods on doctors′ willingness to work at the primary.Methods:The questionnaire was designed based on mental account theory. Random sampling was made in November 2019 for a questionnaire survey among doctors in two district-level medical institutions of the alliance in Longhua District of Shenzhen. The purpose was to analyze their inclination to work at the primary and their selection preferences for economic incentive distribution methods under the current economic incentive policy. The data were analyzed by descriptive analysis, and the influencing factors of doctors′ willingness to work at the primary were analyzed by χ2 test and binary logistic regression. Results:A total of 254 valid questionnaires were collected with an effective recovery rate of 90.7%. Among the respondents, 189(74.4%) were willing to work at the primary, 168(66.1%) chose to receive the economic incentives specifically for working at the primary, and 148 people(58.3%) hoped to receive such economic incentives immediately. Education background, self-rated economic income level of doctors and different payment methods of economic incentive for working at the primary had significant effects on their willingness to work at the primary( P<0.05). Conclusions:The current economic incentive policy of the alliance can meet the demands for economic incentives in terms of doctors′ material accounts, and doctors′ overall inclination to work at the primary was strong. If the amount of economic incentives is constant, doctors preferred to receive the economic incentives specifically, mainly affected by income accounts and additional income accounts. In addition, education and self-assessment of economic income level were important factors affecting the willingness of doctors to work at the primary, which may be affected by mental accounts other than material accounts.

A aplicação da lei de incentivo à cultura na democratização do acesso ao lazer / The application of the law over culture incentive on the democratization of the leisure access

O artigo analisa a Lei de Incentivo à Cultura na democratização das artes, como fonte do lazer popular, inseridas nos direitos sociais. Trata-se de pesquisa bibliográfica com leitura descritiva dos incentivos fiscais e sua parceria público-privada aplicadas no fomento do entretenimento às populações periféricas. Em análise multidisciplinar de Cesnik (2012), Coelho (2009), Costa (2020), Nagayama (2020) dialogadas com Almeida (2020), Barbosa (2012), Dumazedier (1975, 1979), Gomes (2014) e Marcellino (1997, 2015), apresenta-se a necessidade de medidas inclusivas a serviço do lazer, que nesse texto se conecta com as artes e a cultura. Percebe-se a isenção tributária manipulada pelo capital e interesses políticos a reclamar reestruturação das instituições públicas atuantes na exigência das políticas públicas de cultura enquanto lazer acessível às camadas de baixa renda, de forma regional e pluralista.

The article analyzes the law of culture incentive on the art democratization, as source of popular leisure, inserted on social rights. It`s about the bibliographic research with descriptive reading of tax incentives and their public ­ private partnership applied in the promotion of entertainment to peripheral populations. In multidisciplinar analysis of Cesnik (2012), Coelho (2009), Costa (2020), Nagayama (2020) dialogued with Almeida (2019, 2020), Barbosa (2012), Bretas (1997), Dumazedier (1975, 2015), Gomes(2014) and Marcelinho (1997, 2015), introduces the needs of inclusive measures for leisure service purpose. Realizes the tax exemption manipulated by capital and political interests to demand restructuring of social movements in the requirement of public politics of leisure as culture accessible to lowincome layers, in a regional and pluralistic way.

Integração ensino-serviço no âmbito do Sistema Único de Saúde: perspectivas de acadêmicos de enfermagem / Teaching-service integration within the Unified Health System: perspectives of nursing students / Integración enseñanza-servicio en el ámbito del Sistema Único de Salud: perspectivas de los estudiantes de enfermería

Introdução: A integração ensino serviço faz parte do processo de formação dos acadêmicos de enfermagem, mediante os estágios curriculares, e atividades de ensino, pesquisa e extensão. Objetivos: Compreender a perspectiva dos acadêmicos de enfermagem, sobre a integração ensino-serviço no âmbito do Sistema Único de Saúde. Métodos: Trata-se de um estudo descritivo e qualitativo que incluiu 15 acadêmicos matriculados no 7º e 8º período, do segundo semestre letivo de 2017. Os dados foram submetidos à análise de conteúdo temático. Emergiram-se três categorias: a inserção precoce do acadêmico no serviço; os preceptores como facilitadores do processo ensino aprendizagem; e os fatores que dificultam a atividade prática na atenção primária à saúde. Resultados: Os discentes valorizaram a territorialização, como processo essencial para a elaboração de intervenções frente as fragilidades identificadas na comunidade, além de oportunizar o amadurecimento acadêmico. Enfatizaram como satisfatória, a presença do preceptor para o aperfeiçoamento das suas habilidades, principalmente quando se sentem receosos para realizarem algum procedimento. Porém, salientaram as precariedades estruturais das unidades, a ausência de demanda, o número de pessoas em um grupo de estágio, e a resistência dos funcionários como condições que dificultam a inclusão deles no campo de prática. Conclusão: Na perspectiva dos acadêmicos a integração ensino-serviço é positiva. Entretanto, as unidades requerem intervenções dos responsáveis pela sua estrutura física, e o plano pedagógico do curso de novas propostas que possibilitem práticas mais integradas com a teoria e a comunidade.

Introduction: Teaching-service integration is part of the training process of nursing students, through curricular internships, teaching, research, and extension activities. Objectives: To understand the perspective of nursing students about the teaching-service integration within the Unified Health System. Methods:This is a descriptive and qualitative study, which included 15 students enrolled in the 7th and 8th periods in the second semester of 2017. The data were submitted to content analysis thematic. Three categories emerged: the early insertion of the student in the service; preceptors as facilitators of the teaching-learning process; and factors that hinder the practical activity in primary health care. Results: The students valued territorialization as an essential process for the development of interventions in the face of the weaknesses identified in the community, in addition to providing opportunities for academic maturation. They emphasized that the presence of the preceptor to improve their skills was satisfactory, especially when they felt afraid to perform some procedure. However, they pointed out the structural precariousness of the units, the lack of demand, the number of people in an internship group, and the resistance of the employees as conditions that hinder their inclusion in the practice field. Conclusion: From the academics' perspective, the teaching-service integration is positive. However, the units require interventions from those responsible for their physical structure, and the pedagogical plan of the course for new proposals that enable practices more integrated with theory and the community.

Introducción: La integración de la docencia y el servicio es parte del proceso de formación de los estudiantes de enfermería, a través de pasantías curriculares y actividades de docencia, investigación y extensión. Objetivo: Comprender la perspectiva de los estudiantes de enfermería sobre la integración de la docencia y el servicio en el ámbito del Sistema Único de Salud. Métodos: Se trata de un estudio descriptivo y cualitativo que incluyó a 15 estudiantes matriculados en el 7° y 8° períodos del segundo semestre académico de 2017. Los datos se enviaron para Análisis de contenido temático. Surgieron tres categorías: la inserción temprana del estudiante en el servicio; los preceptores como facilitadores del proceso de enseñanza-aprendizaje; y los factores que dificultan la actividad práctica en atención primaria de salud. Resultados: Los estudiantes valoraron la territorialización, como un proceso fundamental para la elaboración de las intervenciones ante las debilidades identificadas en la comunidad, además de brindar oportunidades para la maduración académica. Destacaron como satisfactoria, la presencia del preceptor para la mejora de sus habilidades, especialmente cuando sienten miedo de realizar cualquier procedimiento. Sin embargo, destacaron la precariedad estructural de las unidades, la ausencia de demanda, el número de personas en un grupo de prácticas y la resistencia de los empleados como condiciones que dificultan su inclusión en el ámbito de la práctica. Conclusión: Desde la perspectiva de los académicos, la integración enseñanza-servicio es positiva. Sin embargo, las unidades requieren la intervención de los responsables de su estructura física, y el plan pedagógico para el rumbo de nuevas propuestas que posibiliten prácticas más integradas con la teoría y la comunidad.

Prevenção quaternária e práticas integrativas e complementares(II): aproximação contextual / Quaternary prevention and integrative and complementary practices(II): contextual approach / Prevención cuaternaria y prácticas integradoras y complementarias (II): enfoque contextual

Introducción: La prevención cuaternaria (P4) puede implicar el uso de prácticas integrales y complementarias de salud (PICS), que se han ofrecido progresivamente en la atención primaria de salud (APS). Objetivo: Discutir aspectos contextuales de la atención de APS que facilitan el ejercicio de PICS como práctica de P4. Métodos: Ensayo en una perspectiva hermenéutica, que implica comprender la literatura seleccionada ("reconstrucción") y dialogar con las prácticas actuales de P4 ("integración"), para ampliar sus horizontes. Resultados y discusión: Varios factores dificultan el uso de PICS como P4 en APS. Una es la evocación de la medicina basada en la evidencia (MBE) como evaluador de la efectividad de PICS. Sin embargo, cinco conjuntos de argumentos contextuales facilitan este uso: (1) Un enfoque crítico de MBE para P4 y PICS; (2) La comprensión de la colonización de las PICS por la biomedicina; (3) Seguridad contextual derivada de la longitudinalidad de la atención en APS; (4) La influencia del espectro de severidad clínica de los usuarios en APS al considerar la efectividad; y (5) Las limitaciones inherentes a la MBE asociadas con el conocimiento de los profesionales de salud sobre PICS y otras racionalidades médicas pueden enriquecer y contribuir a la práctica de P4. Para esto, las PICS - especialmente en racionalidades médicas vitalistas - deberían ser contextualizadas y alineadas con los valores y preferencias de los pacientes. Conclusión: Una variedad de PICS y evidencia científica componen varias fuentes de conocimiento en la APS que pueden contribuir para la P4 en la toma de decisiones clínicas. Las PICS como estrategia de P4 son posibles, justificadas y deberían ser estimuladas en vista de la complejidad de la atención en el contexto de la APS, especialmente en el espectro de baja a media gravedad clínica.

Introduction: Quaternary prevention (P4) may involve the use of integrative, complementary and alternative medicine (I&CAM), which have been progressively offered in primary health care (PHC). Objective: To discuss contextual aspects of PHC care that facilitate I&CAM as a P4 practice. Methods: Hermeneutic perspective essay, which involves the understanding of selected literature ('reconstruction') and a dialogue with the current practices of P4 ('integration') to broaden its horizons. Results and discussion: Several factors hinder the use of I&CAM as P4 in PHC. One of them is the evocation of evidence-based medicine (EBM) as an evaluator of the effectiveness of I&CAM. However, five sets of contextual arguments facilitate the use of I&CAM in PHC: (1) Critical approach by EBM to P4 and I&CAM; (2) Understanding I&CAM colonisation by biomedicine; (3) Contextual security derived from the longitudinality of care in PHC; (4) Patients' clinical severity spectrum in PHC and effectiveness; and (5) The limitations inherent to EBM associated with health professionals' knowledge on I&CAM and other medical rationalities can enrich and contribute to P4 practice. For this, I&CAM - especially in vitalistic medical rationalities - should be contextualised and aligned with patients' values and preferences. Conclusion: A range of I&CAM and scientific evidence compose several sources of knowledge in PHC that can contribute to P4 in clinical decision-making. The I&CAM as P4 strategy is possible, justified, and should be stimulated in view of the complexity of care in the context of PHC, especially in spectrum of low to medium clinical severity.

Introdução: A prevenção quaternária (P4) pode envolver o uso de práticas integrativas e complementares em saúde (PICS), que progressivamente têm sido ofertadas na atenção primária à saúde (APS). Objetivo: Discutir aspectos contextuais do cuidado na APS que facilitam o exercício de PICS como prática de P4. Métodos: Ensaio em perspectiva hermenêutica, que envolve compreender a literatura selecionada ('reconstrução') e dialogar com as práticas atuais da P4 ('integração'), para ampliar seus horizontes. Resultados e discussão: Vários fatores dificultam o uso de PICS como P4 na APS. Um deles é a evocação da medicina baseada em evidências (MBE) como avaliadora da eficácia das PICS. Todavia, cinco conjuntos de argumentos contextuais facilitam esse uso: (1) Uma abordagem crítica da MBE frente à P4 e às PICS; (2) A compreensão da colonização das PICS pela biomedicina; (3) A segurança contextual derivada da longitudinalidade do cuidado na APS; (4) A influência do espectro de gravidade clínica dos usuários na APS na consideração da eficácia; e (5) As limitações inerentes à MBE associadas ao conhecimento de outras racionalidades médicas e PICS pelos profissionais podem enriquecer a prática da P4. Para isso, as PICS - especialmente em racionalidades médicas vitalistas - deveriam ser contextualizadas e alinhadas com os valores e preferências dos usuários. Conclusão: Uma gama de PICS e evidências científicas compõem diversas fontes de conhecimento na APS que podem contribuir para a P4 na tomada de decisão clínica. As PICS como estratégia de P4 são possíveis, justificadas e deveriam ser estimuladas tendo em vista a complexidade do cuidado no contexto da APS, principalmente no espectro de baixa a média gravidade clínica.

Implementation and assessment of personalized incentive measures for standardized residency training in department rotation / 中华医学教育探索杂志

Incentive system is an indispensable means in the process of standardized residency training, which plays an important role in improving the work efficiency and service quality of residents, teachers and other participants. Based on the analysis of the problems existing in the holistic incentive system, we have implemented a set of personalized incentive measures for the training of residents in department rotation and achieved preliminary results, which provides ideas for exploring personalized incentive system for standardized residency training.

Os incentivos e as medidas de proteção social na adesão de pacientes ao tratamento da tuberculose no município de São Paulo / Incentives and social protection measures on patients' adherence to tuberculosis treatment in the city of São Paulo

Introdução: A tuberculose (TB) ganhou expressividade como problema de saúde pública a partir da Revolução Industrial, principalmente devido às más condições de vida e trabalho, e ainda continua como enfermidade negligenciada e de relevância epidemiológica. No Brasil, apresenta índices importantes, com especial destaque para o abandono do tratamento, e acomete particularmente os grupos sociais com menor acesso. Em decorrência, recentemente, a Seguridade Social promove o amparo público para o enfrentamento de dificuldades inerentes à precariedade da vida, com destaque para o Programa Bolsa Família (PBF) e o auxílio-doença. Objetivo: O objetivo geral deste estudo foi analisar a influência de incentivos sociais e de medidas de proteção social no processo de adesão ao tratamento de pacientes com TB no Município de São Paulo. Metodologia: Estudo observacional descritivo-analítico com abordagem quanti-qualitativa, realizado em duas etapas. A TB como um agravo socialmente determinado, a adesão ao tratamento e a proteção social foram os pilares para a interpretação do objeto de estudo. As Supervisões Técnicas de Saúde (STS) do Butantã, Campo Limpo e Penha do Município de São Paulo constituíram o local de estudo que foi realizado com pacientes que realizavam tratamento da TB nas STS indicadas, entre 2015-2017. Na Etapa 1 foram capturados dados secundários disponibilizados pela Coordenação de Vigilância em Saúde e, a Etapa 2, foi realizada por meio de entrevista orientada por questionário semiestruturado. Foram realizadas análises descritivas, associação entre variáveis e os depoimentos foram objeto de análise de discurso. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: Na Etapa 1, 2.225 pessoas compuseram a amostra. Verificou-se associação significativa entre a cura e as seguintes variáveis: idade média de 37,7 anos (p<0,001), raça (p = 0,026), tipo de caso (p<0,001), forma clínica (p<0,001), tipo de tratamento (p<0,001) e algumas comorbidades como HIV/AIDS (p<0,001), alcoolismo (p<0,001) e drogadição (p<0,001). Na Etapa 2, 56 pacientes foram entrevistados; 87,5% receberam cesta básica e 16,1% receberam vale-transporte; 14,3% receberam auxílio-doença e 10,7% o aporte do PBF. Na análise dos depoimentos, emergiram quatro categorias: os benefícios sociais no tratamento da TB, fortalecedores da adesão ao tratamento da TB, barreiras para o tratamento da TB, e representações sobre o tratamento e o processo saúde-doença. Conclusão: Os incentivos e as medidas de proteção social contribuíram para a adesão ao tratamento, salientando-se que devem constituir o alicerce da sociedade, como políticas públicas orientadas à diminuição das desigualdades. O estudo supre uma lacuna para que profissionais de saúde e gestores compreendam a importância da oferta de benefícios sociais, minimamente durante o processo de tratamento.

Introduction: Tuberculosis (TB) has gained much attention as a public health problem since the Industrial Revolution, mainly due to poor living and working conditions and it is still considered a neglected disease of epidemiological relevance. In Brazil, TB presents important indexes with special emphasis on treatment default, and it particularly affects social groups with less access. As result, Social Security promotes public support to face difficulties inherent to the precariousness of life, with emphasis on the Bolsa Família Program (BFP) and paid sick leave. Objective: The main goal of this study was to analyze the influence of social incentives and social protection measures in the process of adherence to the treatment of TB patients in the city of São Paulo, Brazil. Methodology: Observational descriptive-analytical study with a quanti-qualitative approach, carried out in two stages. TB as a socially determined problem, adherence to treatment, and social protection were pillars for the interpretation of the study object. The study was performed at the Technical Health Supervisions (THS) of Butantã, Campo Limpo, and Penha in the city of São Paulo with patients who underwent TB treatment between 2015-2017. In Stage 1, the Health Surveillance Coordination provided the data; and interviews guided by a semi-structured questionnaire were done in Stage 2. Descriptive analyses and variable associations were made, and the speeches were the object of discourse analysis. The study was approved by a Research Ethics Committee. Results: In Stage 1, the sample size was 2,225 people. There was a significant association between cure and the following variables: mean age of 37.7 years (p <0.001), race (p = 0.026), type of case (p <0.001), clinical form (p <0.001), type of treatment (p<0.001) and some comorbidities such as HIV/AIDS (p<0.001), alcoholism (p <0.001) and drug addiction (p<0.001). In Stage 2, 56 patients were interviewed; 87.5% received food baskets, and 16.1% received transportation vouchers; 14.3% received paid sick leave, and 10.7% received the BFP. In the analysis of the speeches, four categories emerged: the social benefits in the treatment of TB, strengthening adherence to the treatment of TB, barriers to the treatment of TB, and representations regarding the treatment and the health-disease process. Conclusion: Incentives and social protection measures contributed to treatment adherence, highlighting that they must constitute the foundation of society as public policies oriented for reducing inequalities. The study fills a gap for health professionals and managers to understand the importance of offering social benefits, at least during the treatment process.

Financing constraints, tax incentives and R&D investment: Evidence from traditional Chinese medicine industry / 中草药

Innovation plays an important role in the development of the traditional Chinese medicine enterprises, whereas financing constraints may restrain the investment activities. Therefore, whether financing constraints may impact the R&D investment of traditional Chinese medicine enterprises is worthy of being studied. Based on a sample of listed A-share firms in traditional Chinese medicine industry from 2009 to 2018 in China, we investigate the relationship between financing constraints and R&D investment. It is found that financing constraints have a significantly negative effect on R&D investment. In addition, the tax incentives may moderate the negative relation between financing constraints and R&D investment. This study highlights the research on stimulation of R&D investment and provides valuable enlightenment to policy makers and regulators.

Evaluation of Unilateral Masticatory Muscle Function by Comprehensive Intervention / 中山大学学报(医学科学版)

@#【Objective】 To compare the changes of electromyographic activity of masticatory muscles in unilateral chewers before and after comprehensive intervention，and to evaluate the effect of comprehensive intervention.【Methods】 Thirty patients with unilateral mastication were selected，aged（19.3±0.5）years old. There was no statistically significant difference in general conditions ，which met the selection criteria for unilateral mastication. Randomly divided into intervention group and control group，with 15 cases in each group. The control group did not undergo any treatment，and the intervention group was given comprehensive intervention treatment mainly by eliminating inducement and muscle function training. Six months later，the electromyogram of masseter（left：LMM，right：RMM）and anteriovent of digastric muscle（left：LDA，right：RDA） were recorded in the two groups during the maximum opening and closing movement（M1）and masticatory movement（M2）. Statistical analysis was performed for the above.【Results】① There were significant differences in the average electromyographic difference values of LDA［M1：-7.4（-12.98，-1.84）］and RMM［M2：-2.28（- 4.42，- 0.13）］before and after intervention in the intervention group（P < 0.05）；the average EMG values of RMM and RDA in M2 after intervention were 9.62（5.99，9.98），9.96（7.91，12.62），compared with RMM［4.88（3.87~5.88）］，RDA［5.05（3.07~8.12）］in control group，the difference was statistically significant（P < 0.01）. ② The peak electromyogram values of bilateral DA （M1） and MM （M2） in intervention group were higher than those before intervention （P < 0.05）；the peak electromyogram values of LDA（M1）after intervention was 760.24（322.34~953.81），compared with LDA［M1 ：317.41（186.17~474.81）］in the control group，the difference was statistically significant（P < 0.05）.③ The activity asymmetry index of MM and DA in intervention group was lower than that before intervention（P < 0.05）；the value of the MM index［M1（15.59 ± 10.52），M2（10.84 ± 7.35）］after the intervention was lower than that in control group［M（129.89 ± 20.56），M（222.39 ± 16.87）］（P < 0.05），the DA index value［M1：7.60（5.00~26.5）］was lower than that in control group［25.4（13.8~43.50）］（P < 0.05）.【Conclusions】After comprehensive intervention，the contractility and symmetry of masseter and anteriovent of digastric muscle were significantly improved ，and the function of masticatory muscles recovered well.

A tecnologia nos torna melhores ou apenas adia nosso dilema moral? O caso dos xenotransplantes / Does technology make us better or only postpone our moral dilemma? The case of xenotransplantation

Objetivo: A obtenção do número adequado de órgãos cadavéricos para transplantes é um item de política pública importante. Modelos econômicos tradicionais supõem que a solução pode ser obtida por incentivos financeiros. Críticos dessa abordagem insistem que o mercado não resolve o problema, mas a intervenção estatal sim. Métodos: Este artigo apresenta o modelo do homo economicus maturus de Frey (1997), cujo principal mérito é mostrar que ambas as críticas estão incorretamente colocadas, pois indivíduos respondem não apenas a incentivos monetários de forma positiva, como demonstram os modelos tradicionais, mas também podem apresentar reações psicológicas adversas. Esse modelo é aplicado ao dilema da doação de órgãos com a inclusão do fator tecnológico, por meio da substituição de órgãos humanos por órgãos não humanos (xenotransplantes). Resultados: O principal resultado do artigo é mostrar como um avanço tecnológico pode melhorar o bem-estar sem alterar o dilema moral dos indivíduos. Conclusões: A extensão do modelo econômico tradicional permite uma análise com novas possibilidades acerca de mudanças tecnológicas e dos dilemas morais que elas podem trazer.

Objective: Obtaining the adequate number of cadaveric organs for transplantation is an important public policy item. Traditional economic models assume that solution can be obtained by financial incentives. Critics of this approach insist that the market does not solve the problem, but state intervention does. Methods: This article presents Frey's (1997) homo economicus maturus model, whose main merit is to show that both critics are incorrectly because individuals respond not only to monetary incentives in a positive way, as traditional models demonstrate, but they can also present adverse psychological reactions. This model is applied to the dilemma of organ donation with the inclusion of the technological factor, through the replacement of human organs by non-human organs (xenotransplantation). Results: The main result of the article is to show how a technological advance can improve well-being without changing the moral dilemma of individuals. Conclusions: The extension of the traditional economic model allows an analysis with new possibilities about technological changes and the moral dilemmas that they can bring.

Analysis on the Policy Measures of Clinical Use Incentives and Risk Control for Biosimilars in the European Union / 中国药学杂志

OBJECTIVE: The supervision of biosimilars in EU is based on scientific and reasonable principles. It not only had lots of laws, regulations and policy guidelines on marketing approval, but also made great efforts in clinical use and risk monitoring. To provide reference for the supervision and management of biosimilars in China. METHODS: Through the data summary and system comparison, the article described and analyzed the clinical use incentives and post-marketing risk control policies of biosimilars in EU countries. RESULTS: It is found that under the background of perfecting the regulatory systems and policies, EU countries encourage the vigorous development of the biosimilar industry and strictly control the drugs' safety, effectiveness and clinical risks. CONCLUSION: China could learn from the EU experience, encourage the development of biosimilars by improving pricing, reimbursement, clinical substitution and other policies. At the same time, we should also pay attention to the specificity of biosimilars, ensure that clinical risks are controllable and drugs are safe and effective.

Analysis of the relationship between the psychological resilience of newly-served nurses and the change-oriented leadership behavior of head nurses / 中国基层医药

Objective@#To analyze the correlation between the psychological flexibility of newly recruited nurses and the change leadership behavior of head nurses, so as to guide nursing managers to strengthen management and improve the quality of nursing care of new nursing staff.@*Methods@#From May 2017 to April 2018, 80 new nursing staff were surveyed using the psychological resilience scale and the change leadership style, and their correlation was analyzed.@*Results@#According to the statistics, the total score of psychological reinforcement of new nursing staff was (2.74±0.52)points, the overall level was not high, and the head nurses' change leadership behavior and various dimension scores were positively correlated with the nursing staff's psychological elasticity score (r=0.240, P<0.05).@*Conclusion@#Nursing managers should give full play to the role of the head nurses' transformational leadership behavior, so as to act on the psychological flexibility of nursing staff and improve the overall level of care.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

Associação político-partidária e influência da estrutura de incentivos na adesão dos municípios às políticas de saúde: evidências do Projeto Mais Médicos para o Brasil / Political partisanship and influence from the funding structure on the adhesion of municipalities to health policies: evidence from the project Mais Médicos para o Brasil

O projeto Mais Médicos para o Brasil é uma ação do programa Mais Médicos, formulada pelo governo federal e implementada pelos municípios brasileiros a partir de 2013. Sua finalidade é levar médicos brasileiros e estrangeiros para regiões onde faltam esses profissionais. O estudo investiga se há associação político-partidária e influência da estrutura de incentivos na decisão dos municípios em aderir ao projeto. Para tanto, utiliza dados de adesão dos municípios em função da filiação partidária dos prefeitos e realiza entrevistas com secretários de saúde de dois municípios selecionados da região de saúde de Limeira, no estado de São Paulo. Os resultados sugerem haver tanto associação político-partidária como influência da estrutura de incentivos. Conclui-se que mesmo em países federativos e com marcadas desigualdades regionais, políticas públicas nacionais que demandam cooperação de diferentes esferas de governo podem ser implementadas com relativo sucesso, desde que uma estrutura apropriada de incentivos tenha sido prevista na formulação da política.(AU)

The project Mais Médicos para o Brasil (More Doctors for Brazil) is an action of the program Mais Médicos, created by the Brazilian federal government and implemented by the Brazilian municipalities starting in 2013. The goal of the program is to provide Brazilian and foreign doctors to regions of the country where these professionals are lacking. This study investigates if political partisanship and the funding structure have influence in the decision of municipalities to join the project. For such, this study uses data of adhesion from municipalities depending on the party affiliation of mayors and conducts interviews with health secretaries from two municipalities selected in the region of Limeira in the state of São Paulo, Brazil. The results suggest that both political partisanship and the funding structure have influence. This study concludes that even in federated countries marked by regional differences, national public policies that require cooperation from different government levels can be implemented with relative success, as long as a proper funding structure is designed during the formulation of the policy.(AU)

A comparative study on impact of tax incentives and financial subsidies on R&D investment of Chinese materia medica enterprises / 中草药

By comparing the incentive effect of indirect tax incentives and direct financial subsidies on R&D investment of Chinese medicine enterprises, this empirical study aims to provide empirical evidence for the government subsidies to encourage the R&D investment of traditional Chinese medicine industry, and also provide valuable reference for the government to encourage enterprises to carry out innovation activities. Using a total of 301 observations in 62 traditional Chinese medicine enterprises from 2012 to 2016 as the research object, the paper analyzed the impact of tax incentives and financial subsidies on enterprise innovation performance. The results show that tax incentives have a significant incentive effect on R&D investment of traditional Chinese medicine enterprises, for every 1% reduction in tax costs, R&D investment increase by 0.99%, and R&D investment tax elasticity is -0.99; Financial subsidies have a significant positive effect on R&D investment but the estimated coefficient is only 0.24. When tax incentives and financial subsidies exist at the same time, the effect of financial subsidies on R&D investment is not significant. Moreover, the regression results of adding firm size as a moderator variable showed that incentive effects of tax incentives on R&D investment decreased with the increased size of the enterprise. Therefore, government subsidies should be based on tax incentives, supplemented by financial subsidies, and tax incentives should be properly inclined to SMEs.

Reform and explorations on appraisal and incentives mechanism for senior medical professionals at hospitals / 中华医院管理杂志

The paper presented the " Professors Evaluation System" initiated by the hospital since July 2009, which was designed for quantitative assessment of senior medical professionals of non-management category in terms of their performance in medical, teaching, research and management work. Seven periods of appraisal have witnessed a significant elevation of the rate of excellence among such professionals, proving that such a system can motivate and guide these professionals to continuously improve their competence in medical, teaching, research and management work.

International experiences and implications for education and training of health professionals in rural areas / 中国卫生政策研究

Objectives:To describe and summarize international evidences on policies and programs for training health personnel in rural areas,to identify best practice to increase health manpower in rural areas, and to provide references for China's policy of targeted admission program. Methods:This is a literature review based research. 48 literatures in Chinese and English were selected about the training of health professionals in rural areas at home and a-broad. Thematic framework approach was applied to review and analyze the related strategies and practices,and les-sons learned. Results: Common measures to train health personnel in rural areas included: enrollment of students with a rural background,tutoring system in medical training,internship in rural health institutions, financial incen-tives,and compulsory rural services after graduation. Lessons learnt:(1) adequate financial resources are a prereq-uisite for smooth program implementation;(2) Good project management and evaluation are critical aspects of effec-tive project implementation;(3) choosing the right combination of various practices to implement such projects can improve effectiveness. Conclusions:The policy of targeted admission program is suitable for China's current situation. Meanwhile,international experiences can provide valuable lessons to improve China's program design and implemen-tation and these include:increasing capital investment,strengthening management and evaluation,and strengthening sector cooperation to further improve targeted admission program.

Impact of the Outpatient Prescription Incentive Program on Reduction of Pharmaceutical Costs of Clinics in South Korea / 보건행정학회지

BACKGROUND: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. METHODS: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011–2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. RESULTS: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, β=6.8179; p-value <0.0001; OPCI, β=−0.0227; p-value <0.0001; reference=non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. CONCLUSION: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

Impact of the Outpatient Prescription Incentive Program on Reduction of Pharmaceutical Costs of Clinics in South Korea / 보건행정학회지

BACKGROUND: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. METHODS: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011–2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. RESULTS: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, β=6.8179; p-value <0.0001; OPCI, β=−0.0227; p-value <0.0001; reference=non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. CONCLUSION: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

La investigación desde un referente epistemológico como aporte para la reflexión misional de las Instituciones de Educación Superior (IES), en Colombia

La investigación en las sociedades modernas, también denominadas sociedades de la información y/o del conocimiento, juega un papel fundamental como puntal del desarrollo y del progreso económico, científico, tecnológico y social de los países. En este artículo derivado de investigación, se examina la investigación en Colombia teniendo en cuenta el planteamiento de bucles desde el referente epistemológico del pensamiento complejo. Metodológicamente, se analizan los postulados que aparecen en la normatividad colombiana (teniendo en cuenta las disposiciones supraestatales), considerando los retos que imponen las Tecnologías de la Información y la Comunicación (TIC) a la luz de la crisis contemporánea del humanismo. Se halló que en Colombia el conocimiento se gestiona prioritariamente en torno de aquello que implica o significa mayor ganancia y progreso, en desmedro de la función social de todo conocimiento y que existen cuatro retos que deben afrontar las IES colombianas respecto a la investigación: sociales; TIC; económicos; calidad y certificación de programas. Se concluye que las IES deben revisar los soportes epistémicos que sustentan sus procesos investigativos con el fin de contemplar los cuatro fines que demanda el contexto colombiano en función de la superación o de la búsqueda de alternativas a la crisis del humanismo.

Research in modern societies, also known as societies of information and/or knowledge, plays a fundamental role as pillar of development and of economic, scientific, technological and social progress of the countries. In this article derived from research, research in Colombia is examined taking into account the approach of loops from the epistemological referent of complex thinking. Methodologically, the principles that appear in the Colombian regulations are analyzed (taking into account the supranational provisions), considering the challenges imposed by the technologies of information and communication technology (ICT) in the light of the contemporary crisis of humanism. It was found that in Colombia the knowledge is primarily managed around that implies or means higher profit and progress, to the detriment of the social function of all and that there are four challenges faced by the Colombian Higher Education Institurions (HEI) regarding research: social; ICT; economic; quality and certification of programs. It was concluded that the HEI should review brackets epistemic underpinning its investigative processes in order to contemplate the four goals that demand the Colombian context according to the improvement or the search for alternatives to the crisis of humanism.

Pesquisa nas sociedades modernas, também chamado de sociedades e / ou o conhecimento de informações, desempenha um papel fundamental como a pedra angular do desenvolvimento e do desenvolvimento econômico, científico, tecnológico e social dos países. Este artigo derivado de pesquisa, pesquisa é discutida na Colombia considerando a abordagem das alças de referência epistemológicos do pensamento complexo. Metodologicamente, postulados que aparecem na lei colombiana são analisados (tendo em conta o disposto supra), considerando os desafios colocados pela tecnologia da informação e comunicação (TIC), à luz da crise contemporânea do humanismo. Verificou-se que na Colombia o conhecimento é gerido principalmente em torno de o que significa ou significa maior ganho e progresso, à custa da função social de todo o conhecimento e que há quatro desafios enfrentados pelas IES da Colômbia em matéria de investigação: social; TIC; económica; programas de qualidade e certificação. Conclui-se que as IES devem rever os suportes epistêmicas que suportam os processos de investigação, a fim de contemplar as quatro extremidades exigidos pelo contexto colombiano em termos de superação ou encontrar alternativas para a crise do humanismo.