Contratos y recontratos / Contracts and recontracts / Contrats et recontrats / Contratos e recontratos

Este trabajo se apoya en los conceptos contrato narcisista primario y secundario para dar cuenta del proceso de filiación y afiliación de la paciente (caso de Agustina) AU

This work relies on the concepts of primary and secondary Narcissistic Contract to understand the process of affiliation and filiation of the patient (Agustina ́s case) AU

Ce travail s'appuie sur les concepts de contrat narcissique primaire et secondaire pour rendre compte du processus de filiation et du processus d ́adhésiondu patient (cas d ́Agustina) AU

Este trabalho baseia-se nos conceitos de contrato narcísico primário e secundário para dar conta do processo de filiação e afiliaçãodo paciente (caso de Agustina) AU

Construction of a Theoretical Framework for the Performance Assessment of Basic Medical Insurance Designated Medical Institutions Based on the Objectives of Medical Insurance Policy / 中国医院管理

It collected relative policy documents systematically and analyzed the development process and policy objective evolution of Chinese basic medical insurance system.Based on this,it determined the performance assessment objectives of the designated medical institutions of basic medical insurance and constructed the assessment framework guided by the goal realization.Then,from the perspective of contract management and performance management,it determined the assessment elements of contract enforcement assessment system of designated medical institutions and the logical relationship between the elements,and to construct a conceptual model,which provides a reference for guiding the research of the contract enforcement assessment of the designated medical institutions of basic medical insurance.

Efficacy of CARTO Three-dimensional Mapping and Zero X-ray Radiofrequency Catheter Ablation of Ventricular Premature Contraction Originating From Aortic Sinus / 中国循环杂志

Objectives:To finely divide the aortic sinus into sections and accurately localize the coronary ostium through CARTO three-dimensional mapping,and to assess the clinical effects of treating aortic sinus cusps premature ventricular contraction(ASC-PVC)and the ablation risk in the corresponding area with zero X-ray radiofrequency ablation. Methods:A total of 66 patients who underwent radiofrequency ablation for ASC-PVC from January 2020 to January 2023 were included in this analysis,patients were divided into experimental group(n=34)and conventional group(n=32).In the conventional group,the CARTO 3 system was used to create an aortic sinus model through the conventional method.The earliest stimulating target was identified by using electrical stimulation mapping(ESM).Radiofrequency ablation treatment was performed after the distance between the target and the coronary ostium was precisely measured by coronary angiography through the hollow tube of the ablation catheter or coronary angiography tube.In the experimental group,the CARTO 3 system was used to build a model of the aortic sinus and the coronary ostium and aortic sinus were divided into sections.The earliest stimulating target was identified by ESM.After localizing coronary ostium through the impedance changing pattern on the ablation catheter tips,catheter ablation was performed with zero X-ray.The data regarding the impedance of the ablation catheter in the aortic sinus were collected.The total operative time,the operative time in the aortic sinus,contrast dosage,X-ray exposure time,immediate and short-term success rates of the operation and complication rates were compared between the two groups.Besides,the distribution of successfully ablated targets and their relationship with the risk of ablation were analyzed in both groups. Results:There was no significant statistical difference in the immediate and short-term success rates between the two groups(93.8%vs.94.1%;90.6%vs.88.2%,both P>0.05).The experimental group did not receive contrast agents during the operation,and the total operation time and intra-aortic sinus operation time in the experimental group were significantly shorter than those in the conventional group([58.76±4.94]min vs.[66.91±5.94]min,P<0.001;[43.12±4.49]min vs.[50.31±5.18]min,P<0.001).During the process of moving the ablation catheter from the intra-aortic sinus to the coronary artery opening and into the coronary artery,the impedance suddenly increased,which was significantly different from the impedance in other parts of the intra-aortic sinus(all P<0.001). Conclusions:Radiofrequency ablation of ASC-PVC with zero X-ray can simplify the procedures and shorten the operative time.The steep increase in impedance at the tip of the ablation catheter can be used as a basis for localizing the coronary ostium.Dividing the aortic sinus into sections allows a detailed assessment of the risk for ablation treatment at the targets.

A participação das Organizações Sociais no Sistema Único de Saúde: estudo de caso do Hospital Estadual da Mulher Heloneida Studart / The participation of Social Organizations in the Unified Health System: case study of the Heloneida Studart Women's State Hospital

Esta dissertação tem como objeto de estudo a participação das Organizações Sociais no Sistema Único de Saúde (SUS), a partir do estudo de caso do Hospital Estadual da Mulher Heloneida Studart (HEMHS). Os objetivos gerais são contribuir para o entendimento da participação das Organizações Sociais no âmbito do SUS, com base na análise dos contratos de gestão em unidade de saúde pertencente à Secretaria de Estado de Saúde do Rio de Janeiro (SES-RJ) e na avaliação do desempenho da produção hospitalar dessa unidade no período de 2012 a 2022, e cooperar para o aperfeiçoamento dos processos de contratualização das unidades de saúde no âmbito da SES-RJ. São objetivos específicos: identificar e descrever os contratos de gestão do HEMHS no período de 2012 a 2022, comparar a evolução dos valores pagos nos contratos de gestão para operacionalização do HEMHS de 2012 a 2022, analisar a evolução da produção do HEMHS de 2012 a 2022 e o atingimento das metas pactuadas relacionadas aos indicadores quantitativos disponíveis nos contratos de gestão e sugerir ajustes nos contratos de gestão e nas formas de monitoramento e avaliação da SES-RJ, com base nas lições aprendidas. Para alcançar os objetivos propostos, foram utilizadas pesquisas documentais e bibliográficas. Na pesquisa bibliográfica, buscaram-se conhecimento e aprofundamento dos diferentes modelos de gestão dos serviços de saúde no Brasil, e mais especificamente no Estado do Rio de Janeiro, com o advento das Organizações Sociais no SUS. A pesquisa documental teve como fonte de dados os instrumentos normativos sobre Organizações Sociais no Brasil e no Estado do Rio de Janeiro, como leis, decretos e portarias, além dos contratos de gestão e relatórios de prestações de contas disponibilizados no sítio da SES-RJ. Os resultados da pesquisa demonstraram que, ao longo do período estudado, os recursos firmados em contratos tiveram pouca variação, bem como os recursos efetivamente pagos. As metas de produção obtidas demonstraram que alguns procedimentos tiveram resultados superiores ao contratado e outros procedimentos, resultados inferiores. Apesar da demanda pelos serviços no período de 2012 a 2022, os procedimentos de vídeo-histeroscopia, mamografia e mamografia guiada por ultrassonografia jamais alcançaram os resultados pactuados. A pesquisa também não conseguiu estabelecer uma relação direta entre o repasse de recurso e o alcance das metas contratuais. (AU)

This dissertation aims to study the participation of Social Organizations in the Unified Health System (SUS), based on the case study of the Heloneida Studart Women's State Hospital (HEMHS). The general objectives are to contribute to the understanding of the participation of Social Organizations within the scope of the SUS, based on the analysis of management contracts in a health unit belonging to the State Department of Health of Rio de Janeiro (SES-RJ) and the evaluation of the performance of this unit's hospital production from 2012 to 2022, and cooperate to improve the contracting processes of health units within the scope of SES-RJ. Specific objectives are: identify and describe HEMHS management contracts from 2012 to 2022, compare the evolution of amounts paid in management contracts for the operationalization of HEMHS from 2012 to 2022, analyze the evolution of HEMHS production from 2012 to 2022 and the achievement of agreed goals related to the quantitative indicators available in the management contracts and suggesting adjustments to the management contracts and the forms of monitoring and evaluation of SES-RJ, based on the lessons learned. To achieve the proposed objectives, documentary and bibliographical research was used. In the bibliographical research, we sought knowledge and deepening of the different management models of health services in Brazil, and more specifically in the State of Rio de Janeiro, with the advent of Social Organizations in the SUS. The documentary research had as its data source the normative instruments on Social Organizations in Brazil and the State of Rio de Janeiro, such as laws, decrees and ordinances, in addition to management contracts and accountability reports available on the SES-RJ website. The research results demonstrated that, throughout the period studied, the resources signed in contracts had little variation, as well as the resources actually paid. The production targets obtained demonstrated that some procedures had results superior to those contracted and other procedures had inferior results. Despite the demand for services from 2012 to 2022, video hysteroscopy, mammography and ultrasound-guided mammography procedures never achieved the agreed results. The research was also unable to establish a direct relationship between the transfer of resources and the achievement of contractual goals. (AU)

Analysis of the time consumption of clinical trials contract signing and its influencing factors / 中华医学科研管理杂志

Objective:To study the time consumption of clinical trial projects in each link of contract signing in medical institutions and its influencing factors, to provide a reference for further optimizing the clinical trial management process and improving the efficiency of contract signing.Methods:All of the review records of projects that signed clinical trial contracts at Peking Union Medical College Hospital from January 1st, 2018 to December 31st, 2021 were retrospectively analyzed by comparing the time consumption in each link before signing the contracts and the frequency of contract reviews. Multiple linear regressions were applied to multivariate analyze the influence of different factors on contract signing.Results:A total of 761 clinical trial contracts signed at Peking Union Medical College Hospital from 2018 to 2021 were included in this study, and the average time consumption of contract signing was 127.0 days, among which the consumption of contract review by the hospital was 10.5 days and by sponsors was 99.0 days. The time consumption of contract signing has been decreasing in recent 4 years, from 154.0 days in 2018 to 104.0 days in 2021. The phase of clinical trials, category of sponsors, frequency of contract reviews, and different policies of the institutions were the main influencing factors for contract signing time ( P<0.05). Conclusions:Clinical trial institutions should optimize the contract approval progress, provide agreement templates and targeted service, and strengthen propaganda and information system construction, to improve the efficiency of reviewing and signing clinical trial contracts.

Application of business contract audit in the management of multi-campus hospitals / 中华医院管理杂志

With business activities expanding and number of business contracts growing, the management of multi-campus hospitals is faced with constantly escalating requirements for risk prevention and control within the hospital. Being an important part of hospital internal management, the internal audit plays an irreplaceable role in the high-quality development of hospitals. The authors elaborated on the value of business contract audit in the management of multi-campus hospitals from three dimensions of internal control, risk management and hospital added value, introduced the practices by the Second Affiliated Hospital Zhejiang University School of Medicine in the management of its multi-campus management since 2018, by adopting the strategy of architecture integration, rule homogenization, process standardization, and vertical supervision, and put forward suggestions from three aspects, including the practical difficulties in the participation process, the dynamic adjustment of role positioning, and the development of better integrating business contract auditing into multi-campus hospital management.

Study on the Construction of Harmonious Doctor-patient Relationship under the Family Doctor Contract Service System / 中国医学伦理学

【Objective:】 To understand the current status and problems of the doctor-patient relationship under the family doctor contract service system through the investigation on residents contracted by community family doctors, and to provide reference for constructing harmonious doctor-patient relationship and promoting the healthy operation of the family doctor contract service system. 【Methods:】 A questionnaire survey was conducted on 1 655 residents of a certain university community in Xi’an from January to February 2023 who completed family doctor contract services in 2022. Through the general situation of signed residents, the willingness of signed family doctors, and the satisfaction and opinions with signed family doctors’ services, this paper investigated the current status of the doctor-patient relationship and proposed corresponding improvement strategies. 【Results:】 A total of 856 residents(52.68%) were willing to sign the contract, 322 residents(19.82%) were unwilling to sign the contract, 397 residents(24.43%) expressed indifference, and 50 residents(3.07%) abstained from signing the contract. There was no statistical difference in service satisfaction between residents of different genders(P=0.292). The satisfaction of working staff aged 40-60(72.33%) was higher than that of retirees aged over 60(61.05%, P<0.001). The satisfaction of those with bachelor’s degree or above(58.23%) was higher than that of those with bachelor’s degree below(51.77%, P=0.008). The satisfaction of individuals living alone(70.21%) was significantly higher than that of non-solitary individuals(54.35%, P<0.001). The overall satisfaction score of contracted residents with contracted services was(4.48±0.14) points, including 4.31 points for satisfaction with service methods, 4.47 points for satisfaction with service attitudes, 4.52 points for satisfaction with service content, and 4.60 points for satisfaction with service effectiveness. 【Conclusion:】 Most community residents have a positive attitude towards family doctor contract services. Improving service satisfaction and strengthening doctor-patient communication are feasible ways to improve grassroots doctor-patient relationships and promote the operation of the family doctor contract service system.

Guidelines for Ethical Review Entrustment Contract of Life Science and Medical Research Involving Humans / 中国医学伦理学

The passing of ethical review is a necessary conditions and prerequisite for the development of life science and medical research involving humans. At present, some medical and health institutions have no or insufficient ethical review capabilities. The lack of ethical review ability has become a bottleneck restricting the development of life science and medical research involving humans. According to documents such as Opinions on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Pharmaceutical and Medical Devices, Opinions on Strengthening the Ethical Governance of Science and Technology, institutions can entrust competent institutional ethics review committees or regional ethics review committees in writing to conduct ethical review. Entrustment ethical review provides a viable solution for institutions that need to carry out life science and medical research involving humans but do not have an ethics (review) committee or the ethics (review) committee is not competent to review. To conduct the entrustment ethical review, the entrustment between the principal and the trustee is required. According to The Measures for Ethical Review of Life Sciences and Medical Research Involving Humans, if medical and health institutions and their ethical review committees do not accept the formal entrustment to provide the ethical review opinions for other institutions, the local health authorities at or above the county level will impose administrative penalties and sanctions on the relevant institutions and personnel in accordance with the law. Signing the entrustment ethical review contract, implementing legal compliance entrusted ethical review to protect the rights and interests of the trustee and the principal, and protect the research participants.

Online Symposium Held on June 10, 2023 / 医学教育

In the revised Core Curriculum, professionalism is listed as one of the basic qualities and abilities required of physicians. The definition of professionalism and related learning objectives (1. trust, 2. compassion, 3. liberal arts, and 4. bioethics) are also presented. However, the Core Curriculum does not explain why these objectives were listed. Therefore, some of them are difficult to understand or differ from what has been discussed in previous meetings of the current subcommittee (and previous committees). To properly and effectively advance professionalism education, it is necessary to confirm the contents of the revised Core Curriculum that are insufficient or inappropriate. It is also necessary to deepen the discussion for the next revision of the Core Curriculum. A symposium was held for this purpose. The main points of each lecture are presented within this report.

Risk Sharing Agreement: a pilot project in the Brazilian Unified Health System

Risk Sharing Agreement is defined as an agreement in which the State agrees to offer temporary access to a new drug, while the pharmaceutical industry accepts to receive the product according to the performance of the drug in real conditions of use. Risk sharing necessarily depends on the collection of additional evidence that may refer to the therapeutic benefits or the volume of patients, according to the assessment of its use in practice. The authors described the experience of the pilot project of a Risk Sharing Agreement in the Unified Health System.

Acordo de Compartilhamento de Risco: projeto-piloto no Sistema Único de Saúde / Risk Sharing Agreement: a pilot project in the Brazilian Unified Health System

O Acordo de Compartilhamento de Risco é definido como um acordo no qual o Estado concorda em oferecer acesso temporário a um novo medicamento, enquanto a indústria farmacêutica aceita receber pelo produto conforme o desempenho do medicamento em reais condições de uso. A partilha de risco depende, necessariamente, da coleta de evidências adicionais, que podem se referir aos benefícios terapêuticos ou ao volume de pacientes, conforme avaliação de seu uso na prática. Os autores descreveram a experiência do projeto-piloto de Acordo de Compartilhamento de Risco no Sistema Único de Saúde.

Risk Sharing Agreement is defined as an agreement in which the State agrees to offer temporary access to a new drug, while the pharmaceutical industry accepts to receive the product according to the performance of the drug in real conditions of use. Risk sharing necessarily depends on the collection of additional evidence that may refer to the therapeutic benefits or the volume of patients, according to the assessment of its use in practice. The authors described the experience of the pilot project of a Risk Sharing Agreement in the Unified Health System.

The influence of job stress and psychological contract on occupational adaptation of newly-hired policemen / 中国职业医学

@#Abstract: Objective ， To explore the relationship among job stress psychological contract and occupational adaptation in - . Methods newly hired policemen A total of 413 new police officers in a southwest province were selected as the research ， subjects using convenient sampling method. The Chinese version of Perceived Stress Scale the Psychological Contract ， Questionnaire and the Occupational Adaptation Scale were used to investigate their job stress psychological contract and occupational adaptation respectively. The effects of job stress and psychological contract on occupational adaptation was analyzed. Results ， （ ），（ ） The total scores of job stress psychological contract and occupational adaptation were 27.6±7.1 63.9±16.6 and （ ）， - 56.2±8.6 respectively. The work pressure of newly hired police officers was negatively correlated with occupational ［ （r） ，P< ］ adaptation correlation coefficient =−0.61 0.01 . There was a positive correlation between psychological contract and （r ，P< ） occupational adaptation =0.59 0.01 . The results of hierarchical regression analysis showed that after adjusting for ， ， ， ， ， confounding factors such as gender education level marriage fertility the stronger the sense of out of control in work stress （P< ）； ， the lower the level of occupational adaptation 0.01 the higher the score of psychological contract the higher the level of （P< ） occupational adaptation 0.01 . The psychological contract played a mediating role between job stress and occupational ， Conclusion - adaption accounting for 12.5% of the total effect. The job stress and psychological contract of the newly hired policemen can affect their occupational adaptation. Psychological contract plays a partial intermediary role in job stress on occupational adaptation.

Efficacy of personalized family doctor contract services on the risk factors of atherosclerotic cardiovascular disease in high-risk people / 中华全科医师杂志

Objective:To investigate the efficacy of personalized family doctor contract services on risk factors of atherosclerotic cardiovascular disease (ASCVD) in high-risk population.Methods:Ten matched-community health centers of Shenzhen Luohu district were divided into intervention group and control group by cluster randomiztion. Subjects with high risks of ASCVD were screened out as intervention group from contracted residents who visited these centers and had complete data of the China-PAR model from August 2018 to April 2019. The control group received conventional general family doctor contract services. The individualized management were given to the intervention group after fully understanding patients′ ideas, concerns, and expectations (ICE). After 2-year intervention, score changes of ASCVD risk factors within and between groups were compared.Results:A total of 571 patients were enrolled, including 288 in the intervention group and 283 in the control group. After 2 years of intervention, 7 and 18 were lost to follow-up in two groups, respectively. Finally, 281 in the intervention group and 265 in the control group were included in the study. At baseline, there was no significant difference in ASCVD scores between the intervention group and the control group [(13.33±3.54) vs. (13.09±3.54) points; t=0.84, P=0.403], and the scores in both groups decreased significantly after the intervention [(10.89±4.01), (11.62±4.11) points], while the intervention group decreased more significantly (both P<0.05). Among the risk factors at baseline, HDL-C and diastolic blood pressure in the intervention group were lower than those in the control group, and there were no significant differences in other factors between the two groups. After the intervention, the levels of total cholesterol, systolic blood pressure and diastolic blood pressure in the two groups decreased significantly, and the number of people taking antihypertensive drugs increased significantly ( P<0.001 and P<0.05); HDL-C decreased in the control group ( P=0.023). After the intervention, compared to control group the intervention group had a higher proportion of patients taking antihypertensive drugs, with lower systolic and diastolic blood pressure ( P<0.05). After the intervention, the increase rate of HDL-C in the intervention group was more than that in the control group, and the decrease rate was less than that in the control group (χ 2=6.65, P=0.036). Conclusion:Family doctor contract services can reduce the risk factors of ASCVD, and personalized family doctor contract services can further improve the effects in the prevention and control of ASCVD. However, the effects might be insignificant and inconsistent for the ASCVD risk factors with deeper management requirements or no specific management measures, which highlights the complexity and diversity of ASCVD prevention and control, calling for multi-level and multi-faceted thinking and exploration.

Effect of family doctor-specialist double-contract service on management of type 2 diabetic patients in community / 中华全科医师杂志

Objective:To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods:Two hundred patients with type 2 diabetes mellitus (T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method. Patients were randomly divided into study group and control group with 100 cases in each group. The control group was managed with the conventional family doctor contract service, and the study group was managed with the family doctor-specialist double contract service. After one year of management, the fasting blood glucose, 2 h-postprandial blood glucose, glycosylated hemoglobin, diet control, blood glucose monitoring, medication compliance, exercise and other health behaviors, quality of life and satisfaction of patients were compared between two groups.Results:After intervention, fasting blood glucose, 2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group ( t=10.29, 8.49, 7.99, all P<0.05); the health related behaviors such as diet control, exercise behavior, blood glucose monitoring, and medication compliance in the study group were significantly better than those in the control group ( t=9.78, 6.72, 39.81, 7.88, all P<0.05); the quality of life in patients of study group was higher than that of the control group ( P<0.05); the satisfaction rate in study group was higher than that of control group (90.0% vs. 69.0%, χ 2=6.39, P=0.031). Conclusion:Compared with conventional family contract service model, the double contract service improves patient self-management, helps to reduce the blood glucose level and gains high patients′ satisfaction, which is worth promoting and applying in the management of type 2 diabetic patients in the community.

Study on the influence of residents′ psychological contracts on their behavioral intentions from the perspective of incomplete contracts / 中华医院管理杂志

Objective:To analyze the psychological contract satisfaction of contracted residents and its impact on their behavioral intentions under the guidance of incomplete contract theory, for reference in improving the effectiveness of contracted family doctor services.Methods:1 100 contracted residents from nine townships/streets in Shandong province were selected as subjects according to stratified random sampling from September 2019 to June 2020, and a questionnaire survey on the level of satisfaction of contracted residents′ psychological contracts(24 items) and assessment of behavior intentions(9 items) was conducted, and the model of the effect of contracted residents′ psychological contracts on behavior intentions was established and analyzed. The correlation was validated by Pearson test and the structural equation method was used for verifying the model.Results:998 valid questionnaires were recovered. The psychological contract satisfaction score of the contracted residents was 3.45±0.56 and the behavioral intention was 2.81±0.29. Both transactional and relational psychological contracts were correlated with all dimensions of behavioral intention( P<0.01). Concerning the impacts of residents′ psychological contracts on behavioral intentions, the effect coefficients of transactional psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.33, 0.24, -0.25 and -0.49 respectively, with an indirect effect on neglect intention; the effect coefficients of relational psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.26, 0.10, -0.14 and -0.50 respectively, with an indirect effect on advice intention and neglect intention. Conclusions:Residents′ psychological contract has yet not been effectively satisfied. Satisfying and improving the residents′ psychological contract can directly enhance their loyalty intention and reduce their exit intention, indirectly influencing the voice and neglect intentions. In order to enhance the effectiveness of family doctor contracted services and improve the healthcare experience of contracted residents, it is suggested that the relevant departments should actively take the following measures, including carrying out a survey on the psychological contract of contracted residents, building a provincial-city-county-township collaborative linkage platform, and so on.

Practice on fine management of contract countersignature process at public hospitals / 中华医院管理杂志

Contract countersignature can effectively avoid potential risks caused by sub-standard contract signing, yet its time consuming process will inevitably delay the contract signing and related business development. Therefore, it is necessary to ensure the timely signing of hospital contracts on the premise of meeting internal control requirements. In order to improve the efficiency of contract countersigning, a tertiary hospital has explored various approaches to optimize the contract countersigning process since 2019. These approaches included establishing a three-level centralized contract management model, clarifying the review responsibilities of each countersigning department, customizing the countersigning process, managing the contract by risk classification, and establishing a meeting opportunity system of contract countersigning modification opinions. These measures had cut back the time spent in the contract countersigning process from 12.1 working days in 2018 to 4.2 working days in 2021.

Launching a CDMO in Brazil aiming to develop biopharmaceuticals for clinical trials

The innovation timeline is expensive, risky, competitive, time-consuming, and labor-intensive. In order to overcome such challenges and optimize financial resources, pharmaceutical companies nowadays hire contract development and manufacturing organizations (CDMO) to help them. Based on the experience acquired first from the development of two biopharmaceuticals, the Heterologous Fibrin Sealant and the Apilic Antivenom, and more recently, during their respective clinical trials; the Center for the Study of Venoms and Venomous Animals (CEVAP) proposed to the Ministry of Health the creation of the first Brazilian CDMO. This groundbreaking venture will assist in converting a candidate molecule - from its discovery, proof of concept, product development, up to pilot batch production - into a product. The CDMO impact and legacy will be immense, offering service provision to the public and private sector by producing validated samples for clinical trials and academic training on translational research for those seeking a position in pharmaceutical industries and manufacturing platforms.(AU)

Sistema de proteção do trabalho e do trabalhador da Educação Física: porque somos contra a regulamentação da profissão / Protection system of work and Physical Education workers: why we are against the regulation of the profession / Sistema de protección del trabajo y del trabajador de la Educación Física: porque somos contra la regulación de la profesión

O texto problematiza a atuação do Conselho Federal de Educação Física e seus Conselhos Regionais de Educação Física (CONFEF/CREF) na defesa dos trabalhadores(as) da Educação Física (EF). Parte de duas perguntas: O que é a Ação de Inconstitucionalidade (ADIn) nº 3.428/2005, sua origem, seu desenvolvimento e seu estágio atual; o que é o CONFEF/CREF e sua (in)capacidade de proteger os trabalhadores(as)? Objetiva subsidiar as posições do Movimento Nacional Contra a Regulamentação do Profissional de Educação Física (MNCR), fortalecer a luta sindical, contribuir com o Movimento Sindical em Defesa do Sistema de Proteção do Trabalho e dos(as) Trabalhadores(as). Como procedimentos de investigação valemo-nos da análise documental. Demonstra que esta ADIn procede, tem respaldo constitucional e que a atuação do CONFEF/CREF não lhe concede prerrogativas que permita proteger os trabalhadores(as). Conclui pela defesa organizada do Sistema de Proteção do Trabalho e do(a) Trabalhador(a) da Educação Física a partir das organizações, considerando que a luta pelos direitos é de interesse público, porque dizem respeito à vida dos(as) trabalhadores(as).

This article discusses the role of the Federal Council of Physical Education and its Regional Councils of Physical Education in the defense of Physical Education workers. It is moved by two questions: What is the Unconstitutionality Action nº 3.428/2005, its origin, its development, and its current stage; what is CONFEF/CREF and its (in)ability to protect the workers? It aims to support the stance of the National Movement Against the Regulation of Physical Education Professionals, to strengthen the labor union in its struggle, to contribute to the Union Movement in Defense of the Labor and Workers Protection System. As our investigation procedure, we used documentary analysis. It demonstrates that this ADIn is valid, has constitutional support, and that the activity of CONFEF/CREF does not grant it prerogatives that allow it to protect the workers. It concludes by the organized defense of the Labor Protection System and the Physical Education Worker based on the associations, considering that the fight for rights is of public interest, because it concerns the life of the workers.

El artículo hace problematización a la actuación del Consejo Federal de Educación Física y sus Consejos Regionales en la defensa de los trabajadores(as) de la Educación Física. Surge de dos preguntas: ¿Lo que es la Acción de Inconstitucionalidad nº 3.428/2005, su origen, su desarrollo y su etapa actual? ¿Lo que es el CONFEF/CREF y su (in)capacidad de proteger los trabajadores(as)? Se tiene como objetivos dar aportes a las posiciones del Movimiento Nacional Contra la Regulación de la Profesional de Educación Física, fortalecer la lucha sindical, contribuir con el Movimiento Sindical en Defensa del Sistema de Protección del Trabajo y de los Trabajadores(as). Como procedimiento de investigación fue utilizada un análisis documental. Demuestra que esta ADIn es legítima, tiene respaldo constitucional y que la actuación del CONFEF/CREF no concede prerrogativas hacia la protección del trabajador(a). Concluye con la defensa organizada del Sistema de Protección Laboral y del Trabajador de Educación Física con base en las asociaciones, considerando que la lucha por los derechos es de interés público, porque atañe a la vida de los trabajadores(as).

Behavior of Seeking Medical Care for People with Disabilities within Context of Health Poverty Alleviation Initiatives / 中国康复理论与实践

Objective:To study the behavior of seeking medical care for people with disabilities under the background of Health Poverty Alleviation. Methods:Descriptive statistics method was used to analyze the behavior of seeking medical care for people with disabilities based on the data of the National Health Poverty Alleviation Dynamic Management System. Results:The Three Batch action plan mainly focuses on contracted services for chronic diseases; the number of visits for people with disabilities gradually increases, the proportion of visits within the county increases, and the proportion of hospitalizations decreases. The hospitals visited are mainly secondary hospitals, township health hospitals and community health service centers, and the medical expenditure is relatively high. These phenomena are different among disability conditions. Conclusion:The behavior of people with disabilities was remarkably improved after Health Poverty Alleviation. In the future, we should consolidate the achievements of Health Poverty Alleviation, increase the prevention of chronic diseases for people with disabilities, and further improve the accessibility of medical services and the level of medical security for people with disabilities.

Preliminary study on the collaborative development of drug clinical trial institutions and Contract Research Organizations from the perspective of "government-application-industry-academia-research" / 中华医学科研管理杂志

Objective:To explore the collaborative development of drug clinical trial institutions and Contract Research Organizations from the perspective of " government-application-industry-academia-research" , and facilitate faster and better conducting of clinical trials.Methods:Based the combination of literature review and the working practice in drug clinical trial management, problems existed during the implementation of clinical trials were summarized, and then the collaborative development of drug clinical trial institutions and Contract Research Organizations were discussed from the perspective of " government-application-industry-academia-research" partnership.Results:Problems identified during the implementation of clinical trials including uneven capacity of CROs, lack of effective supervision department and insufficient cooperation with clinical trial institutions, which resulted difficulties in sharing clinical trial resources and also negatively impacted the quality of clinical trials. Some proposals were offered in this article, including making good use of the " visible hand" of the government to strengthen the supervision of CROs, accelerating the construction of innovation alliance between clinical trial institutions and CROs, establishing the incentive mechanism of collaborative development and the talent team construction, strengthening the personnel professional training.Conclusions:The application of " government-application-industry-academia-research" model in clinical trials would promote the collaboration between drug clinical trial institutions and Contract Research Organizations, which play important roles in the development of clinical trials.