目的:利用从泡菜中分离的一株植物乳杆菌制备发酵乳并研究其降血脂功能.方法:采用该植物乳杆菌混合市售发酵剂制备发酵乳,发酵剂与植物乳杆菌接种量分别为0.05％ (V/V)和2％(V/V),发酵温度为37℃,时间14 h.采用高血脂模型小鼠研究发酵乳的降血脂功能,将30只小鼠随机分成正常组、对照组和发酵乳组3组,正常组喂基础饲料,对照组和发酵乳组喂高脂饲料,正常组和对照组灌胃生理盐水,发酵乳组灌胃发酵乳,正常组和对照组小鼠饲养14d后采血,检测血清中的TC、TG含量,小鼠饲养28 d后,测定血清中的TC、TG、LDL-C、HDL-C含量以及肝脏中的TC、TG含量.结果表明:所得发酵乳具有清香、口感好的特点;动物实验显示,小鼠饲养14 d后,与正常组相比,对照组血清中的TC、TG含量显著升高(p＜0.05),表明高脂模型诱导成功;28 d后,发酵组小鼠血清和肝脏中的总胆固醇(TC)、甘油三酯(TG)与对照组相比显著降低(p＜0.05).微生物检验结果表明,肝脏中没有发现乳酸菌,发酵乳在小鼠体内不会发生肝肠易位现象.结论:含有植物乳杆菌的发酵乳对高脂小鼠具有一定的降血脂功能,可以使小鼠血清和肝脏中的总胆固醇(TC)、甘油三酯(TG)显著降低(p＜0.05).

The "control handles"( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

Objective To examine the occupational stability,training needs and capacity building requirements of the general practitioners purposely trained to work in rural communities,for improvement of policies regarding their training and issues related. Methods There counties were selected by stratified random sampling, where general practitioners graduated from such training completed an anonymous questionnaire. Focus group interviews were made to officials of the local Health and Family Planning Commission,those of primary healthcare institutions,and general practitioners themselves. Results The of the 190 valid questionnaires recovered, male accounted for 34. 2% and female 65. 8%. These general practitioners were mostly satisfied with their working environment, social status, work stress and job achievement,yet with lower satisfaction with their salary and availability of medical devices. Consideration of resignation was reported by only 5. 3% of them,with more males than females. As high as 63. 2% of them prefer to work in hospitals of county level. 91. 1% of them held it as necessary to participate in standard resident training,and 98. 4% held it as necessary to have on-job training. 94. 7% of them have participated in further education to gain a bachelor degree in medicine. Conclusions These doctors were found with high stability to work in rural communities and low turnover intention. Further studies are required to encourage these general practitioners to serve rural communities in a long term, and to improve the standard resident training mechanism,and their career development.

Objective To explore the economic performance after the performance‐based reform at primary medical institutions in Zhejiang Province and put forward measures for improving primary medical services .Methods Questionnaire investigation was conducted among 84 primary medical institutions with staff over 20 .The financial statements of these institutions during 2009‐2014 were collected and studied as well .Results The average outpatients and emergency patients in 2014 increased 113.3% than that in 2009 .The total usage times of laboratory tests and other auxiliary examinations also increased(55.7% and 103.1% ,respectively ) ,yet with a decrease of inpatients.Moreover ,the proportion of income from traditional Chinese medicine (TCM )in gross income increased from 9.39% in 2009 to 17.14% in 2014 .The cost‐profit ratio of TCM drugs at half of such institutions exceeded 120% . Conclusions The performance‐based reform has motivated medical staffs of primary medical institutions and effectively vitalized such institutions.Rules and regulations of these institutions require further improvement .

目的 了解基层医疗机构医生对绩效考核工资制度的评价及其影响因素.方法 随机抽取浙江省不同经济发展水平的27家基层医疗机构的579名医生进行问卷调查,应用logistic回归分析影响因素.结果 反映比较突出的问题为:(1)工资总额核定标准较低,总量封顶.(2)公共卫生经费纳入绩效工资总额.(3)绩效工资缺乏增长机制.在不同人群中,男性、本科及以上、在编职工和临床专业医师认为存在问题较严重.结论 基层医疗机构的岗位绩效考核制度有待完善,制定考核方案时应考虑各岗位的职责特征.

Objective To learn the main problems of performance salary system in primary healthcare institutions after the implement of recent performance salary system guiding opinion in Zhejiang Province.Methods Purposive sampling method was used to separately select 2 counties from high,average and poor economic level regions in Zhejiang Province. Questionnaire survey was conducted among 100 leaders of 84 primary healthcare institutions which the number of staffs is larger than 20.The survey contents included demographic characteristics and the assessment of performance appraisal and performance salary system,which embraced workload,the change of work income and enthusiasm,the incentive function, component ratio and existing problem of performance salary system.Results The average income general increased, however,the staffs working enthusiasm should be further improved.Some problems still exist,such as the public health funds were brought into the total performance salary,and the gross payroll levels were low as well as the performance salary was lack of increasing mechanism.The TCM was the prior development business and contribute most to the revenue and expenditure surplus of primary healthcare institutions.Conclusion The performance salary system should be further improved and the operating effect evaluation in phases and stages should be developed.The decoction pieces should be selled without added profit,and the service ability of primary traditional Chinese medicine should be further strengthened.

目的：了解浙江省基层临床医生工作现状。方法采用问卷方式对浙江省基层临床医生工作现状进行问卷调查。结果基层临床医生学历层次大专为主（60.3%），职称以中级以下为主（80.6%），月收入以3000元以下为主（59.4%）；对医院工作环境表示“一般”；在工作认同感、付出与回报等值、是否得到重视等方面，大多数被调查者持“一般”态度；在离职意愿方面，63.2%的调查者产生过离开本单位的想法。结论基层临床医生学历、职称、收入都较低，同时对工作各方面满意程度为“一般”，应提高他们收入待遇，完善绩效考核制度、创造良好工作环境，提升内部管理。

分析浙江省家庭医生签约服务存在的问题，如全科医生队伍建设滞后、信息化程度不高等，提出分阶段推进浙江省家庭医生制度等建议。

浙江省基层医疗卫生机构的绩效管理制度已经全面实施并取得了一定的成效,但仍存在一些问题,建议进一步加大政府投入,提高基层医疗卫生机构医务人员绩效工资的总体水平;引进第三方考核机制,完善绩效考评体系;建立完善医疗分级就诊制度,对基层医疗卫生机构按照执业能力和水平进行分级管理;引进医疗保险机制,用保险机构的监督促进基层医疗卫生机构的公共服务职能最大化.

在调研卫生监督专业就业岗位需要的基础上，按照卫生检测机构的岗位标准，调整与完善专业实验（实训）项目，自编实验（实训）教材，制订校内实验技能考核标准和具体实施方案，构筑完善的卫生监测实训体系和考核体系，提高学生的职业能力和就业竞争力。

Objective] To lay the foundation for further improve talent training scheme in health supervision major .[Method] On the basis of literature research ,questionnaire method is adopted to investigate the 21 health testing organizations .[ Result] The demand is mainly in undergraduate and there is also demand for college students .The main job tasks in health testing com-pany are occupational hazard evaluation project ,occupational hazards scene detection and sample collection ,sample testing and collection for public places and water ,and so on .The main job knowledge and ability are preventive medicine and public health basic theory ,sampling and testing of hazards in workplace ,occupational hazard evaluation project ,and so on .The main cours-es are occupational health and occupational medicine ,environmental monitoring and evaluation ,environmental health ,health regulations and standards health toxicology , and so on . [Conclusion ] Degree level should be raised as soon as possible for health supervision major .It is important to revise training plan and improve the teaching system .

目的：了解浙江省“订单式”社区临床医生职业稳定性情况，提出相应建议。方法自行设计问卷对浙江省“订单式”社区临床医生进行现场自填式问卷调查。结果“订单式”社区临床医生总体满意度一般，对医患关系、付出与回报和医院管理3方面评分较低。结论应采取有效措施缓和医患关系以及采取科学的绩效考核制度，提升社区临床医生的福利待遇。

社会分层一直以来是社会学研究的重要论题,近年来,已有不少研究者从理论和实践层面剖析了不同社会分层群体之间存在的卫生公平性差异,并试图解释其差异产生的根源。文章通过文献评阅,从社会分层的划分标准、卫生公平性的内涵、不同社会分层的卫生公平性差异、社会分层影响健康公平性的主要通道和机制等四个方面介绍了该领域的研究进展,从而为不同社会分层的卫生公平性研究的实证调查奠定基础。

Objective To summarize the financing conditions of new rural cooperative medical system in Zhejiang from 2003 to 2010,and to provide information for further decision making.Methods The statistical tables and data about new rural cooperative medical system in Zhejiang from 2003 to 2010 were analyzed.Results The financing level of new rural cooperative medical system has increased greatly.Conclusion Measures should be taken to improve the funding situation,such as to widen the funding collection approaches,to increase funding offered by government,and to encourage farmers' positive contribution.

乡镇卫生院是三级卫生服务网的枢纽,在公共卫生事业中扮演着非常关键的角色.新医改文件中,明确规定了乡镇卫生院的职责:负责提供公共卫生服务和常见病、多发病的诊疗等综合服务,并承担对村卫生室的业务管理和技术指导[1].因此,必须明确乡镇卫生院公共卫生服务的职责和范围,尤其是经济发达地区的乡镇卫生院.经济发达地区的乡镇卫生院的公共卫生服务需要符合和谐社会的发展目标,适应发达地区社会经济发展水平,因此,要具有一定前瞻性,同时要紧扣我国新医改精神。

Objective To explore the standard of health manpower allocation for the well-off township hospitals in line with the direction of the new medical reform.Methods A two-round Delphi consultation was used to get the standards among 18 experts.Results The experts'average length of service in related fields was 23.28±10.41 years.The positivity coefficients of the two-round experts were 100%.Kendall's coefficients of the two-round consultation were 0.833 and 0.884(p0.001) and opinions among experts became consistent and the consultation had achieved the need of forecast.The experts suggested the standard allocation of human resources in each well-off township hospital be 25.4 per 10,000 resident population,and health technicians with senior professional titles be 44% and more,and tertiary and higher education be 88% and more.Conclusion The standard allocation of human resources can meet the requirements of new function orientation,and proposes new targets of primary health teams for economically developed areas.

Educational practice in school training base is an important way to develop professional ability in vocational education.Primary public health training base of Zhejiang Medical College is one of the vocational demonstration training bases in Zhejiang Province.Since being founded,the base strengthened the role of professional construction support through the rational distribution and strengthens the software and hardware improvement,actively carried out school-enterprise cooperation,scientific research and social services.The base gradually became a training base combining the functions of teaching,research,training,technique accreditation and technology services into one,so that the base could fully play the exemplary and leading role.This article describes the experience and thinking of the primary public health training base construction,in order to provide reference for other domestic institutions construction multifunction training base.

Objective To know about the infrastructure status quo of township hospitals in Zhejiang developed regions,and to provide the scientific basis for research group to plan developed township hospital.Methods Questionnaire survey was adopted.Results For each township hospital in Zhejiang developed regions,there were 6546 square meters of construction area,and 5321 square meters of business housing area,1169 square meters of construction area and 946 square meters of business housing area for every 10 000 population,0.61 bed for every thousand of population,15.17 medical equipment which cost more than 50 thousand yuan.The possession rate of color Doppler ultrasound equipment,DR,ECG equipment and conventional test equipment was 100% while that of colonoscope was the lowest,5.7%.Conclusion Reasonable construction scale,rational plan of the number of beds,and rational allotment of medica1 equipment are necessary.