At present, the implementation of Internet hospitals is still hampered by the double digital divide between doctors and patients. In order to develop Internet healthcare better, a Grade-A tertiary hospital has implemented digital governance for traditional healthcare system. The healthcare service chain has been reshaped by integrating online and offline health services and using multi-subject synergy and government-driven logic. Information barriers were broken down by strengthening hospital′s top-level design and implementing personalized follow-up visits for specialized diseases and live broadcast of health education. By establishing cross-regional specialist alliances and medical consortia oriented to patient needs, the time and space limitations of medical resources have been broken through. Digital governance practices have realized the two-way bridging of digital divide between doctors and patients, expanded the new mode of digital healthcare, and provided reference for the sustainable development of Internet hospitals.

目的 探讨负性生活事件、反刍和睡眠质量对病区护士情绪状态的影响路径,为减少负性生活事件、反刍和睡眠质量对情绪状态的不良影响提供决策依据.方法 采用广泛性焦虑量表(GAD-7)、抑郁症筛查量表(PHQ-9)、反刍量表(RRS)、匹兹堡睡眠质量指数(PSQI)和生活事件量表对某三级甲等综合医院850名病区护士进行问卷调查,采用SPSS 22.0和AMOS 21.0进行统计学分析及结构方程模型拟合.结果 焦虑、抑郁与负性生活事件、反刍和睡眠质量呈正相关(r=0.25～0.75,P<0.01),负性生活事件可以直接对情绪状态产生影响,也可以通过反刍、睡眠质量间接对情绪状态产生间接影响,其对情绪状态影响的总效应为0.34,其中直接效应为0.09,占总效应的26.47％;通过其他路径产生的间接效应为0.25,占总效应的73.53％.结论 负性生活事件、反刍和睡眠质量对其情绪状态的影响存在多条作用路径.

Objective:To investigate the middle-aged and elderly people′ willingness for family doctor service contracts and its influencing factors, and to provide feasible suggestions for the implementation and promotion of family doctor services.Methods:Stratified random sampling method was adopted to select middle-aged and elderly people aged 45 in 6 urban areas of Xuzhou city for questionnaire survey to investigate their illness, medical treatment and their willingness to contract a family doctor. The data acquired were analyzed with statistical description, univariate analysis( χ2 test), and multivariate logistic regression analysis. Results:Among the 927 valid questionnaires were recovered, 272(29.34%)of them intended to contract a family doctor, and 655(70.66%)had no such intention. Results of multivariate logistic regression showed that the influencing factors of the middle-aged and elderly people′ willingness of contracting family doctors were age, occupation, self-rated health, treatment status within two weeks, chronic diseases, referral experience and their knowledge of family physician contract system.Conclusions:Middle-aged and elderly people at large are not willing to sign up for family doctors. It is recommended to focus the publicity efforts on those who are relatively younger age, farming and healthier, enhancing their awareness of the service, and encouraging them to support the dual-referral policy. These efforts are expected to promote the coordinated progress of both dual referral and family doctor contract service, hence achieving the national coverage of the family doctor system.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的了解山东省老年医保患者住院费用情况,探讨老年医保患者住院费用影响因素,为降低老年人疾病经济负担提供依据。方法基于第五次国家卫生服务调查山东省的部分数据,选取≥60岁的老年医保住院患者1 184例,利用SPSS 17.0软件包对老年医保患者住院费用进行统计描述、聚类分析和相关分析,用Amos 21.0软件包进行影响因素路径分析。结果山东省老年医保患者人均住院费用为10 993.78元,中位数为5 000元,人均住院天数为13.77 d;聚类分析结果显示,20.8%的老年患者住院费用偏高,50.9%的患者住院费用中等,28.3%的患者住院费用较低。路径分析结果显示,住院天数、医院级别、是否手术是影响住院费用的主要因素,路径系数分别为0.435、0.374、-0.271;医院级别、居住地、婚姻状况可通过影响住院天数间接影响住院费用,间接路径系数分别为0.035、0.035、0.028。结论多种因素共同作用影响住院费用,可探索多种方式减轻老年医保住院患者的费用。</span>

Objective To learn the impact of county-level public hospital reform on the expenditure of medical insurance fund.Methods Using the difference-in-differences model to analyze the differences incurred in both hospitalization expenditure and expenditure of the fund at two county-level public hospitals.Results The reform has reduced both the drug expenditure and examination expenses per hospitalization at such hospitals at 318.5 yuan and 410.2 yuan respectively,yet with an increase of treatment expenditure of 535.6 yuan per hospitalization.No significant growth rate was incurred by the reform to the medical insurance fund.A significant difference of both hospitalization expenditure of patients and the fund was found among patients covered by different medical insurance funds.Conclusions The reform has achieved initial success at such hospitals in reducing inpatients′drug and examination expenditures.However,it is important to prevent from the treatment expenditure from an "offset increase";to further reform the payment modes for safety of the fund,to remove the differentiation found in the existing medical insurance system,and leverage the regulating role of various medical insurance funds on medical service behaviors and expenditures.

目的 了解山东省农村学龄前留守儿童的心理健康状况,评价干预效果,为促进学龄前留守儿童心理健康提供依据.方法 采用随机整群抽样的方法,抽取山东省2个县/区的10个乡镇幼儿园共计735例儿童作为调查对象,使用长处和困难问卷(Strength and Difficulty Questionnaire,SDQ)(家长版)进行心理测量,将受试对象分为干预组和对照组,综合干预1年后,再次对受试对象进行心理状况测量.结果 留守儿童在品行问题、多动问题、困难总分上的评分高于非留守儿童;综合干预1年后,留守儿童SDQ各项因子异常检出率均有下降(P<0.05),监护类型为母亲和祖父母的留守儿童SDQ各项因子得分也均有下降,监护类型为外祖父母的留守儿童干预前后SDQ各项因子评分差异无统计学意义(P>0.05).结论 留守儿童心理健康状况较差,适当干预可有效改善学龄前留守儿童心理健康状况;母亲和祖父母监护的留守儿童干预效果比外祖父母监护的效果好.

Objective To learn the emergency response capacity of health authorities at city level in Shandong province in order to discover loopholes and make improvement. Methods The health emergency questionnaire designed by China Health and Family Planning Commission was used for survey of 1 7 city-level health authorities in Shandong province.Results 52.94% of the health authorities were found with health emergency reserve funding; 100.00% of them with public health emergency contingency plans;94.12% of them having health emergency supplies in kind;100.00% of them having health emergency training for all of the staff;100.00% of them with direct web reporting for public health emergency.Conclusion Such authorities were found with satisfactory health emergency capacity in general.Defects were found with emergency funding shortage,poor training and drilling outcomes, poor material reserves management,and insufficient health emergency personnel.

复杂适应系统理论早期应用于经济学、心理学、生物学、控制论、人类学和自然科学等学科.近年来逐渐应用在社会学和、管理学等学科.通过对复杂适应系统基本概念特征以及国际上在卫生领域应用的回顾,旨在于促进该理论模型在我国的发展和研究,为我国卫生领域更好的发展提供启示和借鉴.

Objective Through analyzing data from the China Household Finance Survey (CHFS),this dissertation ex-plores what factors influence participation in medical insurance among internal migrants in China.Methods Basis on medical insurance demand theory,using labor value factors and individual characteristic factors as independent varia-bles,whether or not participating in medical insurance as the dependent variable,medical insurance model of the mi-grant population was establish and then the data were analyzed using logistic regression.Results The medical insur-ance participating rates of migrants was 69.85%.Labor value factors such as educations degree,professional types, professional title,daily working time and income level were significant influence factors of the migrant population to participate in medical insurance(P <0.05).Individual characteristic factors such as living time,health level,number of brothers and sisters,were significant influence factors of the migrant population to participate in medical insurance(P<0.05).Conclusion Labor value factors and individual characteristic factors influence migrant population participat-ing in medical insurance among internal migrants in China.In order to promote the migrant population to participate in medical insurance,we should increase the propaganda dynamics and strengthen supervision.

Left- behind children are lack of family education,psychological sensitive,school education,and the imbalance of the medical information resources,thus they have poor physical and mental development at present.This study focuses on analysis of rural left- behind children's physical and mental development present situation and its causes and solutions of ethics.Several suggestions were given to improve this issue such as childrens guardians should update education concept,improve various aspects education skills.Should construct the rural family education support system,let the left- behind children's guardians aware of the dangers of dysplasia of body and mind;establish various forms of left- behind children protection network,the formation of family,school,society triple protection mechanism;establish and perfect for left-behind children's medical insurance system;improve their childrens early education.