我国基础与临床医学创新体系建设研究

本文是中国工程院"我国全民健康与医药卫生事业发展战略研究"重大咨询项目子课题"我国基础与临床医学研究创新体系"的系统总结。研究围绕全民健康与医药卫生事业国家发展战略需求,深入分析了世界主要国家医学研究管理及体系建设情况,探讨了制约我国医学科技创新发展的瓶颈问题,提出了加强医学研究顶层设计、重构医学研究体系、加大经费投入、完善评价制度、整合共享医学科技资源、加速推动成果转化的对策建议。     

卷首语

<正>健康是促进人的全面发展的必然要求,是经济社会发展的基础条件,是国家富强和民族昌盛的重要标志,也是广大人民群众的共同追求。新中国成立后,特别是改革开放以来,我国全民健康与医药卫生事业取得举世瞩目的成就,医疗卫生服务体系不断完善,公共卫生服务和疾病防控能力显著增强,人民健康水平和身体素质持续提高。同时,随着我国社会经济高速发展,工业化、城镇化进程加快,生态环境、人口结构、生活方式改变,导致疾病谱发生了广泛、深刻、急剧的变化,患病人群数量巨大,人民群众"看病难,看病贵"的形势尚未得到根本解决,我国全民健康与医药卫生事业发展面临着严峻挑战。     

全民健康和医药卫生教育及法规体系研究

我国医药卫生体制改革取得重大进展,但在全民健康教育、卫生人才培养及卫生法律体系建设等方面仍存在巨大挑战。本文总结国内外已有经验,分析我国全民健康和医药卫生教育及法规体系现状和面临的挑战,提出了完善全民健康和医药卫生教育及法规体系的政策建议:构建全民健康教育体系,加强全民健康教育的强制性;根据社会需求培养适宜卫生人才,加强全科医生培养,提高基层医疗卫生服务水平和可及性;尽快推动医药卫生"母法"的出台,并对现行医药卫生相关的法律、规章和规范性文件进行梳理和修订。     

医疗器械与新型穿戴式医疗设备的发展战略研究

医疗器械领域涉及国计民生,发展潜力巨大,但我国医疗器械产业中低端产品较多,高端产品缺乏原创性,发展面临重重困难和挑战。作为快速增长的新兴技术领域,发展新型穿戴式医疗设备具有重要意义。为此,中国工程院启动了"我国全民健康与医药卫生事业发展战略研究"重大咨询项目,其中"医疗器械与新型穿戴式医疗设备的发展战略研究"作为八个重点课题之一,围绕医疗器械与新型穿戴式医疗设备的发展现状和战略需求,研究我国医疗器械产业与新型穿戴式医疗设备领域的现状及特点,分析我国医疗器械国产化与新型穿戴式医疗设备领域健康发展的关键问题,研究该领域的相关政策,理清我国医疗器械发展过程中的重点问题、需求、已有优势和特点,并在此基础上提出了对策建议。     

中国社区体育存在的问题和发展途径

社区体育是我国群众体育和实施全民健身计划的重要载体,是有效地促进社区每一位公民健康的主要组织形式,社区体育的开展状况及其持续发展将直接影响国民的身心健康。通过分析我国社区体育的特点及其发展过程中存在的问题,为进一步完善和发展我国社区体育提供对策和方法。     

筑质量大堤 保民生和谐——江西各地质量月活动剪影

每年集中一段时间、确定一个主题,围绕实现国民经济发展目标,动员和组织社会各方面力量,采取多种形式开展"质量月"活动,对提高全民质量意识,推动质量振兴事业,促进国民经济健康发展,有着重要的现实意义。     

浅析第三次全国文物普查现实意义与实施情况

通过“三普”工怍的开展,我国文物保护工作得到很好的发展,但由于文物保护工作复杂性、系统性,文物保护还存在诸多的挑战,各级政府职能部门以及每一个公民应自觉地参与到文物保护工作中去,这是确保文物保护事业健康发展的关键,也是促进我国文化事业大繁荣、大发展的重要环节。本文首先分析了第三次全国文物普查工作的现实意义,进而探讨了在实施过程中遇到的问题和解决对策。     

中国工程科技医药卫生与人口健康领域2035技术预见研究

为了把握医药卫生和人口健康领域国内外技术发展趋势,适应国家重大战略需求,开展未来20年我国医药卫生和人口健康领域关键技术预见,旨在促进我国居民健康及经济、社会发展。以国内外现有技术预见成果、文献计量和专利分析等为基础,提出备选技术需求清单,向领域内科技专家和产业专家进行德尔菲问卷调查。根据问卷调查结果,结合专家研判,提出了面向2035年我国工程科技医药卫生和人口健康领域的前10项重要关键技术、重要共性技术和重要颠覆性技术,分析了关键技术的实现时间、发展水平和制约因素,为医药卫生和人口健康领域重大工程建设提供了科学依据。     

浅议公民社会的兴起对我国政府行政模式的影响

中国公民社会的兴起,是中国社会整体进步的重要表现,它不仅有助于推进我国特色的民主政治和政治文明进程,而且也有助于市场经济的健康发展。我国各级政府要真正发挥公民社会的作用,就需要地方政府要在社会发展过程中,根据市场经济发展的需要,有一个明确的定位。这个定位就是我国政府应该转变政府以往的行政模式,从管理走向“善治”,充分发挥公民社会的作用,促进政府和公民社会合作,有效地发挥政府治理的作用。     

边疆民族地域现代体育开展现状——以广西德保篮球运动为例

广大边疆民族地区的人们对现代体育的期望和参与通过全民健身工程来实现，促进了体育文化的发展。德保县篮球运动开展模式成为边疆民族地区全民健身事业中的一大亮点，传统与现代共融l对少数民族体育文化走向全国，走出中国搭建了一个良好的交流平台。     

Blockchain application in healthcare service mode based on Health Data Bank

Blockchain is commonly considered a potential disruptive technology. Moreover, the healthcare industry has experienced rapid growth in the adoption of health information technology, such as electronic health records and electronic medical records. To guarantee data privacy and data security as well as to harness the value of health data, the concept of Health Data Bank (HDB) is proposed. In this study, HDB is defined as an integrated health data service institution, which bears no “ownership” of health data and operates health data under the principal–agent model. This study first comprehensively reviews the main characters of blockchain and identifies the blockchain-based healthcare industry projects and startups in the areas of health insurance, pharmacy, and medical treatment. Then, we analyze the fundamental principles of HDB and point out four challenges faced by HDB’s sustainable development: (1) privacy protection and interoperability of health data; (2) data rights; (3) health data supervision; (4) and willingness to share health data. We also analyze the important benefits of blockchain adoption in HDB. Furthermore, three application scenarios including distributed storage of health data, smart-contract-based healthcare service mode, and consensus-algorithm-based incentive policy are proposed to shed light on HDB-based healthcare service mode. In the end, this study offers insights into potential research directions and challenges.     

Health information technologies for patients with diabetes

Patients with chronic illnesses, such as diabetes, need daily care and follow-up beyond occasional visits to healthcare providers. Research has shown that overcoming a multifaceted illness, such as diabetes, requires patients to be engaged in the monitoring and management of their own health. Health information technology (HIT) has been shown to empower chronically-ill patients to take charge of their healthcare, and alleviate their daily frustrations while they strive to lead a normal life. In this paper, we surveyed 31 patients with diabetes to identify the major frustrations they experience daily, examine the role of HIT in their current treatment, and identify gaps in their current care and education that, if addressed, could improve their quality of life. Themes identified in our survey results include a lack of interaction with healthcare providers, difficulties in scheduling appointments, a lack of timely communication with healthcare providers, and challenges in managing the complex care of diabetes. The contributions of this paper include a detailed set of recommendations on how HIT can be utilized to help chronically-ill patients live a better life despite their illnesses, with a particular emphasis on diabetes care and management.     

Artificial Intelligence-Enabled Chatbots in Mental Health: A Systematic Review

Clinical applications of Artificial Intelligence (AI) for mental health care have experienced a meteoric rise in the past few years. AI-enabled chatbot software and applications have been administering significant medical treatments that were previously only available from experienced and competent healthcare professionals. Such initiatives, which range from “virtual psychiatrists” to “social robots” in mental health, strive to improve nursing performance and cost management, as well as meeting the mental health needs of vulnerable and underserved populations. Nevertheless, there is still a substantial gap between recent progress in AI mental health and the widespread use of these solutions by healthcare practitioners in clinical settings. Furthermore, treatments are frequently developed without clear ethical concerns. While AI-enabled solutions show promise in the realm of mental health, further research is needed to address the ethical and social aspects of these technologies, as well as to establish efficient research and medical practices in this innovative sector. Moreover, the current relevant literature still lacks a formal and objective review that specifically focuses on research questions from both developers and psychiatrists in AI-enabled chatbot-psychologists development. Taking into account all the problems outlined in this study, we conducted a systematic review of AI-enabled chatbots in mental healthcare that could cover some issues concerning psychotherapy and artificial intelligence. In this systematic review, we put five research questions related to technologies in chatbot development, psychological disorders that can be treated by using chatbots, types of therapies that are enabled in chatbots, machine learning models and techniques in chatbot psychologists, as well as ethical challenges.     

Deletion and Recovery Scheme of Electronic Health Records Based on Medical Certificate Blockchain

The trusted sharing of Electronic Health Records (EHRs) can realize the efficient use of medical data resources. Generally speaking, EHRs are widely used in blockchain-based medical data platforms. EHRs are valuable private assets of patients, and the ownership belongs to patients. While recent research has shown that patients can freely and effectively delete the EHRs stored in hospitals, it does not address the challenge of record sharing when patients revisit doctors. In order to solve this problem, this paper proposes a deletion and recovery scheme of EHRs based on Medical Certificate Blockchain. This paper uses cross-chain technology to connect the Medical Certificate Blockchain and the Hospital Blockchain to realize the recovery of deleted EHRs. At the same time, this paper uses the Medical Certificate Blockchain and the InterPlanetary File System (IPFS) to store Personal Health Records, which are generated by patients visiting different medical institutions. In addition, this paper also combines digital watermarking technology to ensure the authenticity of the restored electronic medical records. Under the combined effect of blockchain technology and digital watermarking, our proposal will not be affected by any other rights throughout the process. System analysis and security analysis illustrate the completeness and feasibility of the scheme.     

健康管理的现状与发展策略

本文以文献研究为基础,通过选取江苏、浙江、上海三地有代表性的社区卫生服务中心、企业、健康保险公司以及健康管理服务机构共17家单位开展了调研,结果发现我国在开展健康管理过程中存在一些问题,如社区卫生服务中心无论在人员配备上还是服务内容上都与有效的健康管理服务存在差距;企业具有开展健康管理的意愿,外资企业与大型国企都已经开展了有益的尝试并取得了不错的效果,国内中小型企业、公司缺乏独立开展职工健康管理的能力;健康保险公司由于缺乏盈利模式大多不愿意开展健康险服务,健康管理多作为附加选项服务于高端客户;健康管理服务公司的业务以体检为主,大多并没有开展真正意义上的健康管理。针对这些问题课题组提出了八个相关的政策建议及相应的对策。     

Health technology diffusion: Case of remote patient monitoring (RPM) for the care of senior population

Increase in population is causing further increase in senior population which is the major cost factor in health care. Health information technology has been cited as one of the tools to help reduce this cost for this group of patients. Therefore, our study explores strategies and policies helping reduce the barriers for the adoption of a health information technology – teleconsultation – for senior population. The objective of this research is to develop a model to evaluate alternative solutions to increase the adoption of Remote Patient Monitoring (RPM) for the senior population. The research leverages hierarchical decision modeling (HDM) to build a hierarchical multi criteria assessment model. The model elements are derived through literature and validated by an expert panel.     

Current performance and future trends in health care sciences and services research

Health care sciences and services research (HCSSR) has come to the fore in recent years and related research literature increased rapidly over the last few decades. The main purpose of this study is to describe the global progress and to determine the current trends on HCSSR by using a scientometrics approach to survey related literature in the Web of Science database from 1900 to 2012. The document types, languages, publication patterns, subject categories, journals, geographic and institutional distributions, top cited articles, and the distribution of keywords were thoroughly examined. The results show that HCSSR has increased rapidly over the past 20 years, most notably in the last decade. In total, there are currently 128,728 research articles in 156 journals listed in 39 WoS subject categories. The top 20 most productive countries, and institutions were analyzed in detail, and 11 frequently cited papers and research foci were identified based on citation analysis. HCSSR spans many disciplines and focuses mainly on public, environmental & occupational health and education educational research. Medical Care, Academic Medicine, Health Affairs and Journal of School Health are the core journals with both high quantity and quality. High-income countries make up the leading nations, especially G7 countries. Meanwhile, “emerging economies” are also increasingly engaging this field. American and Canadian institutions have made greater advances in productions, citations, and cooperation, with stronger and better development prospects overall. The hot topics include internet use and decision making in health care, palliative care and end of life research, health status and quality of life, quality of healthcare and patient’s satisfaction, medical education, and health communication. Also, most researchers tend to study health care sciences based on the topics of quality-of-life assessment, and their interest in quality-of-life measures has increased. Increasing attention has been paid to the developing countries, especially “emerging economies” like China. Although health research has made much progress, many questions still remain unanswered and there are few assessments of how well research systems carry out their essential functions. Hence, there is currently an urgent need for timely establishment of an effective health research system.     

社区健康服务中心预防保健服务的预约策略

社区健康服务中心主要提供综合性预防保健服务，不仅可以节约医疗资源，也能较好地满足居民对卫生保健的需求，有效的预防可以提高居民的生活质量。从预约的角度探讨这类服务的运营策略，分析运营商的收益，综合考虑居民会取消预约和爽约的情形，建立收益模型，给出求解方法，并通过数值仿真的形式求解不同参数设置下的动态运营方案。数值仿真分析结果表明，存在爽约的情形下运营商会优先选择为预约的居民分配更多的服务容量，且在不同的爽约概率情形下均有最优预约方案可以选择。在同时考虑取消预约和爽约时，运营商可以通过适当调整服务单价来提高居民的满意度和参与度。研究结果为这类服务后续搭建运营预约系统提供理论依据和现实参考。     

Tracing the wider impacts of biomedical research: a literature search to develop a novel citation categorisation technique

There is an increasing need both to understand the translation of biomedical research into improved healthcare and to assess the range of wider impacts from health research such as improved health policies, health practices and healthcare. Conducting such assessments is complex and new methods are being sought. Our new approach involves several steps. First, we developed a qualitative citation analysis technique to apply to biomedical research in order to assess the contribution that individual papers made to further research. Second, using this method, we then proposed to trace the citations to the original research through a series of generations of citing papers. Third, we aimed eventually to assess the wider impacts of the various generations. This article describes our comprehensive literature search to inform the new technique. We searched various databases, specific bibliometrics journals and the bibliographies of key papers. After excluding irrelevant papers we reviewed those remaining for either general or specific details that could inform development of our new technique. Various characteristics of citations were identified that had been found to predict their importance to the citing paper including the citation??s location; number of citation occasions and whether the author(s) of the cited paper were named within the citing paper. We combined these objective characteristics with subjective approaches also identified from the literature search to develop a citation categorisation technique that would allow us to achieve the first of the steps above, i.e., being able routinely to assess the contribution that individual papers make to further research.