农村西医卫生适宜技术的系统评价和需求分析
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摘要
医学技术水平的不断提高使人类抵抗疾病风险的能力不断增强,同时,提供当地需求、安全、有效、经济、医患双方可接受、符合社会伦理道德要求的卫生适宜技术日益被社会所关注。2008年,《卫生部关于加强适宜卫生技术推广工作的指导意见》中指出“坚持依靠卫生科学技术进步,研究农村卫生适宜技术需求,加强面向农村的卫生适宜技术推广工作,是全面贯彻我国卫生和科技工作方针,促进卫生科技成果转化,发展农村卫生服务的重要内容和关键环节,是提高基层医疗卫生技术水平和服务能力的重要措施。”2009年,卫生部新医改方案中明确强调“基层医疗卫生机构要使用适宜技术、适宜设备和基本药物,大力推广包括民族医药在内的中医药,为城乡居民提供安全有效和低成本服务。”因此,分析卫生适宜技术需求、评价卫生适宜技术临床效果对于了解农村居民卫生服务需求,筛选推广卫生适宜技术,发展基层卫生工作具有重要意义。
目的：是评价卫生部第二轮“十年百项计划”第5-7批西医卫生适宜技术的临床效果；分析河南、宁夏2省农村地区的西医卫生适宜技术需求。
方法：采用系统评价方法评价第5-7批西医卫生适宜技术的临床效果；采用访谈和问卷调查的方式分析西医卫生适宜技术需求,共调查河南省长葛、新密以及宁夏回族自治区青铜峡、中宁2省4县19个乡镇、230名县级医院医生、144名乡镇卫生院医生,248名村医。定性资料主要采用描述性分析,定量资料采用的统计分析方法包括t检验、χ2验、Meta分析。
主要结果：
(1)卫生部第5-7批西医卫生适宜技术系统评价结果显示,技术效果评价缺少足够的文献支持并且纳入文献的质量等级较低,其中23项技术纳入的文献数量低于5篇,28项技术的纳入文献中质量等级评定为“A”的文献数量为0,只有1项技术的结论强度评定为“强”。
(2)两省常见病及诊治困难疾病均以常见慢性非传染性疾病为主。在河南省,主要包括脑血管疾病、糖尿病及其并发症、胃肠道疾病(溃疡、炎症)、新生儿疾病、高血压、哮喘、恶性肿瘤、风湿性疾病、妊娠合并症、慢性盆腔器官炎症10种疾病；在宁夏自治区,主要包括心脏病、脑血管疾病、糖尿病及其并发症、新生儿疾病、腰椎间盘突出、慢性盆腔器官炎症6种疾病。
(3)河南省县乡村三级医疗机构主要需求心脏病、脑血管疾病、哮喘、新生儿窒息、慢性胃炎、糖尿病及其并发症6种疾病的治疗技术；宁夏自治区主要需求心脏病诊治技术以及慢性盆腔器官炎症的诊断技术。
(4)推广时间短、缺少配套的医疗设备及药品是制约2省已推广卫生技术扩大需求的主要影响因素；特别在宁夏地区,“药品三统一”政策限制了部分推广技术所需的药品,是医生反映比较突出的问题。在推广技术清单中,缺少针对职业病(主要包括尘肺、矽肺、职业中毒等)、精神疾病的诊治技术。
(5)影响西医卫生适宜技术需求的主要因素包括技术推广需要投入的资金、适宜技术引入对医院带来的经济效益、医务人员是否充足等。
结论与建议：
(1)增加文献数量、提高证据质量,不断完善适宜技术系统评价的结论
(2)增加心脏病、脑血管疾病等慢性非传染性疾病诊治技术种类,适当筛选纳入常见职业病和社会病的诊治技术
(3)加强医生对西医卫生适宜技术的认知,增加培训机会
(4)为西医卫生适宜技术推广提供充足的资金保障
The ability of resistance to diseases of human beings is improved due to the development of health technologies, meanwhile appropriate health technologies with the feature of local needs, safe, effective, economic, and acceptance to both parties, the respectance of health ethics are becoming important.In 2008, "Ministry of Health guidance on strengthening the promotion of Appropriate Health Technology " points "Relying on health technology, studying appropriate technology demands in rural, strengthening the promotion of appropriate health technology are important aspects and key segments for implementing the health principles, promoting health technology achievements, developping health services in rural and important measures to raise up the level and capability of primary health care. "In 2009, new medical reform plan published by the Ministry of Health clearly emphasizes "primary health institutions should use appropriate technology, appropriate equipment and essential drugs, expand to cover the national medicine including Chinese medicine greatly for the urban and rural residents with safe, effective and low cost services." Therefore, the research of appropriate health technology demands and systematic review for appropriate health technologies is important to meet the demands of rural residents and the development of primary health care.
Aims:of this research:we evaluate clinical effection of the 5th-7th appropriate health technologies and analyze appropriate western health technology demands in provinces of Henan and Ningxia.
Methods:Systematic evaluation is used to evaluate clinical effection of the 5th-7th appropriate health technologies; in order to research health technology demands, we surveyed 4 countries,19 towns,230 doctors from country hospicals,144 doctors from town hospicals,248village doctors through interview and stratified random sampling in Henan and Ningxia. Survey information is consisted of qualitative and quantitative data, including discriptive analysis, t test,χ2 test and Meta analysis.
Key findings:
(1) Through systematic evaluation on 5-7 western apprpriate health technologies, the relative articals were few and down grade.The artical number of 23 technologies was below 5 and no articles'quality was assessed "A". Only one techonology's conclution was affirmed to"strong"and supported promotion.
(2) Common or difficultly diagnostic (therapeutical) diseases are non-communicable chronic diseases. The disease mainly include cerebrovascular disease, diabetes and its complications, gastrointestinal disease (ulcer, inflammation), neonatal disease, hypertension, asthma, cancer, rheumatic diseases, pregnancy complications, chronic pelvic inflammatory 10 kinds of diseases in Henan; heart disease, cerebrovascular disease, diabetes and its complications, neonatal disease, lumbar disc herniation, chronic pelvic inflammation 6 kinds of diseases in Ningxia Autonomous Region.
(3) There are therapeutic technology demands in connection with heart disease, cerebravascular disease, asthma, neonatal asphyxia, chronic gestritis, diabetes and its complications in Henan; diagostic and therapeutic technology demands in connection with heart disease, diagostic technology demand in connection with gynecopathy inflammation in Ningxia.
(4) Short promoting time and lack of assorted medical equipment and medicine are the main influence factors restricting health technology demands in two provinces. Especially in Ningxia, "Unifying medicine in three aspects" policy restricts some essential medicine for generalized health technologies which is the main problem doctors reflected.There are lack of therapeutical technologies for occupational diseases and sociopath in technology lists.
(5) The main factors influencing western appropriate health technology demands include found, economic benefit, the number of doctors and so on.
Conclusions and recommendations:
(1) To increase number and improve quality of relative articals for perfect conclusion by systematic review.
(2)To increase therapeutical technologies used to chronic diseases such as heart disease, cerebrovascular disease and diagnostic and therapeutic technologies for occupational diseases and sociopath.
(3)To strength the acceptance and increase training opportunities of health appropriate technologies in doctors in rural.
(4)To provide enough fund for popularizing appropriate western health technologies.
目的：是评价卫生部第二轮“十年百项计划”第5-7批西医卫生适宜技术的临床效果；分析河南、宁夏2省农村地区的西医卫生适宜技术需求。
方法：采用系统评价方法评价第5-7批西医卫生适宜技术的临床效果；采用访谈和问卷调查的方式分析西医卫生适宜技术需求,共调查河南省长葛、新密以及宁夏回族自治区青铜峡、中宁2省4县19个乡镇、230名县级医院医生、144名乡镇卫生院医生,248名村医。定性资料主要采用描述性分析,定量资料采用的统计分析方法包括t检验、χ2验、Meta分析。
主要结果：
(1)卫生部第5-7批西医卫生适宜技术系统评价结果显示,技术效果评价缺少足够的文献支持并且纳入文献的质量等级较低,其中23项技术纳入的文献数量低于5篇,28项技术的纳入文献中质量等级评定为“A”的文献数量为0,只有1项技术的结论强度评定为“强”。
(2)两省常见病及诊治困难疾病均以常见慢性非传染性疾病为主。在河南省,主要包括脑血管疾病、糖尿病及其并发症、胃肠道疾病(溃疡、炎症)、新生儿疾病、高血压、哮喘、恶性肿瘤、风湿性疾病、妊娠合并症、慢性盆腔器官炎症10种疾病；在宁夏自治区,主要包括心脏病、脑血管疾病、糖尿病及其并发症、新生儿疾病、腰椎间盘突出、慢性盆腔器官炎症6种疾病。
(3)河南省县乡村三级医疗机构主要需求心脏病、脑血管疾病、哮喘、新生儿窒息、慢性胃炎、糖尿病及其并发症6种疾病的治疗技术；宁夏自治区主要需求心脏病诊治技术以及慢性盆腔器官炎症的诊断技术。
(4)推广时间短、缺少配套的医疗设备及药品是制约2省已推广卫生技术扩大需求的主要影响因素；特别在宁夏地区,“药品三统一”政策限制了部分推广技术所需的药品,是医生反映比较突出的问题。在推广技术清单中,缺少针对职业病(主要包括尘肺、矽肺、职业中毒等)、精神疾病的诊治技术。
(5)影响西医卫生适宜技术需求的主要因素包括技术推广需要投入的资金、适宜技术引入对医院带来的经济效益、医务人员是否充足等。
结论与建议：
(1)增加文献数量、提高证据质量,不断完善适宜技术系统评价的结论
(2)增加心脏病、脑血管疾病等慢性非传染性疾病诊治技术种类,适当筛选纳入常见职业病和社会病的诊治技术
(3)加强医生对西医卫生适宜技术的认知,增加培训机会
(4)为西医卫生适宜技术推广提供充足的资金保障
The ability of resistance to diseases of human beings is improved due to the development of health technologies, meanwhile appropriate health technologies with the feature of local needs, safe, effective, economic, and acceptance to both parties, the respectance of health ethics are becoming important.In 2008, "Ministry of Health guidance on strengthening the promotion of Appropriate Health Technology " points "Relying on health technology, studying appropriate technology demands in rural, strengthening the promotion of appropriate health technology are important aspects and key segments for implementing the health principles, promoting health technology achievements, developping health services in rural and important measures to raise up the level and capability of primary health care. "In 2009, new medical reform plan published by the Ministry of Health clearly emphasizes "primary health institutions should use appropriate technology, appropriate equipment and essential drugs, expand to cover the national medicine including Chinese medicine greatly for the urban and rural residents with safe, effective and low cost services." Therefore, the research of appropriate health technology demands and systematic review for appropriate health technologies is important to meet the demands of rural residents and the development of primary health care.
Aims:of this research:we evaluate clinical effection of the 5th-7th appropriate health technologies and analyze appropriate western health technology demands in provinces of Henan and Ningxia.
Methods:Systematic evaluation is used to evaluate clinical effection of the 5th-7th appropriate health technologies; in order to research health technology demands, we surveyed 4 countries,19 towns,230 doctors from country hospicals,144 doctors from town hospicals,248village doctors through interview and stratified random sampling in Henan and Ningxia. Survey information is consisted of qualitative and quantitative data, including discriptive analysis, t test,χ2 test and Meta analysis.
Key findings:
(1) Through systematic evaluation on 5-7 western apprpriate health technologies, the relative articals were few and down grade.The artical number of 23 technologies was below 5 and no articles'quality was assessed "A". Only one techonology's conclution was affirmed to"strong"and supported promotion.
(2) Common or difficultly diagnostic (therapeutical) diseases are non-communicable chronic diseases. The disease mainly include cerebrovascular disease, diabetes and its complications, gastrointestinal disease (ulcer, inflammation), neonatal disease, hypertension, asthma, cancer, rheumatic diseases, pregnancy complications, chronic pelvic inflammatory 10 kinds of diseases in Henan; heart disease, cerebrovascular disease, diabetes and its complications, neonatal disease, lumbar disc herniation, chronic pelvic inflammation 6 kinds of diseases in Ningxia Autonomous Region.
(3) There are therapeutic technology demands in connection with heart disease, cerebravascular disease, asthma, neonatal asphyxia, chronic gestritis, diabetes and its complications in Henan; diagostic and therapeutic technology demands in connection with heart disease, diagostic technology demand in connection with gynecopathy inflammation in Ningxia.
(4) Short promoting time and lack of assorted medical equipment and medicine are the main influence factors restricting health technology demands in two provinces. Especially in Ningxia, "Unifying medicine in three aspects" policy restricts some essential medicine for generalized health technologies which is the main problem doctors reflected.There are lack of therapeutical technologies for occupational diseases and sociopath in technology lists.
(5) The main factors influencing western appropriate health technology demands include found, economic benefit, the number of doctors and so on.
Conclusions and recommendations:
(1) To increase number and improve quality of relative articals for perfect conclusion by systematic review.
(2)To increase therapeutical technologies used to chronic diseases such as heart disease, cerebrovascular disease and diagnostic and therapeutic technologies for occupational diseases and sociopath.
(3)To strength the acceptance and increase training opportunities of health appropriate technologies in doctors in rural.
(4)To provide enough fund for popularizing appropriate western health technologies.
引文
[1]孙永波,王义明,张慧民.面对医疗技术主义的若干思考.医学与哲学,2003,24(4)：33-34.
[2]李虹.论医学技术评估.医学与哲学,1994,11：17-19.
[3]陈洁,卫生技术评估.北京人民卫生出版社,2008.
[4]张建华,郑文贵,尹爱田等.乡村医生行医现状及存在的主要问题.中国卫生事业管理,2003,4：232-234.
[5]马进,蒋飞,王春明等.我国乡村医生队伍素质现状分析.中国初级卫生保健,2003,17(8)：19-21.
[6]曹洪民,林万龙,邓娴.村级医疗卫生服务机构现状及存在的问题.农村经济,2007,9：3-5.
[7]2005年全国1%人口抽样调查主要数据公报.中华人民共和国统计局.http://www.ststs.gov.cn/tjgb.
[8]黄成华,黄钢.医疗技术管理的伦理建制.辽宁医学院报,2009,7(1)：17-20.
[9]Smoking Cessation Method.The Swedish Council on Technology assessment in health care(SBU)
[10]Back Pain-Caues,Diagnosis, Treatment. The Swedish Council on Technology assessment in health care(SBU)
[11]JACOB R, GARDNER E, THAMER M. The status of health technology assessment worldwide:results of an international survey [J]. International Journal of Technologly Assessment in Health Care,1997,13(1):81-98.
[12]于龙凤,尹爱田,宋春燕等.农村卫生适宜技术需求研究.中国卫生事业管理,2009,4：259-260.
[13]王红妹,刘盼盼,钱晓萍等.浙江省农村卫生适宜技术的供方需求调查.中国卫生事业管理,2008,11：763-765.
[14]卫生部信息统计中心.2008中国卫生服务调查研究.北京,中国协和医科大学出版社,2009：28.
[15]卫生部信息统计中心.2008年我国卫生事业发展统计公报.http://www.moh. gov.cn/publicfiles.
[16]刘克军,王梅.我国慢性病直接经济负担研究.中国卫生经济,2005,24(10)：186-188.
[17]孙荣国,曾智,饶莉.中国农村卫生适宜技术推广应用的探索.现代预防医学,2007,34(3)：570-571.
[18]王润华,刘俊,王艳等.农村中医适宜技术推广难点及对策分析.中国卫生经济,2007,26(6)：54-55.
[19]蒋健敏,杨再峰,朱炜等.农村卫生适宜技术推广应用的影响因素及对策探讨.中华医学科研管理杂志,2006,19(6)：333-335.
[20]任建萍,郭清,王红妹.浙江省农村中医适宜技术推广应用的影响因素研究.卫生经济研究,2006,12：29-30.
[21]吴跃进,熊墨年,张进等.当前农村卫生适宜技术推广存在的问题与对策.中医药管理杂志,2008,16(3)：169-171.
[22]高三友,郭金玲,林艳丽.河南农村卫生适宜技术推广应用影响因素分析.郑州大学学报(医学版),2007,42(3)：488-490.
[23]李幼平主编.循证医学.高等教育出版社,2003.14.
[24]王建华主编.实用医学研究方法.人民卫生出版社,2003.211.
[25]Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUAD AS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol,2003,3:25.
[26]QUADAS的制定：用于系统评价中评价诊断性研究质量的工具.中国循证医学杂志.2907 7(4)：296～306.
[27]Higgins JPT, Green S (editors).Cochrane Handbook for Systematic Reviews of Interventions.Version 5.0.0 [updated February 2008].The Cochrane Collaboration, 2008.Available from www.cochrane-handbook.org.
[28]何寒青,陈坤.Meta分析中的异质性检验方法.中国卫生统计,2006,23(6)：486-488.
[29]方积乾主编.卫生统计学.北京：人民卫生出版社,2004.400.
[30]王亚峰.医学技术主义与医学人道主义的对立统一.医学伦理学,2000,4：30- 31.
[31]苏振峰,翟淑君.适宜技术概念与其它技术概念之比较[J].云南科技管理,2004.4：51-52.
[32]方积乾主编.卫生统计学.北京,人民卫生出版社,2004,第5版：120.
[33]崔岚,崔景柏.细菌性阴道病及其实验室检查[J].中华现代临床医学杂志,2004,2(7)：615.
[34]王世阆.细菌性阴道病与微生态平衡.中华妇幼临床医学杂志,2005,1(1)：2.
[35]Chmm W.The relationship between bacterial vaginosis and preterm birth.Arch Gynecol Obstet.1977,259:51.
[36]周乐飞,丁雅萍,徐富珍.检测阴道分泌物诊断细菌性阴道病的2种方法对比分析.现代中西医结合杂志.2008,17(25)：4016.
[37]熊海燕,张克霞,王朔等.微生态检测在细菌性阴道病诊断中的评价.现代检验医学杂志.2008,23(1)：18-19.
[38]芦芝君.细菌性阴道病联合测定的应用价值.临床医学,2007,27(2)：72-74.
[39]王兆芬.BV三联法在细菌性阴道病诊断中的应用与评价.医学理论与实践.2008,21(3)：340-341.
[40]沈涌海,倪爱青,唐文芳.BV三项联合检测法对细菌性阴道病的诊断评价.中国卫生检验杂志.2007,17(11)：2120.
[41]蒋雁,夏郑世,叶飞君.唾液酸酶联合过氧化氢浓度测定诊断细菌性阴道病的价值.浙江预防医学,2007,19(4)：51-52.
[42]Holzman C, Leventbal JM, Qui H, et al. Factors linked to bacteria vaginosis in nonpregnant women[J]. Am J Public Health,2001,91(10):1664-1670.
[43]Calzolari E, Masciangalo R, Milite V, etal. Bacterial vaginosis and contraceptive methods. Int J Gynecol Obstet,2000,70(3):341-346.
[44]Joesoef MR, Karundeng A, Runtupalit C, et al. High rate of bacteria vagino sis among women with intrauterine devices in Manado. Indonesia[J].Contraceptio n,2001,64(3):169-172.
[45]Hellberg D, Nilsson S, Mardh PA. Bacterial vaginosis and smoking[J]. Int J STD AIDS,2000,11 (9):603-606.
[46]King EA, Britt R, McFarlane JM, et al. Bacteria vaginosis and chlamydia trachmatis among pregnant abused and nonabused Hispanic women[J]. J Obste Gynecol Neonatal Nurs,2000,29(6):606-612.
[47]Culhane JF, RauhV, McCoUum KF, et al. Maternal stress is associated with bacterial vaginosis in human pregnancy [J].Matern Child Health.2001,5(2): 127-134.
[48]HellbergD, Mogilevkinal. Mardh-PASexually transmitted diseases and gynecol ogic symptoms and signs in women with a history of induced abortion[J]. Sex Transm Dis,1999,26(4):197-200.
[49]Morris MC, Rogers PA, Kinghorn GR. Is bacterial vaginosis a sex ually transmitted infection[J]. Sex Transm Infect,2001,77(1):63-68.
[50]于普林,郑宏,苏鸿学等.中国六城市老年人前列腺增生的患病率及相关因素[J].中华流行病学杂志,2000,21(4)：276-279.
[51]刘凡,欧宗泉,李彤.经尿道前列腺电气化术和电化学治疗高龄高危前列腺增生的比较.中国现代医药杂志,2006,8(6)：67-69.
[52]张再高,丁贤,张培.电化学治疗高危前列腺增生临床观察.中华医学实践,2004,3(11)：996-997.
[53]张杰,殷毅,张孝斌等.电化学治疗良性前列腺增生实验及临床观察.中华泌尿外科杂志,2003,24(8)：552-554.
[54]尤建川,陈贵平,邹太勋.电化学治疗前列腺增生症36例.现代医药卫生,2004,20(14)：1352.
[55]祖林先,邵怀卿,杨永申等.电化学治疗前列腺增生症.中华男科学,2000,3：204-205.
[56]乔亮,王全兵.电化学治疗前列腺增生症的临床疗效观察.中国现代医学杂志,2003,13(19)：141-142.
[57]张翼,张东升,梁长春.经尿道电化学治疗高危前列腺增生合并尿潴留76例体会.河北医药,2006,28(71)：613.
[58]唐迎九,薛钧尘,王克明.经尿道电化学治疗前列腺增生症104例.现代泌尿外科杂志,2002,7(4)：230-231.
[59]程广舟,王维科,王培祥.经尿道电化学治疗前列腺增生症.临床泌尿外科杂志,2001,16(3)：126-127.
[60]宋有军.经尿道前列腺增生症电化学治疗.实用诊断与治疗杂志,2003,17(3)：215-216.
[61]余清平,张清武,刘克华.电化学治疗前列腺增生症10例报告.中华泌尿外科杂志,1999,(2).
[62]贝忠东.电化学治疗前列腺增生尿漪留12例分析.当代医学,2007,12：99.
[63]张翼,张东升,詹毓彦等.经尿道电化学治疗高危前列腺增生患者的体会.中国医药导报,2006,3(26)：65-66.
[64]薛塞峰,崔学光,张文胜等.宁夏农村卫生适宜技术推广模式探讨.中国卫生经济,2007,26(1)：55-57.
[65]陈洁主编.卫生技术评估.北京,人民卫生出版社,2008：84.
[66]马进,蒋飞,王春明等.我国乡村医生队伍素质现状分析.中国初级卫生保健,2003,17(8)：19-21.
[67]卫生部信息统计中心.2006年中国卫生事业发展情况统计公报.Http://www. moh.gov.cn/newshtml/18903.htm[2007-7-9].
[68]沈洪兵,俞顺章,徐耀初.我国糖尿病的发病变化及其经济负担研究[J].中华预防医学杂志,1998,10(9)：387-390.
[69]李艳艳,胡东生,李春阳等.农村居民糖尿病患病率及危险因素分析.中国公共卫生,2008,24(10)：1273-1275.
[70]陈娟,张光鹏.中国西部40个贫困县村卫生室费用及村医相关行为分析.中国初级卫生保健,2001,15(6)：3-4.
[71]陈坚,金稳.推行药品招标“三统一”的实践与思考.中国卫生资源,2008,11(4)：197-198.
[72]史俊庭.民工职业病亟待社会关注[N].科学时报,2005,8：23.
[73]李献云,杨荣山,张迟等.自杀未遂危险因素的病例对照研究.中华流行病学杂志,2001,22(4)：281-283.
[74]北京回龙观医院临床流行病学研究室.卫生部／WHO预防自杀讲习班”的会议报告中国心理卫生杂志,2000,14(5)：295-298.
[75]全国协作组.国内12地区精神疾病流行病学调查资料分析[J].中华神经精神科杂志,1986,19：65-68.
[76]向孟泽.农村社区精神卫生服务模式研究的总结报告.第二届中国精神康复学术会议论文集,1992,69-70.
[77]史蕴萍,王秋艳,赵桂荚等.吉林省农村卫生适宜技术推广培训情况分析.中华医学科研管理杂志,2007,20(6)：382-383.
[78]邹嘉明.关于农村卫生适宜技术推广机制的思考.中华医学科研管理杂志,2006,19(6)：329-832.
[79]刘卫平,王润华,陈永忠等.重庆市农村卫生适宜技术培训和应用效果及影响因素分析.现代预防医学,2007,34(20)：3815-3817,3820.
[2]李虹.论医学技术评估.医学与哲学,1994,11：17-19.
[3]陈洁,卫生技术评估.北京人民卫生出版社,2008.
[4]张建华,郑文贵,尹爱田等.乡村医生行医现状及存在的主要问题.中国卫生事业管理,2003,4：232-234.
[5]马进,蒋飞,王春明等.我国乡村医生队伍素质现状分析.中国初级卫生保健,2003,17(8)：19-21.
[6]曹洪民,林万龙,邓娴.村级医疗卫生服务机构现状及存在的问题.农村经济,2007,9：3-5.
[7]2005年全国1%人口抽样调查主要数据公报.中华人民共和国统计局.http://www.ststs.gov.cn/tjgb.
[8]黄成华,黄钢.医疗技术管理的伦理建制.辽宁医学院报,2009,7(1)：17-20.
[9]Smoking Cessation Method.The Swedish Council on Technology assessment in health care(SBU)
[10]Back Pain-Caues,Diagnosis, Treatment. The Swedish Council on Technology assessment in health care(SBU)
[11]JACOB R, GARDNER E, THAMER M. The status of health technology assessment worldwide:results of an international survey [J]. International Journal of Technologly Assessment in Health Care,1997,13(1):81-98.
[12]于龙凤,尹爱田,宋春燕等.农村卫生适宜技术需求研究.中国卫生事业管理,2009,4：259-260.
[13]王红妹,刘盼盼,钱晓萍等.浙江省农村卫生适宜技术的供方需求调查.中国卫生事业管理,2008,11：763-765.
[14]卫生部信息统计中心.2008中国卫生服务调查研究.北京,中国协和医科大学出版社,2009：28.
[15]卫生部信息统计中心.2008年我国卫生事业发展统计公报.http://www.moh. gov.cn/publicfiles.
[16]刘克军,王梅.我国慢性病直接经济负担研究.中国卫生经济,2005,24(10)：186-188.
[17]孙荣国,曾智,饶莉.中国农村卫生适宜技术推广应用的探索.现代预防医学,2007,34(3)：570-571.
[18]王润华,刘俊,王艳等.农村中医适宜技术推广难点及对策分析.中国卫生经济,2007,26(6)：54-55.
[19]蒋健敏,杨再峰,朱炜等.农村卫生适宜技术推广应用的影响因素及对策探讨.中华医学科研管理杂志,2006,19(6)：333-335.
[20]任建萍,郭清,王红妹.浙江省农村中医适宜技术推广应用的影响因素研究.卫生经济研究,2006,12：29-30.
[21]吴跃进,熊墨年,张进等.当前农村卫生适宜技术推广存在的问题与对策.中医药管理杂志,2008,16(3)：169-171.
[22]高三友,郭金玲,林艳丽.河南农村卫生适宜技术推广应用影响因素分析.郑州大学学报(医学版),2007,42(3)：488-490.
[23]李幼平主编.循证医学.高等教育出版社,2003.14.
[24]王建华主编.实用医学研究方法.人民卫生出版社,2003.211.
[25]Whiting P, Rutjes AW, Reitsma JB, et al. The development of QUAD AS:a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol,2003,3:25.
[26]QUADAS的制定：用于系统评价中评价诊断性研究质量的工具.中国循证医学杂志.2907 7(4)：296～306.
[27]Higgins JPT, Green S (editors).Cochrane Handbook for Systematic Reviews of Interventions.Version 5.0.0 [updated February 2008].The Cochrane Collaboration, 2008.Available from www.cochrane-handbook.org.
[28]何寒青,陈坤.Meta分析中的异质性检验方法.中国卫生统计,2006,23(6)：486-488.
[29]方积乾主编.卫生统计学.北京：人民卫生出版社,2004.400.
[30]王亚峰.医学技术主义与医学人道主义的对立统一.医学伦理学,2000,4：30- 31.
[31]苏振峰,翟淑君.适宜技术概念与其它技术概念之比较[J].云南科技管理,2004.4：51-52.
[32]方积乾主编.卫生统计学.北京,人民卫生出版社,2004,第5版：120.
[33]崔岚,崔景柏.细菌性阴道病及其实验室检查[J].中华现代临床医学杂志,2004,2(7)：615.
[34]王世阆.细菌性阴道病与微生态平衡.中华妇幼临床医学杂志,2005,1(1)：2.
[35]Chmm W.The relationship between bacterial vaginosis and preterm birth.Arch Gynecol Obstet.1977,259:51.
[36]周乐飞,丁雅萍,徐富珍.检测阴道分泌物诊断细菌性阴道病的2种方法对比分析.现代中西医结合杂志.2008,17(25)：4016.
[37]熊海燕,张克霞,王朔等.微生态检测在细菌性阴道病诊断中的评价.现代检验医学杂志.2008,23(1)：18-19.
[38]芦芝君.细菌性阴道病联合测定的应用价值.临床医学,2007,27(2)：72-74.
[39]王兆芬.BV三联法在细菌性阴道病诊断中的应用与评价.医学理论与实践.2008,21(3)：340-341.
[40]沈涌海,倪爱青,唐文芳.BV三项联合检测法对细菌性阴道病的诊断评价.中国卫生检验杂志.2007,17(11)：2120.
[41]蒋雁,夏郑世,叶飞君.唾液酸酶联合过氧化氢浓度测定诊断细菌性阴道病的价值.浙江预防医学,2007,19(4)：51-52.
[42]Holzman C, Leventbal JM, Qui H, et al. Factors linked to bacteria vaginosis in nonpregnant women[J]. Am J Public Health,2001,91(10):1664-1670.
[43]Calzolari E, Masciangalo R, Milite V, etal. Bacterial vaginosis and contraceptive methods. Int J Gynecol Obstet,2000,70(3):341-346.
[44]Joesoef MR, Karundeng A, Runtupalit C, et al. High rate of bacteria vagino sis among women with intrauterine devices in Manado. Indonesia[J].Contraceptio n,2001,64(3):169-172.
[45]Hellberg D, Nilsson S, Mardh PA. Bacterial vaginosis and smoking[J]. Int J STD AIDS,2000,11 (9):603-606.
[46]King EA, Britt R, McFarlane JM, et al. Bacteria vaginosis and chlamydia trachmatis among pregnant abused and nonabused Hispanic women[J]. J Obste Gynecol Neonatal Nurs,2000,29(6):606-612.
[47]Culhane JF, RauhV, McCoUum KF, et al. Maternal stress is associated with bacterial vaginosis in human pregnancy [J].Matern Child Health.2001,5(2): 127-134.
[48]HellbergD, Mogilevkinal. Mardh-PASexually transmitted diseases and gynecol ogic symptoms and signs in women with a history of induced abortion[J]. Sex Transm Dis,1999,26(4):197-200.
[49]Morris MC, Rogers PA, Kinghorn GR. Is bacterial vaginosis a sex ually transmitted infection[J]. Sex Transm Infect,2001,77(1):63-68.
[50]于普林,郑宏,苏鸿学等.中国六城市老年人前列腺增生的患病率及相关因素[J].中华流行病学杂志,2000,21(4)：276-279.
[51]刘凡,欧宗泉,李彤.经尿道前列腺电气化术和电化学治疗高龄高危前列腺增生的比较.中国现代医药杂志,2006,8(6)：67-69.
[52]张再高,丁贤,张培.电化学治疗高危前列腺增生临床观察.中华医学实践,2004,3(11)：996-997.
[53]张杰,殷毅,张孝斌等.电化学治疗良性前列腺增生实验及临床观察.中华泌尿外科杂志,2003,24(8)：552-554.
[54]尤建川,陈贵平,邹太勋.电化学治疗前列腺增生症36例.现代医药卫生,2004,20(14)：1352.
[55]祖林先,邵怀卿,杨永申等.电化学治疗前列腺增生症.中华男科学,2000,3：204-205.
[56]乔亮,王全兵.电化学治疗前列腺增生症的临床疗效观察.中国现代医学杂志,2003,13(19)：141-142.
[57]张翼,张东升,梁长春.经尿道电化学治疗高危前列腺增生合并尿潴留76例体会.河北医药,2006,28(71)：613.
[58]唐迎九,薛钧尘,王克明.经尿道电化学治疗前列腺增生症104例.现代泌尿外科杂志,2002,7(4)：230-231.
[59]程广舟,王维科,王培祥.经尿道电化学治疗前列腺增生症.临床泌尿外科杂志,2001,16(3)：126-127.
[60]宋有军.经尿道前列腺增生症电化学治疗.实用诊断与治疗杂志,2003,17(3)：215-216.
[61]余清平,张清武,刘克华.电化学治疗前列腺增生症10例报告.中华泌尿外科杂志,1999,(2).
[62]贝忠东.电化学治疗前列腺增生尿漪留12例分析.当代医学,2007,12：99.
[63]张翼,张东升,詹毓彦等.经尿道电化学治疗高危前列腺增生患者的体会.中国医药导报,2006,3(26)：65-66.
[64]薛塞峰,崔学光,张文胜等.宁夏农村卫生适宜技术推广模式探讨.中国卫生经济,2007,26(1)：55-57.
[65]陈洁主编.卫生技术评估.北京,人民卫生出版社,2008：84.
[66]马进,蒋飞,王春明等.我国乡村医生队伍素质现状分析.中国初级卫生保健,2003,17(8)：19-21.
[67]卫生部信息统计中心.2006年中国卫生事业发展情况统计公报.Http://www. moh.gov.cn/newshtml/18903.htm[2007-7-9].
[68]沈洪兵,俞顺章,徐耀初.我国糖尿病的发病变化及其经济负担研究[J].中华预防医学杂志,1998,10(9)：387-390.
[69]李艳艳,胡东生,李春阳等.农村居民糖尿病患病率及危险因素分析.中国公共卫生,2008,24(10)：1273-1275.
[70]陈娟,张光鹏.中国西部40个贫困县村卫生室费用及村医相关行为分析.中国初级卫生保健,2001,15(6)：3-4.
[71]陈坚,金稳.推行药品招标“三统一”的实践与思考.中国卫生资源,2008,11(4)：197-198.
[72]史俊庭.民工职业病亟待社会关注[N].科学时报,2005,8：23.
[73]李献云,杨荣山,张迟等.自杀未遂危险因素的病例对照研究.中华流行病学杂志,2001,22(4)：281-283.
[74]北京回龙观医院临床流行病学研究室.卫生部／WHO预防自杀讲习班”的会议报告中国心理卫生杂志,2000,14(5)：295-298.
[75]全国协作组.国内12地区精神疾病流行病学调查资料分析[J].中华神经精神科杂志,1986,19：65-68.
[76]向孟泽.农村社区精神卫生服务模式研究的总结报告.第二届中国精神康复学术会议论文集,1992,69-70.
[77]史蕴萍,王秋艳,赵桂荚等.吉林省农村卫生适宜技术推广培训情况分析.中华医学科研管理杂志,2007,20(6)：382-383.
[78]邹嘉明.关于农村卫生适宜技术推广机制的思考.中华医学科研管理杂志,2006,19(6)：329-832.
[79]刘卫平,王润华,陈永忠等.重庆市农村卫生适宜技术培训和应用效果及影响因素分析.现代预防医学,2007,34(20)：3815-3817,3820.
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