伤残调整寿命年(专业知识值得参考借鉴)

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我国糖尿病疾病负担研究

我国糖尿病疾病负担研究一、本文概述糖尿病，作为一种日益严重的全球性健康问题，已经在我国形成了巨大的疾病负担。

随着我国经济社会的快速发展和人口老龄化的加剧，糖尿病的患病率呈现出逐年上升的趋势，严重影响了国民的健康水平和生活质量。

为了全面了解我国糖尿病的疾病负担状况，探讨其影响因素，本文对我国糖尿病的疾病负担进行了深入的研究和分析。

本文将首先介绍糖尿病的基本概念、分类及其全球和我国的流行情况，阐述糖尿病对个体健康和社会经济的影响。

然后，通过收集和分析大量的流行病学数据、临床研究资料以及相关政策文件，从患病率、并发症发生率、医疗费用支出、劳动力损失等多个维度，全面揭示我国糖尿病的疾病负担现状。

本文还将探讨糖尿病的疾病负担在不同地区、不同人群之间的差异，以及影响糖尿病疾病负担的主要因素。

本文将提出针对性的政策建议和研究展望，以期为我国糖尿病的防治工作提供科学依据和决策支持，推动糖尿病防治工作的深入开展，降低糖尿病的疾病负担，提高我国人民的健康水平。

二、糖尿病疾病负担评估方法糖尿病疾病负担的评估是一个多维度、复杂的过程，涉及流行病学、卫生经济学、临床医学等多个领域。

为了全面、准确地评估我国糖尿病的疾病负担，本研究采用了以下几种方法：流行病学调查：通过大规模的流行病学调查，收集糖尿病的患病率、发病率、死亡率等关键数据。

这些数据能够直观地反映糖尿病在我国人群中的分布和流行趋势，为政策制定和资源配置提供科学依据。

疾病负担测量：采用疾病负担测量指标，如伤残调整生命年（DALYs）和潜在减寿年数（YLLs）等，从健康损失的角度量化糖尿病对患者和社会的影响。

这些指标能够综合考虑疾病的发病率、死亡率以及病程中的伤残情况，全面反映疾病的负担情况。

卫生经济学评价：通过卫生经济学评价，分析糖尿病的直接医疗费用、间接经济损失以及社会福利损失等。

这些数据能够揭示糖尿病对患者和社会造成的经济负担，为政策制定者提供决策依据。

临床数据分析：收集和分析糖尿病患者的临床数据，包括病程、并发症发生情况、治疗效果等。

流行病学题库(全)

流行病学试题一一、单项选择题[A型题]1、现代流行病学的形成于发展不包括下面哪个部分A、对传染病流行因素的研究B、对慢性病流行因素的研究C、对疾病防制措施的研究D、对疾病临床治疗的研究E、流行病学研究方法的发展2、流行病学研究的主要用途是A、进行统计学检验B、探讨病因与影响流行的因素及确定预防方法C、研究疾病的发生概率D、研究疾病的死亡情况E、研究疾病的临床表现3、流行病学描述性研究不包括A、检测B、抽查C、队列研究D、现患调查E、生态学研究4、流行病学的实验性研究不包括A、临床试验B、干预试验C、人群现场试验D、病例对照研究E、防制实验研究5、下列哪项因素与患病率的变化无关A、发病率的升高或下降B、病死率的升高或下降C、人口总数自然增加或减少D、治疗水平的提高或降低E、存活时间长短6、在比较不同地区发病率或死亡率时应注意使用A、年龄别发病率，年龄别死亡率B、性别发病率，性别死亡率C、职业别发病率，职业别死亡率D、民族别发病率，民族别死亡率E、标化发病率，标化死亡率7、疾病年龄分布中的出生队列分析方法是A、不需要随访B、观察一时间断面的死亡率C、将同一时期同一年龄的人划为一组D、说明同一时期不同年龄组死亡率的变化E、说明不同年代出生的各年龄组的死亡率的变化8、时点患病率在理论上是无长度的，但实际上以不超过多长时间为度A、1天B、1个星期C、1个月D、6个月E、1年9、不同地区的粗死亡率不能进行直接比较，因为A、不同地区发病率水平不一样B、不同地区环境因素不一样C、不同地区人口年龄构成不一样D、不同地区医疗诊治水平不一样E、不同地区经济水平不一样10、甲乙令人群中几种特殊部位癌肿报告新病例的相对数如下：癌肿部位甲人群（%）乙人群（%）肺10.0 6.7乳腺30.0 20.0子宫颈25.0 16.7其他35.0 56.6合计100.0 100.0据此推论甲人群较乙人群更易患肺癌、乳腺癌和子宫颈癌，该推论是：A、正确B、不正确，以为未区分发病率或死亡率C、不正确，因为未用率指标测量D、不正确，因为未设对照组E、不正确。

卫生事业管理学重点

卫生事业管理（6月18日15W周四上午9：00-11:00，2204）一、名词解释1.卫生事业：泛指为增进人民健康所采取的组织体系、系统活动和社会措施的总和，这些组织和活动以追求社会效益为主要目的，，由政府领导并提供必要的经费补助。

2.卫生事业管理：是政府根据卫生事业的规律和特点，以保障和增进人民健康为目的，对卫生组织体系、系统活动和社会措施进行计划、组织和控制的过程。

3.德尔菲法：是专家会议法的一种发展，采用匿名方式通过几轮函询，征求专家们的意见，然后将他们的意见综合、整理、归纳，再反馈给各个专家供他们分析判断，提出新的论证。

如此反复，意见逐渐趋于一致。

4.临床路径：首先按病种、病情进行分类，然后对每一类制定规范的诊疗方案，形成规范的医疗路径。

5.卫生规划：是一个过程，在这一过程中，规划者评价特定地理区域内或特定人群的卫生服务需要，确定如何通过分配现存或预期可控资源，以一种最有效的方式去满足这些健康需要的过程。

6.区域卫生规划：是在一个特定的区域范围内，根据其经济发展、人口结构、地理环境、卫生与疾病状况、不同人群需求等多方面因素，来确定区域卫生发展方向、发展模式与发展目标，合理配置卫生资源，合理布局不同层次、不同功能、不同规模的卫生机构，使卫生总供给与总需求基本平衡，形成区域卫生的整体发展。

7.卫生筹资：是指为各项卫生活动筹资所用资金，以及合理配置和利用这些资金。

8.卫生支付：是指卫生市场在交易过程中资金从一方转移至另一方的过程。

9.按项目付费：属后付费的传统形式，其特点是医院收入与提供的服务项目数量直接相关，即总费用=∑（服务项目费×项目价格）。

10.总额预付：属于预付制，由政府或医疗保险机构与医疗服务供方协商，确定供方一年的年度总预算额，医疗保险机构在支付供方费用时，依此作为最高限额，相当于对供方设立了一个封顶线。

11.按人头付费：属于预付制，该支付方式以注册的个人为支付单元，固定支付一定时间内（比如1年内）的所有服务费用。

农村老年人健康不平等的测度及影响因素分析

宁夏农林科技，Ningxia Journal of Agri.and Fores.Sci.&Tech.2023，64（04）：50-58·农林经济与信息技术·基金项目：国家社会科学基金项目“农村家庭育赡投入之代际冲突与干预对策研究”（21CSH020）、宁夏自然科学基金项目“基于ABM 的农村家庭人力资本投资的决策机制及仿真研究”（2022AAC03015）。

作者简介：邓皓喆（1996—），男，山西太原人，在读硕士研究生，研究方向为农村发展。

*通信作者：华静，博士研究生，副教授，研究方向为农村社会学。

收稿日期：2022-09-08农村老年人健康不平等的测度及影响因素分析邓皓喆1，华静21.宁夏大学农学院，宁夏银川750021；2.宁夏大学经济管理学院，宁夏银川750021摘要：当前人口老龄化趋势日益加深，老年人的健康问题尤为突出，随之而来的是由多种因素导致的农村老年人健康不平等问题。

农村老年人健康不平等程度过高会对实现健康老龄化、建设健康中国产生不利影响。

基于CHARLS_2018年调查数据，首先运用集中指数法测度健康不平等程度，其次选用二元Logistic 模型测度各自变量对健康不平等的影响因素，最后分解各自变量对健康不平等的贡献。

结果表明，从整体来看，我国农村老年人健康的集中指数为0.0408，健康不平等状况明显；从地区来看，我国东、中、西部农村老年人健康的集中指数分别为0.0424、0.0587、0.0180，中部地区健康差异性更严重。

其中：收入水平、是否患慢性病、锻炼状况、受教育程度因素对加大健康不平等影响很大；婚姻状况、居住区域、社交状况、饮酒状况、吸烟状况等因素是造成农村老年人健康不平等的重要因素。

因此，政府应采取有效措施改善农村老年人的健康不平等现状。

关键词：农村老年人；健康不平等；集中指数分解中图分类号：D669.6；R195文献标识码：A文章编号：1002-204X （2023）04-0050-09doi:10.3969/j.issn.1002-204x.2023.04.012Measurement of and Influencing Factorson Health Inequality among Elderly People in Rural AreasDeng Haozhe 1,Hua Jing 2(1.School of Agriculture Ningxia University,Yinchuan,Ningxia 750021;2.School of Economics and Management,Ningxia University,Yinchuan,Ningxia 750021)Abstract The current trend of population aging is deepening,and the health problems of the elderly are particularly prominent.With this,there are various factors leading to health inequality among rural elderly people.The high level of health inequality among rural elderly people will have adverse effects on achieving healthy aging and building a healthy China.Based on CHARLS_2018data,this article measured the degree of health inequality with the centralized index method,then the influencing factors of each variable on health inequality by using a binary logistic model,and finally decomposed the contribution of each variable to health inequality.The results indicate that overall,the concentration index of health among rural elderly people in China is 0.0408,indicating significant health inequality.From a regional perspective,the concentration indices of elderly health in rural areas of eastern,central,and western China are 0.0424,0.0587and 0.0180,respectively,with more severe health disparities in the central region.Among them,factors such as income level,chronic illness,exercise status,and education level play an important role in increasing health inequality.5064卷04期Factors such as marital status,residential area,social status,alcohol consumption and smoking status are important factors that contribute to health inequality among rural elderly people.Therefore,the government should take effective measures to alleviate the health inequality of rural elderly people.Key words Rural elderly;Health inequality;Concentration index decomposition近年来，我国人口老龄化程度日益加深，预计至2025年，65周岁及以上人口占我国总人口比例将会达到14.3%，我国将从轻度老龄化迈入中度老龄化[1]。

从全球视角看中国脑卒中疾病负担的严峻性

从全球视角看中国脑卒中疾病负担的严峻性一、本文概述随着全球人口老龄化和生活方式的变化，脑卒中已成为全球性的重大公共卫生问题。

中国，作为世界上人口最多的国家，其脑卒中疾病负担的严峻性尤为突出。

本文旨在从全球视角出发，深入剖析中国脑卒中疾病负担的现状、原因及其对社会经济的影响，以期引起社会各界对脑卒中防治工作的高度重视，共同应对这一日益严峻的健康挑战。

文章首先将概述脑卒中的定义、分类及其全球流行趋势，为后续分析提供背景信息。

接着，将重点介绍中国脑卒中疾病负担的现状，包括发病率、死亡率、致残率等关键指标的变化趋势，以及不同地区、不同人群之间的差异。

在此基础上，文章将探讨中国脑卒中疾病负担的成因，包括但不限于人口老龄化、生活方式变化、高血压等高危因素的普及，以及医疗资源分布不均等。

文章还将分析脑卒中给中国社会经济带来的沉重负担，包括医疗资源的消耗、劳动力减少、家庭负担增加等方面。

文章将提出针对性的建议和措施，旨在加强脑卒中防治工作，降低脑卒中疾病负担，提高人民健康水平。

通过本文的阐述，我们期望能够引起社会各界对脑卒中防治工作的广泛关注，共同推动中国脑卒中防治事业的进步，为构建健康中国贡献力量。

二、全球脑卒中疾病负担概况在全球范围内，脑卒中已经成为一个日益严重的公共卫生问题，其疾病负担的严峻性不容忽视。

据世界卫生组织（WHO）统计，每年全球约有1500万人罹患脑卒中，其中约500万人因此死亡，存活者中约三分之一会遗留严重残疾。

脑卒中不仅对个人健康造成巨大威胁，也对全球经济产生沉重负担。

脑卒中的发病率、死亡率和致残率在全球范围内呈现出显著的地理差异。

在一些发达国家，由于人口老龄化、生活方式改变和医疗水平提高等因素，脑卒中的发病率和死亡率虽然有所下降，但仍然是影响国民健康的主要疾病之一。

而在一些发展中国家，由于经济发展水平低、医疗资源匮乏、公众健康意识不足等原因，脑卒中的发病率和死亡率居高不下，给社会和家庭带来了巨大的经济和心理压力。

伤残调整生命年名词解释

伤残调整生命年名词解释
生命年是一个在伤残金额调整中扮演重要角色的术语。

伤残金额调整就是根据伤残比例来决定特定年份的假设死亡年龄、死亡抚恤金和伤残生活费的年金等。

此外，伤残金额调整的的计算也包括“抚恤金以外的家庭抚恤金和伤残生存期津贴”。

生命年是用来计算伤残金额调整的重要工具。

生命年是指抚恤金和抚恤金以外的家庭抚恤金、伤残生存期津贴等都按年支付的准确年限。

一般情况下，生命年的计算只有在伤残比例超过50%的情况下才会进行，只有在这种情况下，该受益人才能获得抚恤金以外的家庭抚恤金和伤残生存期津贴抚恤金等。

为了计算生命年，伤残金额调整必须考虑受益人的实际年龄，扣除重大疾病或伤害发生前的预期寿命，并将其减少的寿命年限减去假设死亡年龄，结果就是受益人的生命年数。

此外，受益人死亡时的抚恤金根据其实际年龄和生命年来计算。

受益人的实际年龄和生命年的计算根据受益人的出生日期、重大疾病或伤害发生日期和假设死亡年龄等来确定。

伤残金额调整中的生命年是一个重要的术语，它不仅关系到伤残金额的调整，而且还与受益人的实际年龄和死亡抚恤金有关。

因此，它是一个需要准确计算的重要工具，可以确保受益人获得伤残金额调整中应有的受益金额。

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高血压合理用药指南(第2版)

（2）本指南的工作组由多专业学科的专家，特别是一直从事高血压研究的专家以及流行病学和药理学专家组成，他们是：曾哲淳、詹思延教授（循证医学专家），王丽敏、王增武、孙宁玲教授（第 1 章：高血压流行及治疗现状），蔡军、陈鲁原、刘蔚教授（第 2 章：高血压药物分类），孙宁玲、郭艺芳、陈源源、林金秀、陈晓平、冯颖青、王浩、初少莉、张宇清、卢新政教授（第 3 章：用药原则及规范），范利、张新军、吴海英、荆珊、袁洪、李建平、陈源源、陈鲁原教授（第 4 章：国产创新药物），林金秀、孙刚、陶军、李玉明、谢良地、王鸿懿、李勇、孙跃民教授（第 5 章：高血压特殊合并症的药物治疗原则），祝之明、姜一农、李玉明、牟建军、高平进、李南方、宋雷、尹新华教授（第 6 章：常见特殊类型高血压的治疗原则和药物选择），孙英贤教授（第 7 章：基层高血压患者的国家基本药物的应用原则），赵志刚教授（附录：常见降压药物列表）。完稿后由《中国医学前沿杂志（电子版）》编辑部负责统稿，最终由主编孙宁玲教授组织修订，并亲自逐字逐句地审稿最后定稿。
管病最重要的危险因素。据世界卫生组织（WHO）烟、过量饮酒、高盐和高脂食物摄入、身体活动不
统计资料显示，2012 年全球心血管病死亡人数为 1700 万，占慢性病死亡人数的 46%，其中高血压
足、超重和肥胖及总胆固醇水平升高等）在人群中普遍存在 [7]，并且不断增加或居高不下，成为高血
并发症死亡人数为 940 万，占全部疾病负担的 7% 压、心肌梗死及卒中等心脑血管病的潜在威胁。而
（3）写作团队针对每个核心问题，确定文献检索策略，检索的数据库包括 PUBMED、EMBASE、 CBMDISC、CNKI、万方、维普及 CMCC 等数据库中 2006—2017 年发表的关于高血压药物治疗的相关文献，并对文献进行初步筛选。

伤残调整生命年

Putting health metrics into practice:using the disability-adjusted life year for strategic decision makingKim Longfield 1*,Brian Smith 1,Rob Gray 2,Lek Ngamkitpaiboon 1,Nadja Vielot 1BackgroundProgram impact and the cost effectiveness of investments in health interventions are pressing concerns among glo-bal health organizations,due to an environment of decreasing resources.Donors and implementing organi-zations are increasingly asked to demonstrate value formoney,prompting the use of health metrics to show quantifiable results.Donors use health metrics to moni-tor and evaluate the performance of their recipients and to inform their investments.Implementing organizations use metrics to measure program success,document best practices,and report back to donors on performance.The larger global health community -which includes donors and implementers as well as researchers and pol-icy makers -uses metrics to inform its discussions and identify each stakeholder ’s role in health promotion.*Correspondence:klongfield@ 1Population Services International,112019th Street NW,Suite 600,Washington,DC,20036Full list of author information is available at the end of the article Longfield et al .BMC Public Health 2013,13(Suppl 2):S2/1471-2458/13/S2/S2©2013Longfield et al.;licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (/licenses/by/2.0),which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly cited.The pressure on implementing organizations to be accountable for performance is increasing.Recently,the United States Agency for International Development, the Global Fund,the United Kingdom’s Department for International Development,and the World Bank have adopted performance-based funding systems to reward programs that deliver positive health outcomes,while reducing aid to organizations that do not[1-4].To prioritize program development and improve decision making,standard measurement processes and agreement on which health metrics best address the majority of the global health community’s concerns are needed[5-7].In the past,health impact has typically been expressed through metrics such as cases averted and deaths averted for interventions preventing disease acquisition or progression.Calculations for cases and deaths averted are disease specific and can be applied to any health area where the outcome includes mortality,including HIV/AIDS,sexually transmitted infections(STIs),diar-rheal diseases,maternal health,and malaria[8-10]. Another metric,couple-years of protection(CYPs),has been used to estimate the impact of FP products and services[11,12].While useful for disease-specific inqui-ries,these metrics pose a major challenge for priority setting:they do not permit comparisons across different interventions or health areas to inform decision making based on potential health impact.Summary measures of population health(SMPH)are more comprehensive than the aforementioned metrics: they provide convenient,single-unit snapshots of a par-ticular health situation in a given context.Murray and Lopez identified eight uses of SMPH for improved deci-sion making:comparing health status across various populations;comparing health status of the same popu-lation over time;identifying health inequalities among populations;accounting for the burden of nonfatal health outcomes and not simply mortality;setting prio-rities for health services improvements;setting priorities for health research and development;improving public health training curricula;and analyzing the cost-effec-tiveness of health promotion programs[13,14].SMPH combine all relevant health information about a popula-tion into a bottom-line measure that can be used with stakeholders[15].This paper focuses on one particular SMPH,the dis-ability-adjusted life year.The World Bank and World Health Organization(WHO)developed the DALY in 1993to address the need for SMPH that account for mortality and morbidity,as well as provide objective information about population health status for decision making[7,16,17].DALYs have been preferred to other “gap measures”because they allow morbidity and mor-tality to be disaggregated into years of life lost and years of life lost due to disability[18].The result is a metric that combines the value of lives saved with illness and disability prevented.The most common use of DALYs is to estimate the BOD in a population.The WHO Global Burden of Dis-ease uses DALYs to demonstrate where certain diseases are concentrated and where health areas have been dispro-portionately addressed,particularly at the national level [19,20].DALYs are a convenient unit of measurement because researchers and decision makers can disaggregate results by region,sex,age group,and disease type.Estima-tion of health burden using DALYs also enables users to detect key differences across populations[21,22]. Researchers and implementers frequently apply DALYs to estimate BOD for health conditions perceived as neglected in order to garner funding and program support from donors and policy makers[23-29].Like other metrics,DALYs can also be used along with cost data to estimate the cost-effectiveness of health inter-ventions by simply dividing overall costs by health impact, the number of DALYs averted by the intervention.Cost-effectiveness is a critical input to strategic decision making, particularly when interventions are life saving,but costs vary greatly between strategies.Cost-effectiveness analyses using cost per DALY averted have become standard for health programs in low-and middle-income countries [30-42].This paper describes why one international non-governmental organization(INGO),Population Services International,adopted the DALY as its bottom-line esti-mate for health impact.It describes how the organiza-tion uses DALYs averted for strategic decision making at the global,regional,and country levels,and relates how the adoption of this metric had a profound impact on PSI’s strategic direction.The paper also presents the advantages and practical constraints of using DALYs averted to optimize an organization’s health impact and offers considerations for using the metric in the future. PSI’s history of health impact measurementPSI is an INGO that uses social marketing to improve the health status of the poor and vulnerable in developing countries.By adapting marketing strategies and methods developed in the for-profit sector,PSI helps those in need adopt healthy behaviors.PSI has also modeled its manage-ment practices on the for-profit sector,creating an organi-zational culture where there is a strong focus on its bottom line,a discrete set of metrics that quantify organi-zational achievement.Since performance management goals for programs,as well as individual staff,are tied to this organization-wide measure,program staff actively work to maximize their contributions and increase the bottom line.For its first two decades,PSI measured its bottom line by the number of products sold.Since the organizationworked primarily on FP,sales of contraceptives were also converted into CYPs.During these early years, many meetings among senior decision makers revolved around the monthly sales report,which compiled activ-ities from all PSI interventions.While reviewing sales reports is a simplistic way to view programmatic pro-gress by today’s standards,the process did help identify areas of high and low performance.More importantly, this use of metrics helped the organization think more strategically by looking beyond individual intervention deliverables to focus on building“programs,”portfolios of interventions that would deliver value over the long term.In the1980s and mid-1990s,PSI introduced other programs into its portfolio,including diarrheal disease (early1980s),HIV/AIDS(late1980s),and malaria(early 1990s).In the late1990s,PSI adopted Person-Years of Protection(PYP),a new,simple conversion factor,to estimate the number of person-years protected by the number of health product units sold or distributed. While the PYP allowed PSI to create an aggregate bot-tom-line measure,its utility was limited.The PYP did not estimate health impact;rather,it expressed sales using a common denominator for interventions of dif-ferent durations.Therefore,this metric did not allow decision makers to see differences in the potential health impact across interventions.It also did not include esti-mates of effectiveness and gave equal weight to all pro-ducts distributed.Finally,the PYP was specific to PSI, which did not allow the organization to compare its per-formance to that of other implementation organizations. To address the limitations of PYPs,PSI adopted DALYs averted as its key performance metric in2006. DALYs averted counts the number of DALYs that are not lost,but averted,by a health intervention.By using DALYs averted,the organization could estimate the health impact of its products,services,and behavior change interventions across all of its health areas.These results,in turn,would inform strategic decision making. While international standards existed to calculate DALYs at the national level for determining BOD,PSI’s use of DALYs averted was novel.It used DALYs averted to measure the effectiveness of a portfolio of interventions and to estimate the health impact of those interventions. Basing a metric on the DALY offered several advantages for estimating organizational health impact.The DALY is a recognized unit for measuring BOD,which ensures alignment with the international public health community. It also enables PSI to measure the impact of all of its inter-ventions and in relation to BOD,which rewards and rein-forces targeted interventions.PSI can combine this impact with cost for internal comparisons of its interventions’cost-effectiveness as well as to compare its costs with other INGOs and against global standards.Additionally,the DALY permits comparisons of impact across different health conditions and across countries.It is important to note that while the DALY captures information on maternal and child mortality and morbid-ity,it does not capture the full contribution of FP ly,the DALY does not include the protection from unplanned pregnancies and birth spacing provided by FP methods.For this reason,PSI continues to measure FP program impact with CYPs,the standard global metric for family planning.CYPs serve as a com-plementary measure to DALYs averted,each capturing different impacts of PSI’s FP products and services.With the switch to DALYs averted as its key perfor-mance metric,PSI made the strategic decision to double its global health impact in five years,from2007-2011. This goal and the adoption of the DALYs averted metric aligned and motivated PSI’s staff operating in67coun-tries,either through its own country offices or through locally governed affiliates.The DALYs averted measure was factored into individual performance goals,annual appraisals,and incentive compensation,in addition to the country and regional operating plans.MethodsTo use DALYs averted as its primary health impact mea-sure,PSI developed several models.These models estimate the impact of a range of preventive and therapeutic inter-ventions for seven specific health areas:HIV/AIDS and other STIs,FP,maternal health(e.g.,abortion,clean deliv-ery practice,and micronutrient deficiencies),child health (e.g.,nutrition,acute respiratory infection,and diarrhea), malaria,tuberculosis(TB),and cervical cancer.Most model parameters come from one of four data sources: Demographic Health Surveys,United Nations Population Division,WHO,or Multiple Indicator Cluster Surveys. When parameters are unknown,modelers use assump-tions based on the published literature or,when necessary, PSI country experiences.Specific details about the model parameters and methodology,together with specific exam-ples of two of PSI’s DALYs averted models,are found in another paper in this supplement[43].Through stochastic modeling,DALYs averted models produce coefficients that are,effectively,the estimated number of DALYs averted by a single product unit(e.g., a condom)in a single country.Each month,PSI esti-mates health impact from the sales,distribution,and service utilization(collectively referred to forthwith as “distribution”)figures reported by each of the country offices.These figures are multiplied by country-level coefficients to determine the number of DALYs averted by each intervention.When products provide multiple years of effectiveness(e.g.,long-lasting,insecticide-trea-ted bednets(LLINs),the multi-year impact is credited during the year in which the products are distributed.PSI also estimates the impact of its product and ser-vice promotion efforts done in collaboration with part-ners.To avoid“over-claiming”impact,PSI counts only partial impact from results stemming from these part-nerships,according to policies developed by an internal working group of researchers,modelers,technicians, and implementers.For example,the service referral pol-icy applies to interventions in which PSI generates demand for health services,but does not actually deliver the service,such as adult male circumcision,intrauterine device(IUD)insertions,or HIV testing and counseling. Successful referrals are counted as50%of the health impact from that service.The significant involvement policy describes how much health impact can be counted from activities in which PSI plays a role in pro-duct procurement,communication,and distribution,but is not entirely responsible for product delivery.When PSI participates in a subset of these activities with part-ners,that subset can be counted toward DALYs averted. PSI has applied this policy to its large-scale,LLIN distri-bution campaigns in which PSI collaborated with part-ners to distribute LLINs,but did not actually place the nets directly into the hands of recipients.Finally,PSI estimates the impact of its behavior change communication(BCC)activities on non-product beha-viors and the use of non-PSI brands.Doing so is impor-tant for interventions that do not require a product,like the reduction of sexual partners for HIV prevention,or when PSI interventions promote the use of a category of products,such as condoms,rather than simply the use of its own brands.To correlate behavior change with expo-sure to PSI interventions,PSI uses population-based sur-vey data.When a significant correlation is detected,PSI estimates the size of the population covered,multiplies it by the exposure rate,and estimates the number of new infections averted.These new infections averted are then converted into DALYs averted.Currently,PSI has seven models to estimate DALYs averted through exposure to BCC activities.Thus,in the most basic terms:PSI’s overall estimate of health impact=(DALYs averted coefficients*PSI distribution)+Service Referral DALYs averted+Significant Involvement DALYs averted+DALYs averted through BCCKeeping the DALYs averted models current is an ongoing process.As new or more relevant evidence becomes available,PSI revises its models to ensure that its calculations are as accurate as possible.Revised coef-ficients are applied yearly and adjustments to the models directly affect PSI’s bottom line.When appropriate, changes are applied retrospectively;for example,when WHO revises its BOD figures.The health impact in any given year may increase or decrease depending on the models’magnitude of change.PSI applies the most recent model coefficients when calculating its health impact on a monthly basis.Senior managers at all levels of the organization-global,regio-nal,and country-use these results to monitor progress against intended targets and to guide strategic decision making.They identify areas for improvement and redir-ect program and funding priorities as needed.For this paper,PSI’s health impact data over the last 10years(2001-2011)were compiled and analyzed by program area and geographic region in order to demon-strate PSI’s progress in achieving its strategic goal of doubling health impact between2007and2011.Show-ing10years of data enables comparison with the years preceding this decision.To generate DALYs averted and standardize annual comparisons,distribution figures for each year were multiplied by the most up-to-date coun-try-level DALYs averted coefficients(2011coefficients at the time of writing).Following these results,a case study is presented to illustrate how the adoption of DALYs averted as PSI’s primary health impact metric affected decision making at the regional level and then within one country in that region.ResultsBetween2007and2011,PSI distributed billions of pro-ducts and services throughout its worldwide operations. Table1presents distribution figures for products and services that accounted for the majority(90%)of the organization’s health impact during this time.Two pro-ducts-LLINs and male condoms-account for75%of this health impact.Over the course of this five-year per-iod,PSI distributed nearly114million LLINs and five billion condoms.Figure1portrays PSI’s health impact as measured in DALYs averted over the course of10years.Different colors in the bar charts indicate the health areas in which impact was achieved.Between2002and2006,PSI averted a total of30.5 million DALYs,with a compound growth rate of28.7%. The organization then established the goal of doubling its health impact between2007and2011.During this time there was a marked increase in the total number of DALYs averted.By the end of2011,PSI had doubled its health impact,averting22.8million DALYs in that year. From2007-2011,79.7million total DALYs were averted, with a compound growth rate of26.6%each year.Most DALYs averted were in malaria,which accounted for58%of PSI’s overall health impact between2007-2011.In addition to the high volumes of product distribution,the multi-year effectiveness for LLINs(three years for every net distributed)also helped rapidly increase the number of DALYs averted in malaria,particularly given that this multi-year impact was credited in the year the nets were distributed.Changes in resource flows influenced PSI’s decision making.The Global Fund,for example,invested heavily in LLINs for malaria prevention during this period. Combined with PSI’s shift to a BOD-focused strategy, this change in donor priorities made it easier for PSI to recognize that rapid gains in health impact could be achieved by changing its approach from one of sales through commercial channels to one that included free distribution campaigns.A narrower view about the role of PSI as a social marketing organization would have left too much health impact unrealized.As a result, approximately58%of PSI’s health impact in2007-2011 was from the distribution of free products,namely LLINs and condoms,which means that product sales stopped growing during this period and free distribution became more important for PSI to achieve its bottom line.The dip in PSI’s health impact in2010is primarily explained by large LLIN distribution campaigns in coun-tries with lower malaria burdens than those in preceding and subsequent years.Countries with the greatest LLIN distribution over the course of five years were Kenya and the Democratic Republic of Congo with more than 15million LLINs distributed in each,followed by Mada-gascar(9.8million)and Côte d’Ivoire,Uganda,and Cameroon,which each received more than eight million LLINs from PSI distribution channels.By2011,PSI was also distributing artemisinin-based combination thera-pies(ACTs)in12countries and rapid diagnostic tests in five countries,contributing to additional health impactTable1Product distribution,2007-2011,in number of units and percentage of DALYs avertedPSI Product or Service2007Distribution2008Distribution2009Distribution2010Distribution2011DistributionTotalDistribution%of2007-2011DALYs AvertedLLINs8,539,21116,367,86419,025,76026,564,49043,413,442113,910,76746% Condoms973,626,1611,092,370,4521,175,647,9271,266,880,2721,297,766,4265,806,291,23829% Malaria pre-packaged therapy(ACTs)339,5933,713,5029,379,30510,796,68211,438,86335,667,9455%Insecticide retreatment forbednets*2,770,5135,636,9335,022,9901,428,482272,85415,131,7724% Oral contraceptives25,060,19228,595,11030,187,83938,336,01638,272,868160,452,0252% HIV counseling and testing807,8131,158,0111,569,7361,833,4151,414,5916,783,5662% IUDs**284,127349,704618,082613,595567,1992,432,7071% Basic Care Package for peopleliving with HIV/AIDS75,64860,493352,708757,18717,349,69318,595,7291%*Either bundled with malaria nets(not LLINs)or distributed alone**Figures are for IUD distribution only.PSI counts IUD insertions through its service delivery sites differently,applying a higher DALYs averted coefficient. Figure1PSI’s global health impact,2002-2011,in DALYs averted,by health area.in malaria.All of these prevention and treatment inter-ventions produced a compound annual growth rate of 44.4%for DALYs averted in malaria between2007and 2011.While a distant second to malaria,HIV/AIDS also experienced steady gains in health impact,increasing at an annual compound growth rate of7.3%between2007and 2011.Increases in HIV DALYs averted were primarily due to extensive condom distribution programs in all three of PSI’s African regions.Male circumcision programs also contributed to gains in HIV/AIDS health impact,following its launch in Zambia in2007and expansion to another four countries by2011.The marginal decline in HIV health impact in2011is largely attributed to stock outs of free condoms in South Africa.Health impact within PSI’s FP programs steadily increased over the course of2007-2011,with the greatest gains in the last four years.Condom distribution accounted for the bulk of these increases,which factors into both HIV/AIDS and FP DALYs averted due to con-doms’role in dual protection.Grants from an anon-ymous donor to increase IUD insertions and implants also played a role.The DALYs averted compound growth rate from2007-2011in FP was11.6%each year.During the same period,the organization generated80.4million CYPs,with the greatest increase in2010and2011.(Note: CYPs are not featured in Figure1.)While PSI achieved small strides with other interven-tions,such as safe water solution(e.g.,chlorination),oral rehydration salts(ORS),and pneumonia pre-packaged therapy(PPT),these products contributed very little to PSI’s overall health impact due to limited distribution. They accounted for only3%of PSI’s total DALYs averted between2007and2011.Of these products,PPT shows the greatest promise for health impact,but,so far,PSI’s distribution has been limited to just five countries.Addi-tionally,directly observed therapy,short-course(DOTS) for TB shows promise as a contributor to DALYs averted, but PSI’s role in distribution is currently limited to only three countries.In terms of nutrition interventions,only PSI/Pakistan has received funding for one nutrition pro-duct(Sprinkles)at present.Strategic changes in Asia and Eastern European region from the use of DALYs avertedPSI’s decision to measure organization-wide impact using DALYs averted challenged managers to frame their decisions about strategy,implementation,fundrais-ing,and performance goals in relation to BOD across the regions in which it operates.The Asia and Eastern European(A/EE)region,and one of the countries within it,Laos,offer an instructive example of how the use of DALYs averted affected strategic decisions.PSI is organized into five regions:1)West and Cen-tral Africa,2)East Africa,3)Southern Africa,4)Asia and Eastern Europe,and5)Latin America and the Car-ibbean.Each region develops a strategy that is consis-tent with PSI’s global strategy while respecting varying contexts.Regions are accountable for health impact goals set on an annual basis and monitored throughout the year.As a result,regional directors and country managers develop their intervention strategies and evaluate new funding opportunities based on their potential to contribute to the bottom line in terms of health impact.Under the measurement system of PSI’s early years-one based on sales and CYPs-PSI’s A/EE region was a relatively high performer,mainly due to large contracep-tive social marketing programs in India and Pakistan that sell high volumes of condoms and oral contraceptives. Well-funded programs in Cambodia and Myanmar also made substantial contributions to the regional bottom line.The switch to PYPs had a modest effect on A/EE’s relative performance in2002and2003,but as PSI started to scale up malaria programming in sub-Saharan Africa, the relative performance of the region declined(Figure2). The switch to DALYs averted had an even greater impact on the region’s relative performance.While A/ EE averted a total of5.3million DALYs from2007-2011,this achievement represented,on average,just7% of the organization’s overall health impact.The A/EE region’s five-year compound growth rate was11.7%, with the largest increases in child survival and malaria product distribution(30.5%and20.9%,respectively).By comparison,PSI’s country offices in Africa averted more than74million DALYs during the same period,with a five-year compound growth rate of28%.Figure3por-trays the DALYs averted in both of these regions over the course of10years.Thus,the“success”that Asia and Eastern Europe had experienced from its FP programs when it relied on sales and CYPs was diminished:lower BOD from mater-nal mortality,perinatal conditions,and HIV/AIDS in Asia meant lower health impact from condoms and modern contraception when PSI adopted DALYs averted as the bottom-line metric.It quickly became clear to managers that meeting the need for HIV pre-vention and modern contraception in India did not have the same impact as meeting that need in Nigeria where HIV prevalence and maternal mortality are higher. Some managers in the A/EE region initially viewed the switch to DALYs averted with skepticism,especially those who thought the metric undervalued the region’s FP work since it did not capture protection from unplanned pregnancies and the benefits of birth spacing. Others argued that the approach did not adequatelyvalue intervening early in an HIV epidemic and with key populations at risk -that is,before the emergence of the high prevalence,generalized epidemic that resulted in high DALYs averted in Africa.Still others,seeing low health impact figures for their programs,paid less atten-tion to PSI ’s bottom line and continued to focus on pro-cess level indicators,which had always been important to the majority of donors and monitored as deliverables under individual interventions.Managers also realized that many of PSI ’s programs in A/EE were simply not that relevant to the disease burden in each country.Globally,PSI works heavily in HIV pre-vention and malaria -despite lower disease burdens in Asia and Eastern Europe -because donor resources are focused on those areas at present.Working in those dis-ease areas in Africa addresses a substantial part of that continent ’s disease burden.But the shift to DALYs averted pushed the A/EE region toward greater examination ofFigure 3PSI ’s global health impact,2002-2011,in DALYs averted,by region .*PSI ’s interventions in Latin America and the Caribbean are smaller than those in other regions of the world,with an average of 65,000DALYs averted per year between 2002and 2011.The narrow orange strip at the top of the bar graphs represents this region ’s contribution to PSI ’s global health impact.Figure 2Contribution of PSI ’s A/EE Region to global impact,2002-2011,in PYPs and DALYs averted*.*PYPs were used as the performance metric from 2002-06and DALYs averted from 2007-11.。

伤残调整生命年名词解释

伤残调整生命年名词解释
伤残调整生命年（DisabilityAdjustedLifeYear），简称DALY，是一种评估健康状况的指标，主要用于比较不同国家及社区居民的健康状况，它衡量了因某种疾病而失去的有效生命年数。

DALY综合考虑了某种疾病或其他生活状况对个体身体和智力能力的影响，从而推算出病症与疾病的危害程度。

DALY的计算主要基于对健康与疾病的评估，结合健康状况和对其导致的寿命损失比例，将健康状况和损失的综合衡量放到一起，来测算某种健康状况造成的损失有多大。

通俗的说，DALY就是某种疾病或其他生活状况所造成的年龄损失。

DALY可用于评估不同地区之间的健康比较，从而提供与健康有关的有效评估指标，以便有效地计划和发展公共健康项目。

通过将不同地区的健康状况进行比较，DALY可以有效地发现不同地区健康状况的差异。

DALY也可以用来评估健康案例的结果，用于发现病患的健康状况如何受到疾病或社会环境的影响，从而识别改善健康状况的重要途径，促进健康保健对相关疾病的治疗、预防和监测工作。

DALY必须按照一定的标准进行计算，包括根据国际标准统计疾病发病率与死亡率，测算每种疾病及其引起的死亡及致残率，估算相关疾病所造成的损失的有效生命年数，并进行梳理与分析。

以上是关于DALY的解释，我们可以发现，它不仅可以用于比较不同地区的健康状况，而且还可以分析并估算受疾病侵袭的人群的损
失有多大，具有极大的重要性。

能准确准确地评估某种健康状况所造成损失的有效生命年数，有助于我们妥善应对各种疾病，从而更有效地改善人类的健康水平。

老年护理学全套课件

20世纪90年代我国高等护理教育发展迅速
• 老年护理学陆续被全国多所护理高等院校列为必修课程
（二）面临的问题和对策问题：老年人口的抚养和照料问题：空巢、高龄、带病老年人
慢性病护士紧缺……
对策：☺借鉴国外的先进经验 ☺扩大护理教育规模，加强老年护理教育 ☺加强老年人常见疾病的防治护理研究 ☺开拓专业护理保健市场 ☺逐步建立以“居家养老为基础、社区服务为依托、机构养老为补充”的养老服务体系；……
老年护理学
第一章绪论
第一节老年人与人口老龄化
一、人的寿命和年龄划分
（一）人的寿命
• 平均期望寿命（average life expectancy）简称平均寿命，是指通过回顾性死因统计和其它统计学方法，计算出一定年龄组的人群能生存的平均年数。一般常用出生时的平均预期寿命，作为衡量人口老化程度的重要指标。平均寿命是以死亡作为终点。 • 健康期望寿命（active life expectancy）是指去除残疾和残障后所得到的人类生存曲线，即个人在良好状态下的平均生存年数。
这个例子有什么问题?
（1916.12.18—2012.2.6）出生在安徽芜湖市一个普通教师的家庭。我国“两弹一星”元勋、著名的火箭与导弹技术专家。
85—（95+0.5）= —10.5
孙院士和黄院士的潜在减寿年数总和孙院士：85—（66+0.5）=18.5 黄院士：85—（95+0.5）= —10.5 两院士合计减寿年数：18.5+（—10.5）=8年
残疾失能指标：
1.潜在减寿年数（potential years of life lost , PYLL） 2.伤残调整寿命年（disability adjusted life year , DALY） 3.质量调整寿命年（quality adjusted life years , QALYs）

残疾调整生命年的定义

残疾调整生命年的定义残疾调整生命年的概念源于对残疾人士生活情况的深入了解。

残疾人士由于身体或认知上的障碍，常常需要花费更多的时间和精力来完成一些日常活动，如穿衣、进食、洗漱等。

这些额外的努力和时间成本，可以被称为残疾调整生命年。

残疾调整生命年的定义在评估残疾人士的健康状态和生活质量时具有重要意义。

传统的健康评估工具往往无法准确反映残疾人士面临的困难和挑战。

残疾调整生命年的概念可以帮助我们更全面地了解残疾人士的健康状况，为其提供更精准的支持和资源。

残疾调整生命年的概念也对社会政策和资源分配具有指导意义。

通过对残疾人士的生活情况进行全面评估，可以更好地了解他们的需求和困难，从而制定出更合理、更有针对性的政策措施。

同时，合理分配资源，提供必要的康复和支持服务，也是改善残疾人士生活质量的重要途径。

然而，残疾调整生命年的概念也存在一些挑战和争议。

首先，如何准确评估和计算残疾调整生命年仍然是一个复杂的问题。

由于残疾人士的情况各异，无法简单地通过一套标准公式来进行计算。

其次，残疾调整生命年的概念容易被滥用和误解。

在一些情况下，可能存在滥用残疾调整生命年的行为，例如将普通老年人或一些临时受伤的人士也纳入到计算范围内，从而使统计数据失真。

为了解决以上问题，我们需要通过进一步的研究和讨论，建立一套科学准确的评估体系。

这包括考虑残疾人士的个体差异，制定符合实际情况的评估指标和方法，并将其应用于实际的政策制定和资源分配中。

残疾调整生命年是一个重要的概念，它有助于评估残疾人士的健康状况和生活质量，并为其提供相应的支持和资源。

然而，为了更准确地应用这一概念，我们需要进一步的研究和讨论，建立科学的评估体系，以促进残疾人士的全面发展和融入社会。

伤残等级变更的怎么支付工伤待遇文档范例

问：伤残等级变更的,怎么支付工伤待遇？答：工伤职工伤残等级变更有两种情况：1）当事人不服初次鉴定结论,要求再次鉴定后,最终鉴定结论与前比较有变化的；2）伤残鉴定结论作出之日起1年后,工伤职工或者其近亲属、所在单位或社保经办机构,认为工伤职工伤残情况发生变化的,申请复查的鉴定结论发生变更.再次伤残鉴定以及复查鉴定等级发生变更,工伤待遇如何支付,各社会保险协议统筹地区的规定不尽相同,参考《河南省工伤保险协议条例》的规定,伤残等级发生变更的,工伤待遇支付做如下处理：●工伤职工经再次鉴定,鉴定结论发生变化的,按再次鉴定结论享受相应待遇,享受待遇的起始时间为原鉴定时间的次月；●工伤职工复查鉴定结论发生变化的,应当自复查鉴定结论作出的次月起,按照复查鉴定结论享受有关待遇,但1次性伤残补助金不再调整.参考法规：1.《工伤保险协议条例》第28条；2.《河南省工伤保险协议条例》第30条；3.《安徽省实施〈工伤保险协议条例〉办法》第31条、第32条.例：高某2009年2月与郑州市某运动用品公司签订劳动合同或者协议,4月,高某在工作中受伤,右手被塑机机床严重轧伤,造成右手1～4指离断,右手掌部分缺损,高某被有经验的工友紧急送到工伤定点医院治疗.住院期间,高某的爱人在工友的帮助下为高某申请了工伤认定.医疗终结后,高某又自行申请了劳动能力鉴定,2009年8月,郑州市劳动能力鉴定委员会鉴定高某为5级伤残.由于该公司未为高某参加工伤保险协议,全部工伤待遇需要公司支付,因此公司1直拖付不给.面对公司的拖欠,高某向市劳动争议仲裁委员会申请了劳动仲裁,仲裁庭按5级伤残标准裁决该公司支付高某的工伤待遇.该公司不服,向法院提起上诉.1审过程中,由于距离原来的鉴定结论作出时间超过了1年,公司申请了劳动能力复查鉴定.由于恢复较好,王某的劳动能力复查鉴定结论为6级,王某和该公司都认可该复查鉴定结果,法院遂判决该公司按伤残6级标准支付王某工伤待遇.高某不服,认为1次性伤残补助金、伤残津贴等应按原来认定的5级支付,于是上诉至2审法院.2审法院审理后认为：高某的复查鉴定是在1审过程中进行的,依据《河南省工伤保险协议条例》的规定,复查鉴定结论的等级应自作出的次月才可作为执行依据；而高某申请仲裁与起诉所要求的是其工伤之初就应享受的工伤待遇,即复查鉴定做出前其应享受的工伤待遇,且公司对当时高某5级伤残鉴定的结论并未在法定期限内提出异议,因此判决：撤销1审判决,公司应按5级伤残支付高某的工伤待遇.解：本例提示了以下法律条文要点：●工伤发生后,企事业单位由于劳动争议1直未支付给干部及员工的工伤待遇,应依照劳动能力最终鉴定结论确定的等级支付,而不是复查鉴定结论变更后的等级；●劳动能力复查鉴定结论等级变化只对复查鉴定结论之后的工伤待遇支付等级与标准发生影响.本案中,高某的最终鉴定结论为伤残5级,但公司未依法支付,因此才产生了后面的仲裁与诉讼.高某在仲裁、诉讼中所要求的都是工伤后应享受的工伤待遇,而不是经过1定时期治疗与恢复、复查鉴定作出后的工伤待遇,1审法院判决以复查鉴定变更后的等级标准支付高某复查鉴定前应享受的待遇,没有法律条文依据,也实际损害了工伤职工高某的合法利益,因此被2审法院撤销.但是,复查鉴定作出后,根据《河南省工伤保险协议条例》的规定,高某应按复查鉴定的6级伤残等级享受工伤待遇.操作提示：1）伤残等级变更最直接影响的是伤残津贴发放与否及享受等级.2）1～4级伤残享受的伤残津贴由工伤保险协议基金承担,对于已为职工缴纳工伤保险协议的企事业单位来说,只需及时按程序向工伤保险协议基金申请变更即可.3）5～6级伤残的工伤职工享受伤残津贴的条件是,在企事业单位不能为工伤职工安排工作的情况下由企事业单位按法定标准发放.但是职工要求解除合同或者协议的,按统筹地区所在省、自治区或直辖市的有关规定,由用人单位支付1次性伤残就业补助金,工伤保险协议基金支付1次性工伤医疗补助金等待遇,与职工解除劳动关系后,停止支付伤残津贴,终结工伤保险协议关系.4）伤残等级变更后的工伤待遇支付办法与标准,各省市统筹地区的规定不尽相同,企事业单位需要向本地区劳动保障部门具体咨询确定.。

职工伤残退休规定

3.对于符合条件的伤残退休职工，公司可协助申请公租房、经济适用房等住房保障项目。
十六、伤残退休职工的子女教育
1.伤残退休职工的子女教育，享受国家及地方关于残疾家庭子女教育的优惠政策。
2.公司可根据实际情况，为伤残退休职工的子女提供助学金、奖学金等资助。
3.对于伤残退休职工子女报考高等教育、职业教育的，公司可给予一定的加分照顾。
六、其他规定
1.职工在伤残退休期间，如遇国家及地方政策调整，按照新政策执行。
2.职工在伤残退休期间，如发生死亡，按照国家及地方关于遗属待遇的相关规定执行。
3.本规定自发布之日起实施，原有相关规定与本规定不符的，以本规定为准。
4.本规定的解释权归公司人力资源部门。
七、伤残退休待遇的调整
1.公司将根据国家经济发展水平和物价变动情况，适时调整伤残退休待遇，确保职工的生活水平不因物价上涨而降低。
1.公司应关注伤残退休职工的心理健康，定期开展心理健康讲座和心理咨询，帮助他们调整心态，积极面对生活。
2.对于有特殊需要的伤残退休职工，公司可提供专业的心理辅导服务，帮助他们解决心理问题。
十五、伤残退休职工的住房保障
1.伤残退休职工的住房保障，按照国家及地方住房保障政策执行。
2.公司在分配住房时，对伤残退休职工给予优先考虑，确保他们的基本居住需求。
3.公司应加强对伤残退休职工的法律援助，为他们提供必要的法律支持。
二十、伤残退休职工的日常照料
1.公司应建立健全伤残退休职工的日常照料体系，提供必要的生活照料服务。
2.对于生活不能自理的伤残退休职工，公司可协助安排居家护理服务，或提供集中照料服务。
3.公司应定期检查伤残退休职工的生活设施，确保居住环境安全舒适。
2.公司应设立反馈渠道，及时收集并处理伤残退休职工的反馈信息，不断优化服务。

建议统一残疾辅助器具赔偿年限及配置标准

建议统一残疾辅助器具赔偿年限及配置标准在诉讼实务中，法官、律师经常遇到因伤残需要配置残疾辅助器具的问题。

由于现行法律及司法解释未对残疾辅助器具赔偿年限及配置标准作出统一的规定，在实践中有两种判法，其赔偿数额差距甚大。

对当事人来说，在适用法律上的不统一，造成新的司法不公；对于审判机关来说，由此而产生当事人不服上诉、申诉等缠讼事宜，造成司法资源的浪费；对社会来说，案结事未了，易产生新的不和谐、不稳定因素。

因此，有必要从立法上来统一，明确规定残疾辅助器具赔偿年限及配置标准，做到有法可依、依法办案，案结事了，彰显社会公平正义。

司法实践中的困惑：案同判不同，负担大不同案例1 2006年11月11日凌晨3时许，冯冬驾驶小客车因两车相撞，将在道中候车的吕宁左小腿挤压毁损伤，行左大腿中下3/1裁肢术，2007年5月8日，T市C假肢矫形器C分公司出具证明一份：吕宁适宜安装气压膝关节大腿假肢一条，价格为38，500元，使用年限为4-6年，每年维修费用为假肢价格的5%.C市法医学会司法鉴定所出具司法鉴定书一份，残疾用具费参照C市X医院假肢中心价格，安装大腿假肢1条需2.2万元，假肢使用年限5年，每年维修费用为假肢价格的5%.一审判决按余命计算，按5年使用年限需更换假肢5次，判假肢费用231，000元。

冯冬不服上诉，重庆市中院改判“根据相关法律规定及该分公司出具的假肢装配鉴定证明书，吕宁已安装38，500元假肢一幅，依据每5年尚需更换一次，共还需要更换3次，一审法院共主张5幅残疾辅助器具费欠妥，应予纠正”，终审判决假肢费用为192，500元。

（参见中国法制出版社出版《道路交通法律纠纷处理一本通》第413页《交通事故损害赔偿中的残疾辅助器具费用如何确定？》一文）该判例确认和主张的残疾辅助器具费用赔偿年限不是按余命赔偿，而是按20年赔偿。

案例2 2008年4月9日阳新某校学前班5岁半女童刘某横穿公路被车轧压发生交通事故，致左下肢大腿三分之一处截肢，某假肢厂司法鉴定意见，假肢每2年更换一次，每年维修费为假肢价格的10%，湖北省人均预期寿命为73.5岁。

人身保险伤残评定标准(行业标准)之欧阳化创编

中国保险行业协会、中国法医学会联合发布二零一三年六月八日根据中国保险行业协会联合中国法医学会发布的《人身保险伤残评定标准》以及中国保监会《关于人身保险伤残程度与保险金给付比例有关事项的通知》要求，我公司意外险相关产品将于2014年1月1日起全面采用新伤残标准，本激活卡使用的是旧伤残标准，为保障您的利益，若按新的标准给付金额大于条款约定的旧伤残标准，我公司将按照新伤残标准为您提供给付服务。

新伤残评定标准在伤残评定等级、伤残数目等方面拓展的范围远大于原标准，大幅增加了您的保障利益。

由此给您带来的困扰敬请谅解，详询95519。

新伤残标准如下：（见本文档附录）被保险人遭受意外伤害，并自该意外伤害发生之日起本合同约定的时间范围内因该意外伤害导致身体伤残的，本公司根据《人身保险伤残评定标准（行业标准）》（以下简称《标准》，见附表）的规定，按本合同约定的保险金额乘以该处伤残的伤残等级所对应的保险金给付比例给付伤残保险金。

当同一保险事故导致两处或两处以上伤残时，本公司仅按其中一处的伤残等级给付伤残保险金：如果各处的伤残等级不完全相同且最重的伤残等级所对应的伤残只有一处，本公司按最重的伤残等级所对应的保险金给付比例给付伤残保险金；如果各处的伤残等级完全相同或最重的伤残等级所对应的伤残有两处或两处以上，本公司将该伤残等级在原基础上晋升一级（但最高晋升至第一级），并按晋升后的伤残等级所对应的保险金给付比例给付伤残保险金。

同一部位和性质的伤残，不能采用《标准》条文两条以上或者同一条文两次以上进行评定。

人身保险伤残评定标准（行业标准）说明：1．本标准对功能和残疾进行了分类和分级，将人身保险伤残程度划分为一至十级，最重为第一级，最轻为第十级。

与人身保险伤残程度等级相对应的保险金给付比例分为十档，伤残程度第一级对应的保险金给付比例为100%，伤残程度第十级对应的保险金给付比例为10%，每级相差10%。

2．本标准中出现的“以上”，均包括本数值或本部位。

医疗事故伤残等级赔偿标准

医疗事故伤残等级赔偿标准具体年限或金根据患者的残等来确定：由于?医事故理条例?中假定我国的人均寿命是75周〔与?道路交通事故理法?中假定的人均寿命70相比，延了5年〕，故中“60周以上的，不超15年；70周以上的，不超5年〞的定，可按60周以上年每增加1减少1年的方式行算：60周算15年、61周算14年、62周算13年、⋯68周算7年、69周算6年，依次减，70周以上按5年算。

注意的十，算年限确定后，仍要乘以残等系数。

1、一乙等医事故〔一残〕算30年，即100%；2、二甲等医事故〔二残〕按一残的 90%算。

算公式：居民年平均生活×30年×90%〔残等系数，下同〕；3、二乙等医事故〔三残〕按一残的80%算；4、二丙等医事故〔四残〕按70%算；5、二丁等医事故〔五残〕按60%算；6、三级甲等医疗事故〔六级伤残〕按50%计算；7、三级乙等医疗事故〔七级伤残〕按40%计算；8、三级丙等医疗事故〔八级伤残〕按30%计算；9、三级丁等医疗事故〔九级伤残〕按20%计算；10、三级戊等医疗事故〔十级伤残〕按10%计算。

二、医疗过错致残如何赔偿如果医疗行为由司法鉴定机构进行司法过错鉴定，结论存在医疗过错的，那么适用?民法通那么?及最高法院关于审理人身损害赔偿案件适用法律假设干问题的司法解释之规定，赔偿标准如下：1、医疗费：根据医疗机构出具的医药费、住院费等收款凭证，结合病历和诊断证明等相关证据确定；2、误工费：根据受害人的误工时间和收入状况确定；误工时间根据受害人接受治疗的医疗机构出具的证明确定。

受害人因伤致残持续误工的，误工时间可以计算至定残日前一天；受害人有固定收入的，误工费按照实际减少的收入计算。

受害人无固定收入的，按照其最近三年的平均收入计算；受害人不能举证证明其最近三年的平均收入状况的，可以参照受诉法院所在地相同或者相近行业上一年度职工的平均工资计算；3、护理费：根据护理人员的收入状况和护理人数、护理期限确定；护理人员有收入的，参照误工费的规定计算；护理人员没有收入或者雇佣护工的，参照当地护工从事同等级别护理的劳务报酬标准计算。

人身保险伤残评定标准版之欧阳科创编

2013.11.19人身保险伤残评定标准中国保险行业协会、中国法医学会联合发布二零一三年六月八日目录前言人身保险伤残评定标准（行业标准）1 神经系统的结构和精神功能1.1 脑膜的结构损伤1.2 脑的结构损伤，智力功能障碍1.3 意识功能障碍2 眼，耳和有关的结构和功能2.1 眼球损伤或视功能障碍2.2 视功能障碍2.3 眼球的晶状体结构损伤2.4 眼睑结构损伤2.5 耳廓结构损伤或听功能障碍2.6 听功能障碍3 发声和言语的结构和功能3.1 鼻的结构损伤3.2 口腔的结构损伤3.3 发声和言语的功能障碍4 心血管，免疫和呼吸系统的结构和功能4.1 心脏的结构损伤或功能障碍4.2 脾结构损伤4.3 肺的结构损伤4.4 胸廓的结构损伤5 消化、代谢和内分泌系统有关的结构和功能5.1 咀嚼和吞咽功能障碍5.2 肠的结构损伤5.3 胃结构损伤5.4 胰结构损伤或代谢功能障碍5.5 肝结构损伤6 泌尿和生殖系统有关的结构和功能6.1 泌尿系统的结构损伤6.2 生殖系统的结构损伤7 神经肌肉骨骼和运动有关的结构和功能7.1 头颈部的结构损伤7.2 头颈部关节功能障碍7.3 上肢的结构损伤，手功能或关节功能障碍7.4 骨盆部的结构损伤7.5 下肢的结构损伤，足功能或关节功能障碍7.6 四肢的结构损伤，肢体功能或关节功能障碍7.7 脊柱结构损伤和关节活动功能障碍7.8 肌肉力量功能障碍8 皮肤和有关的结构和功能8.1 头颈部皮肤结构损伤和修复功能障碍8.2 各部位皮肤结构损伤和修复功能障碍前言根据保险行业业务发展要求，制订本标准。

本标准制定过程中参照世界卫生组织《国际功能、残疾和健康分类》（以下简称“ICF”）的理论与方法，建立新的残疾标准的理论架构、术语体系和分类方法。

本标准制定过程中参考了国内重要的伤残评定标准，如《劳动能力鉴定，职工工伤与职业病致残等级》、《道路交通事故受伤人员伤残评定》等，符合国内相关的残疾政策，同时参考了国际上其他国家地区的伤残分级原则和标准。

脑卒中一级预防研究进展

脑卒中一级预防研究进展张红池; 井坤娟; 李雪霏; 李婷婷【期刊名称】《《护理研究》》【年(卷),期】2019(033)022【总页数】4页(P3889-3892)【关键词】脑卒中; 一级预防; 健康教育; 综述【作者】张红池; 井坤娟; 李雪霏; 李婷婷【作者单位】河北大学护理学院河北 071000; 河北大学附属医院【正文语种】中文【中图分类】R473.54脑卒中是一种急性脑血管疾病，2017年《全球疾病负担研究分析》显示，脑卒中在伤残调整寿命年（DALYs）第 3位，与 2007年相比上升 15.7%[1]。

全球脑卒中发病率、死亡率、致残率有所下降，而我国却呈现增长趋势，脑卒中防控形势不容乐观[2]。

脑卒中可防可控，早期识别危险因素，并采取积极有效的干预，可降低脑卒中的发病率，脑卒中一级预防至关重要[3]。

一级预防主要针对脑卒中高危人群，目前脑卒中的二级预防由于初次发病带来不同程度的功能障碍已经引起人们较大的重视，但对脑卒中一级预防却不够重视，开展慢性病的健康教育，对居民进行药物干预和生活方式干预可以降低慢性病的发病率，因此开展脑卒中的一级预防势在必行[4]。

现将脑卒中一级预防的研究现状进行综述，以为有效干预提供依据。

1 脑卒中高危人群现状过去40年中，高收入国家脑卒中发病率下降了约42%，然而在中低等收入国家却增长了近1倍[5]，在我国东部地区的脑卒中筛查中发现，高血压、血脂异常、运动锻炼缺乏、糖尿病等出现农村地区高于城市的状况[6]；2011年对我国六省市脑卒中调查分析显示，40～64岁患病率为45.63%[7]，其中高血压、血脂异常、超重和肥胖为前3位主要危险因素，同样农村高于城市。

可能与我国城市地区居民文化程度、经济水平和医疗保健水平比农村地区高有关，因而表现为健康的生活方式和行为。

据2013年开展的31省份155个城乡调查，我国脑卒中风险因素患病率存在地区差异，其中西北和华东地区高血压患病率最高约为88.0%，华南地区糖尿病患病率最高为18.0%，中部地区血脂异常最高为27.5%[8]。