BACKGROUND & AIMS: STUDY DESIGN:This was a cross-sectional study. OBJECTIVE:The primary aim of the study was to examine the association between low back pain (LBP) and muscle-strengthening activity (MSA) among U.S. adults using gender-stratified analyses. SUMMARY OF BACKGROUND DATA:LBP is a common medical condition that impacts quality of life and professional productivity and increases the financial burden on the health care system by augmenting medical treatment costs. Previous studies analyzing gender-dependent relationships between MSA and LBP have produced mixed results. METHODS:Our sample included 12,721 participants from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES). Participants were categorized into one of three levels of self-reported MSA: no MSA, insufficient MSA (1 day/wk), or meeting the 2008 Department of Health and Human Services (DHHS) recommendation for MSA (≥2 days/wk). RESULTS:Gender-stratified analyses revealed significantly lower odds of reporting LBP among women [odds ratio (OR) 0.82, 95% confidence interval (CI) 0.70-0.96, P = 0.03] and men (OR 0.86; 95% CI 0.70-0.96, P = 0.01) who reported amounts of MSA that met the DHHS recommendation compared with those reporting no MSA. Following adjustment for smoking status, the odds remained significant among women (P = 0.03) but not among men (P = 0.21). CONCLUSION:These findings indicate that engaging in MSA at least 2 days/wk is associated with lower odds of LBP and that smoking may be an important mediating factor that should be considered in future LBP research. LEVEL OF EVIDENCE:4.

背景与目标：

BACKGROUND & AIMS: :Intercellular adhesion in some parenchyma becomes strengthened in response to stress. The present study provides an approach to investigate this phenomenon (usually attributed to pectin methyl esterase and binding of Ca(2+) and/or rhamnogalacturonan-II-borate) through reliable stress simulation by probing organic acid molecules in potato tuber parenchyma. Short-chain monocarboxylic acids induce consistent intercellular adhesion strengthening (3.8-5.3 newton) at pH >or= 3 < pK(a), where pectin methyl esterase activity and Ca(2+) or borate binding are limited, and vice versa at pH > pK(a) with a strength of 1.4-2.0 newton as compared to 0.3-0.4 newton for the nonincubated control. Strengthening of intercellular adhesion is characterized by prominent staining of pectin and protein and immunogold labeling of pectin in the cell wall and the middle lamellar complex, particularly after boiling. Pectin confers strengthening to the primary cell wall, as reflected by: (i) prominent immunogold labeling following boiling; and (ii) puncturing macerated cells by starch gelatinization pressure after enzymatic pectin removal.

背景与目标： : 一些薄壁组织的细胞间粘附在应激反应中得到加强。本研究提供了一种方法，通过探测马铃薯块茎薄壁组织中的有机酸分子，通过可靠的应力模拟来研究这种现象 (通常归因于果胶甲基酯酶和Ca(2) 和/或鼠李糖半乳糖醛酸-II-硼酸酯的结合)。短链单羧酸在pH> 或 = 3 < pK(a) 时诱导一致的细胞间粘附增强 (3.8-5.3牛顿)，其中果胶甲基酯酶活性和Ca(2) 或硼酸盐结合受到限制，与未孵育对照的0.3-0.4牛顿相比，pH> pK(a) 的强度为1.4-2.0牛顿，反之亦然。增强细胞间粘附的特征是果胶和蛋白质的显着染色以及果胶在细胞壁和中层状复合物中的免疫金标记，尤其是在煮沸后。果胶赋予增强原代细胞壁的力量，这反映在 :( i) 沸腾后显着的免疫金标记; (ii) 在酶促果胶去除后，通过淀粉糊化压力刺穿浸软细胞。

BACKGROUND & AIMS: BACKGROUND:Game-based training has been shown to improve behavioural motor learning in various medical fields including rehabilitation. OBJECTIVES:This study aimed to investigate the effects of a tablet PC (personal computer) game-based tongue training on tongue strength, thickness and compliance in healthy adults. METHODS:This study recruited 30 healthy volunteers. Subjects were randomly assigned to two groups (n = 15/group). Group 1 performed game-based tongue training, and group 2 performed tongue resistance training using the Iowa Oral Performance Instrument. Both groups performed the same tongue exercises as follows: frequency (isotonic = 30 times × 3, isometric = 20 seconds × 3), intensity (70% of 1-repeated maximum contraction) and intervention period (5 days for 6 weeks). The primary outcomes were tongue muscle strength and thickness. Secondary outcomes were assessed using a 0-to-10 numerical rating self-report scale that included motivation, interest/fun, physical effort and muscle fatigue/pain. RESULTS:Both groups showed significant improvement in tongue strength and thickness, but there were no significant differences between the groups after the intervention. The self-report scale numerical rating revealed that group 1 had significantly higher motivation and interest/fun after the exercise than group 2. Group 1 had expended a significantly lower physical effort than group 2. No significant differences were noted between the 2 groups for muscle fatigue/pain. CONCLUSION:This study showed that both exercises had similar effects on tongue strength and thickness increase in healthy adults, but game-based tongue training was more fun and physically less demanding.

背景与目标：

BACKGROUND & AIMS: PRIMARY OBJECTIVE:To investigate if an isokinetic strength training programme for leg muscles lead to personally meaningful changes in adults with an acquired brain injury (ABI). RESEARCH DESIGN:A qualitative exploratory design. METHODS:Twelve people with ABI participated in pre- and post-intervention face-to-face interviews with open ended questions. Data were initially analysed using a case study research approach exploring individuals experiences and then cross case analysis to determine common themes for the group. INTERVENTION:Twelve-week isokinetic strength training programme for ankle and knee muscles. OUTCOMES:Participants perceived changes. RESULTS:Thematic analysis determined four main themes arising from the interviews; occupation, vitality, sense of self and personal interactions. Participants reported reductions in impairments as a response to the exercise programme and these changes led to increased function and participation in activities they valued. Also marked improvements in vitality were reported as well as increases in self-esteem and general well-being for many participants. CONCLUSIONS:An isokinetic strength training programme resulted in improvements in motor skills and functional abilities that were meaningful for the participants.

背景与目标：

BACKGROUND & AIMS: :The Hall-Petch relationship, according to which the strength of a metal increases as the grain size decreases, has been reported to break down at a critical grain size of around 10 to 15 nanometres1,2. As the grain size decreases beyond this point, the dominant mechanism of deformation switches from a dislocation-mediated process to grain boundary sliding, leading to material softening. In one previous approach, stabilization of grain boundaries through relaxation and molybdenum segregation was used to prevent this softening effect in nickel-molybdenum alloys with grain sizes below 10 nanometres3. Here we track in situ the yield stress and deformation texturing of pure nickel samples of various average grain sizes using a diamond anvil cell coupled with radial X-ray diffraction. Our high-pressure experiments reveal continuous strengthening in samples with grain sizes from 200 nanometres down to 3 nanometres, with the strengthening enhanced (rather than reduced) at grain sizes smaller than 20 nanometres. We achieve a yield strength of approximately 4.2 gigapascals in our 3-nanometre-grain-size samples, ten times stronger than that of a commercial nickel material. A maximum flow stress of 10.2 gigapascals is obtained in nickel of grain size 3 nanometres for the pressure range studied here. We see similar patterns of compression strengthening in gold and palladium samples down to the smallest grain sizes. Simulations and transmission electron microscopy reveal that the high strength observed in nickel of grain size 3 nanometres is caused by the superposition of strengthening mechanisms: both partial and full dislocation hardening plus suppression of grain boundary plasticity. These insights contribute to the ongoing search for ultrastrong metals via materials engineering.

背景与目标： : 据报道，霍尔-佩奇关系 (根据该关系，金属的强度随着晶粒尺寸的减小而增加) 在临界晶粒尺寸约为10至15纳米1、2时分解。随着晶粒尺寸的减小超过这一点，变形的主要机制从位错介导的过程转换为晶界滑动，从而导致材料软化。在以前的一种方法中，通过松弛和钼偏析来稳定晶界，以防止晶粒尺寸低于10纳米的镍钼合金中的这种软化作用3。在这里，我们使用金刚石砧座电池和径向x射线衍射原位跟踪各种平均晶粒尺寸的纯镍样品的屈服应力和变形纹理。我们的高压实验表明，晶粒尺寸从200纳米降至3纳米的样品持续强化，晶粒尺寸小于20纳米时强化 (而不是减少)。我们在我们的3纳米粒度样品中获得约4.2千兆帕的屈服强度，比商业镍材料强十倍。在此处研究的压力范围内，在晶粒尺寸为3纳米的镍中获得了10.2千兆帕斯卡的最大流动应力。我们在金和钯样品中看到类似的压缩强化模式，直至最小的晶粒尺寸。模拟和透射电子显微镜表明，在晶粒尺寸为3纳米的镍中观察到的高强度是由强化机制的叠加引起的: 部分和全位错硬化以及晶界塑性的抑制。这些见解有助于通过材料工程不断寻找超强金属。

BACKGROUND & AIMS: BACKGROUND:Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. METHODS:The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. DISCUSSION:There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. TRIAL REGISTRATION:MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.

背景与目标：

BACKGROUND & AIMS: :The coronavirus-disease 2019 (COVID-19) was announced as a global pandemic by the World Health Organization. Challenges arise concerning how to optimally support the immune system in the general population, especially under self-confinement. An optimal immune response depends on an adequate diet and nutrition in order to keep infection at bay. For example, sufficient protein intake is crucial for optimal antibody production. Low micronutrient status, such as of vitamin A or zinc, has been associated with increased infection risk. Frequently, poor nutrient status is associated with inflammation and oxidative stress, which in turn can impact the immune system. Dietary constituents with especially high anti-inflammatory and antioxidant capacity include vitamin C, vitamin E, and phytochemicals such as carotenoids and polyphenols. Several of these can interact with transcription factors such as NF-kB and Nrf-2, related to anti-inflammatory and antioxidant effects, respectively. Vitamin D in particular may perturb viral cellular infection via interacting with cell entry receptors (angiotensin converting enzyme 2), ACE2. Dietary fiber, fermented by the gut microbiota into short-chain fatty acids, has also been shown to produce anti-inflammatory effects. In this review, we highlight the importance of an optimal status of relevant nutrients to effectively reduce inflammation and oxidative stress, thereby strengthening the immune system during the COVID-19 crisis.

背景与目标： : 冠状病毒疾病2019 (新型冠状病毒肺炎) 被世界卫生组织宣布为全球大流行。关于如何在一般人群中最佳支持免疫系统，尤其是在自我约束下，出现了挑战。最佳的免疫反应取决于充足的饮食和营养，以防止感染。例如，足够的蛋白质摄入量对于最佳抗体生产至关重要。微量营养素状态低，如维生素a或锌，与感染风险增加有关。通常，营养不良的营养状况与炎症和氧化应激有关，这反过来又会影响免疫系统。具有特别高的抗炎和抗氧化能力的饮食成分包括维生素c，维生素e和植物化学物质，例如类胡萝卜素和多酚。这些中的一些可以与转录因子如NF-kB和Nrf-2相互作用，分别与抗炎和抗氧化作用有关。维生素d尤其可能通过与细胞进入受体 (血管紧张素转化酶2) ace2相互作用而干扰病毒感染。由肠道菌群发酵成短链脂肪酸的膳食纤维也被证明具有抗炎作用。在这篇综述中，我们强调了相关营养素的最佳状态对于有效减少炎症和氧化应激的重要性，从而在新型冠状病毒肺炎危机期间增强免疫系统。

BACKGROUND & AIMS: :Vaccines are one of the most successful health interventions in history. Yet, vaccine-preventable diseases still claim the lives of 2.5 million individuals globally every year. Approximately 60% of the 19.4 million infants that did not have access to routine immunization services in 2018 live in 10 countries, one of which is Indonesia. In order to reach global targets, it is critical for countries such as Indonesia to prioritize, tailor, and operationalize vaccination strategies to address immunization gaps. Pediatricians and national pediatric societies (NPS) are trusted stakeholders in their countries and are uniquely qualified to promote vaccination programs. The American Academy of Pediatrics (AAP) partnered with the Indonesian Pediatric Society (IPS), with support from the US Centers for Disease Control and Prevention (CDC), to initiate a multiyear project to build the capacity of IPS, individual members, and other child health clinicians to strategically advocate for improved immunization services across both public and private sectors.

背景与目标： : 疫苗是历史上最成功的健康干预措施之一。然而，疫苗可预防的疾病仍然每年夺走全球250万个人的生命。1940万名无法获得常规预防接种服务的婴儿中，约有60% 名2018年生活在10个国家，其中一个国家是印度尼西亚。为了达到全球目标，印度尼西亚等国家必须优先考虑、调整和实施疫苗接种战略，以解决预防接种差距。儿科医生和国家儿科学会 (NPS) 是其国家值得信赖的利益相关者，并且具有促进疫苗接种计划的独特资格。美国儿科学会 (AAP) 与印度尼西亚儿科学会 (IPS) 合作，在美国疾病控制和预防中心 (CDC) 的支持下，发起了一个多年项目，以建设IPS的能力，个人成员，和其他儿童保健临床医生在战略上倡导改善公共和私营部门预防接种服务。

BACKGROUND & AIMS: :Since its founding in 1950, the Society for Public Health Education (SOPHE) has evolved in response to the changing needs of both the public and the profession. This SOPHE Presidential Address provides a brief review of SOPHE's history and the legacy of its achievements over some 60 years. It also describes how new challenges being created by the pending organizational realignment between SOPHE and the American Association for Health Education, which promises to further unify the profession, along with changing American community demographics, can provide an opportunity for SOPHE to strengthen the health education profession by becoming more inclusive and further redefining Dorothy Nyswander's concept of the "Open Society" and the role health educators play as agents of change.

背景与目标： : 自成立1950年以来，公共卫生教育协会 (SOPHE) 不断发展，以适应公众和专业人士不断变化的需求。这次索菲总统演讲简要回顾了索菲的历史及其60年来成就的遗产。它还描述了SOPHE和美国健康教育协会之间即将进行的组织重组如何带来新的挑战，该协会有望进一步统一该行业，以及不断变化的美国社区人口结构，可以为SOPHE提供一个机会，通过变得更具包容性，并进一步重新定义Dorothy Nyswander的 “开放社会” 概念以及健康教育者作为变革推动者的角色，来加强健康教育专业。

BACKGROUND & AIMS: :For over three decades, environmental assessment (EA) has gained increasing international recognition as a means of ensuring sustainable development. In light of environmental challenges, Benin has endorsed the principle that a healthy environment is a human right. This concern is manifested by the creation of many institutions for managing environmental issues. But until today, environmental problems are still on the rise and getting worse day by day because of Benin's limited experience in the field of EA. If EA is to be perceived as an instrument of sustainable development, it is important to take into account the achievements and the needs of the country in this field; because we cannot respond properly and adequately in the field of capacity strengthening in EA without first be familiar with what exists, what is fact, and what is needed. In this study, we address and analyze the status of existing resources in the field of EA in Benin with the purpose of identifying the needs for capacity strengthening to enhance environmental assessment effectiveness in the country. The detailed presentation of the results shows that the legislative and institutional resources are available and represent a strong element in the system of environmental management in Benin. However, there is still a room for improvements towards environmental governance before it becomes a solid system of decision supporting all sectors of intervention because the effective application of those laws and texts still constitute big challenges. Below are the main reasons that explain the particular situation: majority of the laws are put in force very late or taken without implementing decree at all; the organizational capabilities have large gaps; the absence of a mechanism for evaluating the needs for strengthening capacity for EA. Recommendations pinpointed three types of needs which must be filled to enhance the effectiveness of EA in Benin: upstream needs of the structure of EA; implementation and enforcement needs; and, maintenance and efficiency needs.

背景与目标： : 三十多年来，环境评估 (EA) 作为确保可持续发展的一种手段，已获得越来越多的国际认可。鉴于环境挑战，贝宁赞同健康环境是一项人权的原则。这种关切体现在建立了许多管理环境问题的机构。但是直到今天，由于贝宁在EA领域的经验有限，环境问题仍在上升，并且日益恶化。如果要将环境评估视为可持续发展的工具，重要的是要考虑到该国在这一领域的成就和需求; 因为如果不首先熟悉现有的情况，事实，我们就无法在环境评估能力增强领域做出适当和充分的反应，以及需要什么。在这项研究中，我们处理和分析贝宁环境评估领域现有资源的状况，目的是确定加强能力以提高该国环境评估效力的需求。结果的详细介绍表明，立法和体制资源是可用的，是贝宁环境管理系统中的重要组成部分。然而，在环境治理成为支持所有干预部门的坚实决策系统之前，仍有改进的空间，因为这些法律和文本的有效适用仍然构成巨大挑战。以下是解释这种特殊情况的主要原因: 大多数法律实施得很晚，或者根本没有执行法令; 组织能力有很大差距; 缺乏评估加强环境评估能力需求的机制。建议指出了必须满足的三种需求，以提高贝宁EA的有效性: EA结构的上游需求; 实施和执行需求; 以及维护和效率需求。

BACKGROUND & AIMS: :Following publication of the original article [1], the authors reported they wanted to reinstate a co-author, who previously declined his authorship due to a misinterpretation of authorship limitations per research center.

背景与目标： : 在发表原始文章 [1] 之后，作者报告说他们想恢复一位合著者，该合著者先前因对每个研究中心的作者限制的误解而拒绝了他的作者身份。

BACKGROUND & AIMS: :Organoarsenic arsanilic acid (ASA) contamination of paddy soil is a serious but less concerned hazard to agriculture and health of people consuming rice as staple food, for rice is one major pathway of arsenic (As) exposure to human food. To date little research has studied the effect of ASA on biochemical process of rice. Silicon (Si) application is able to reduce the toxicities of heavy metals in numerous plants, but little information about ASA. This work investigated whether and how Si influenced alleviation of ASA toxicity in rice at biochemical level to have a better understanding of defense mechanism by Si against ASA stress. Results showed that ASA reduced rice growth, disturbed protein metabolism, increased lipid peroxidation but decreased the efficiencies of antioxidant activities compared to control plants, more severe in roots than in shoots. The addition of Si in ASA-stressed rice plants noticeably increased growth and development as well as soluble protein contents, but decreased malondialdehyde (MDA) contents in ASA-stressed rice plants, suggesting that Si did have critical roles in ASA detoxification in rice. Furthermore, increased superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD) activities along with elevated glutathione (GSH) and ascorbic acid (AsA) contents implied the active involvement of ROS scavenging and played, at least in part, to Si-mediated alleviation of ASA toxicity in rice, and these changes were related to rice genotypes and tissues. The study provided physio-chemical mechanistic evidence on the beneficial effect of Si on organoarsenic ASA toxicity in rice seedlings.

背景与目标： : 水稻土中的有机砷酸 (ASA) 污染是一种严重但对食用大米作为主食的人的农业和健康危害较小，因为大米是砷 (as) 暴露于人类食物的主要途径之一。迄今为止，很少有研究研究ASA对水稻生化过程的影响。硅 (Si) 的应用能够降低许多植物中重金属的毒性，但有关ASA的信息很少。这项工作调查了Si是否以及如何在生化水平上影响水稻中ASA毒性的缓解，以更好地了解Si对ASA胁迫的防御机制。结果表明，与对照植物相比，ASA降低了水稻的生长，干扰了蛋白质代谢，增加了脂质过氧化，但降低了抗氧化活性的效率，根比芽更严重。在ASA胁迫的水稻植物中添加Si可显着增加生长和发育以及可溶性蛋白质含量，但降低了ASA胁迫的水稻植物中丙二醛 (MDA) 的含量，这表明Si确实在水稻ASA解毒中起着关键作用。此外，超氧化物歧化酶 (SOD)，过氧化氢酶 (CAT) 和过氧化物酶 (POD) 活性的增加以及谷胱甘肽 (GSH) 和抗坏血酸 (AsA) 含量的升高暗示了ROS清除的积极参与，至少部分发挥了作用Si介导的水稻ASA毒性的减轻，这些变化与水稻的基因型和组织有关。该研究为Si对水稻幼苗中有机砷ASA毒性的有益作用提供了理化机理证据。

BACKGROUND & AIMS: :Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

背景与目标： : 接触穷人和非正规部门是在欠发达国家实现全民覆盖的主要挑战。在柬埔寨，卫生公平基金对穷人的广泛覆盖创造了机会，可以在政府拟议的社会卫生保护结构下巩固各种非政府卫生筹资计划。本文确定了加强针对穷人和非正规部门的现有安排的主要政策和业务挑战，并考虑了解决这些障碍的政策选择。该研究于2011-12年与柬埔寨卫生部联合进行，审查了政策文件，并通过与政府，非政府和捐助者官员进行的18次半结构化关键线人访谈收集了定性数据。使用组织评估对数据进行了分析，以改善和加强卫生筹资概念框架。我们发现，与机构，组织和健康筹资问题有关的严重短缺导致分散，并限制了社会健康保护计划的实施，包括健康公平基金，社区健康保险，代金券等。关键文件提议建立一个统一非正规部门计划的国家结构，但仍未解决与国家机构的结构，机构能力和第三方地位有关的问题。这项研究增加了发展中国家非正规部门社会健康保护适当和有效的体制和组织安排的证据基础。主要经验教训包括: 需要扩大医疗保健的财政空间; 对公平的承诺; 保护穷人的具体措施; 建设国家管理全民覆盖的能力; 并在特定的国家背景下开展工作。

BACKGROUND & AIMS: :Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports 'best fit' solutions and accommodates political realities in health systems strengthening.

背景与目标： : 治理越来越被认为是卫生系统绩效的一个重要因素，但在概念和实践上，治理仍然知之甚少，而且往往对其作用和如何解决其弱点的模糊和相互竞争的概念。健康治理专题讨论会的这篇概述文章提出了一种健康治理模型，该模型着重于卫生系统中社会行为者的多样性，他们之间的角色和责任分配以及他们履行这些角色和责任的能力和意愿。这一重点突出了行为者之间的委托代理联系，以及由此产生的善治和卫生系统绩效激励。讨论确定了三个脱节，这些脱节构成了卫生系统加强旨在改善治理的干预措施的挑战 :( 1) 善治议程与现有能力之间的差距，(2) 正式治理与非正式治理之间的差异以及 (3) 对社会政治权力动态。本文总结了研讨会中的三个国家案例，并重点介绍了它们的治理发现: 中国的卫生部门改革，巴西市政当局的卫生资源财务管理和莱索托医院的预算改革。结论部分阐明了这三个案例如何应用该模型的委托代理联系，并强调了填补问题诊断与制定支持 “最佳” 解决方案并适应加强卫生系统中的政治现实的实用指南之间剩余差距的重要性。

BACKGROUND & AIMS: INTRODUCTION:Community-engaged research is effective in addressing health disparities but may present challenges for both academic institutions and community partners. Therefore, the need to build capacity for conducting collaborative research exists. The purpose of this study is to present a model for building research capacity in academic-community partnerships. METHOD:The Building Collaborative Research Capacity Model was developed as part of the Community Engagement Research Program (CERP) of the Atlanta Clinical and Translational Science Institute (ACTSI). Six domains of collaborative research capacity were identified and used to develop a model. Inputs, activities, outputs, and outcomes of building collaborative research capacity are described. RESULTS:To test this model, a competitive request for applications was widely distributed and four community-based organizations were funded to participate in a 2-year program with the aim of conducting a pilot study and submitting a research proposal for funding to National Institutes of Health or another major funding agency. During the first year, the community-based organization partners were trained on conducting collaborative research and matched with an academic partner from an ACTSI institution. Three of the academic-community partnerships submitted pilot study results and two submitted a grant proposal to a national agency. DISCUSSION:The Building Collaborative Research Capacity Model is an innovative approach to strengthening academic-community partnerships. This model will help build needed research capacity, serve as a framework for academicians and community partners, and lead to sustainable partnerships that improve community health.

背景与目标：