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目的以长三角三省一市（A、B、C、D）为例，描述耐药结核病定点医院抗结核治疗药品供应现状，基于耐 药结核病诊疗指南分析探讨耐多药和利福平耐药结核病（MDR/RR-TB）患者治疗的可及性。方法采用自行设计 的机构调查表对长三角三省一市耐药结核病定点医院进行问卷调查，了解医院基本情况、药晶使用、短缺、报销 政策等现状。结果调查的20种抗结核治疗药物在不同地区、不同医院的覆盖率不同，其中特立齐酮（Trd）、普瑞 马尼（Pretomanid）、德拉马尼（Dim）和乙硫异烟胺（Eto）等药物的使用覆盖率较低，分别为2.7%、5.4%、5.4%、 5.4%。对照药品供应目录及世界卫生组织和我国耐多药诊疗指南中推荐的规范化耐多药肺结核治疗方案，有5家 医院（A有2家，D有3家）尚不能满足标准治疗方案的药岛基本要求。利奈哇胺（Lzd）、氯法齐明（Cfiz）、环丝氨 酸（Cs）、卷曲霉素（Cm）和乙胺丁醇（EBM）等药晶在使用的医院均出现过不同程度的短缺，其中，B2作为市级 专科医院，药晶短缺情况较为严重，该医院使用药晶中87.5%均出现过短缺。绝大多数调查的药晶均已纳入医疗 保险或通过政府采购免费提供的方式惠及患者。结论部分耐多药肺结核定点医院仍然存在治疗不规范、不合理 的现象。完善医疗供应机制，避免因药品短缺而造成的治疗不规则，提高医疗保险补偿范围，扩大可报销的药品 种类依然是目前急需解决的问题。. [ABSTRACT FROM AUTHOR]

Objective To develop a questionnaire for assessing bone health literacy among perimenopausal and postmenopausal women, then evaluate its reliability and validity, and to provide scientific evidence for the application of the questionnaire in the middle-aged and elderly. Methods A theoretical framework was developed based on the integrated theoretical model of health literacy proposed by Regional Office for Europe of WHO in 2012. Based on the relevant research on bone health at home and abroad, and through two rounds of expert consultation, a bone health literacy questionnaire was formed. The community women aged 45-65 years were investigated in 7 urban and suburban districts of Shanghai. Cronbach’s α and split-half reliability were calculated to evaluate the reliability of bone health literacy questionnaire; content, discriminant, convergent and structural validity were performed to measure the validity of the questionnaire. Results A forty-item bone health literacy questionnaire for perimenopausal and postmenopausal women was finalized through expert meetings. A total of 447 women aged 45-65 years from community were investigated for the evaluation. The overall Cronbach's α of the bone health literacy questionnaire was 0.763 and the split-half reliability was 0.793. The correlation coefficient of each sub-questionnaire with the total questionnaire was 0.403-0.703. The bone health literacy questionnaire had good content validity, with the success rate of calibration experiment of 57.50% and 86.25% respectively. Confirmatory factor analysis showed that the goodness of fit index (GFI) and other indicators reached the adaptation standard, and the structural validity was good. Conclusion The questionnaire has good reliability and validity, and can be used as a simple tool to measure and evaluate bone health literacy among middle-aged and elderly women. [ABSTRACT FROM AUTHOR]