谁在为中国中小学生的健康守门?——中小学校医室人员的现状、功能定位及发展方向

目的：通过研究了解目前中小学校医室人员的现状及功能定位,分析当前健康服务能否满足需求,并就中小学校医室的发展方向提出建议。方法：采用分层抽样方法选择6省18县的中小学校,采取网络问卷和现场访谈结合的调研方式获取数据资料,结合定量与定性研究方法进行描述分析。结果：中小学校医室人员以大学本科及以上学历为主,但多为兼职。工作内容以健康教育、传染病预防、急救为主,在心理咨询、学生健康体质监测方面较为缺乏。未来校医室的发展依赖教育部门与卫生部门的多方合作、校医室及其人员功能的明确定位、校医队伍的培训及发展途径的改善。     

广州市多渠道配置模式后公立中小学校医队伍建设现状

了解广州市采用多渠道配置校医模式后公立中小学校医队伍建设情况,为中小学校校医配置改革提供借鉴.方法 以广州市1099所中小学校为调研对象,采用问卷调查收集和分析校医配备、校医个人基本信息及工作情况.结果 中小学校中有638所配备了707名专职校医,配备率为58.05%,合格率为28.20%;校医招聘仍以自主招聘为主(55.87%),购买服务模式(社区派驻、医院购买服务、校医室托管)配置的占44.13%.校医专业以护理为主(56.86%),其次为临床(26.03%)、预防医学(9.76%);在职称方面,初、中、高级职称分别占52.47%,37.34%,1.27%;高达68.74%的校医工作年限在5年以下:平均每0.5年1次的培训占68.60%.校医对工资待遇满意率为33.95%,不满意率为20.79%.与2016年相比,校医队伍的学历、职称、工作条件变化不大,专业构成方面,临床医学减少,护理明显增多,工作负荷有所减少,但工资待遇满意度下降(P值均<0.01).结论 采用多渠道配置校医模式后,广州市中小学校医队伍建设取得突破性进展.建议完善校医规范化工作指引,加强专业技能培训与考核,整体提升全市学校卫生工作水平.     

河南省中小学校医室现况

了解河南省中小学校医室的现状,为中小学校卫生政策的科学决策提供依据.方法 采用调查问卷形式,对河南省全部18个地市所有设置校医室的中小学校共2 005所进行调查.结果 河南省中小学校医室的配置率为8.90%,校医室配置率低于10%的地区有9个;不同类别学校的校医室配置率最低的为小学,配置率为4.67%;设立时间在5 a及以下的校医室占60.95%,校医室医疗机构执业许可证持有率为23.29%.8项基本医疗设备配备齐全的学校校医室所占比例为32.71%.9.87%的校医室没有建立相关工作档案.结论 河南省中小学校校医室配置率较低,医疗机构执业许可证持有率低,医疗设备配备不齐全.应进一步规范和加强校医室的建设工作.     

中国中小学校医队伍建设现状

  目的  分析《学校卫生工作条例》实施以来中国学校校医队伍建设现状，为引发对中小学校医管理制度的思考提供依据。  方法  在中国东、中、西部选择有代表性的省份(江苏、山东、江西、河北、青海、陕西)，通过定量研究和定性访谈进行混合方法研究。  结果  具有医学背景的校医占比为33.64%，部分校医(31.6%)尚未落实编制。校医在学校中地位较低，在收入、奖金分配、评优等方面较一线教师差距大，校医工资水平远低于教育行业和社会卫生保障福利业工资水平，有些地区甚至低于当地社会平均工资。薪酬水平呈现地域间不平衡，东部地区薪酬水平较高，中西部除个别地区，整体薪酬水平低。医学背景校医与非医学背景校医在最高学历、年收入水平、工作性质、是否在编、职业发展机会、收入满意度、福利待遇满意度和培训满意度之间差异均有统计学意义(χ2值分别为10.73，26.64，313.44，14.13，29.14，13.22，12.97，19.44，P值均 < 0.05)。  结论  需充分重视中小学校医队伍建设，将学校卫生纳入公共卫生管理体系，划分校医管理主体，规范校医务室工作办法，畅通校医人事薪酬及职称晋升通道。     

我国中小学校专职校医配备现状

探讨我国中小学校专职校医配备现状及分布差异,为制定国家卫生决策和优化学校卫生工作人员配备提供参考.方法 采用现况研究的方法,对全国8省市7 753所中小学校进行问卷调查,内容包括学校基本情况及学校专职校医配备情况,采用SPSS 13.0软件进行统计学分析.结果 我国中小学校专职校医总体配备率及配备合格率分别为9.65%,1.95%;专职校医配备率在不同地区(东部24.95%,中部4.22%,西部3.83%)、城乡(城市46.54%,农村3.90%)、学校类型(普通小学3.32%,普通初中21.29%,普通高中75.76%,其他类型学校40.32%)、学校规模(≤600人学校2.36%,601~1 200人学校16.40%,>1 200人学校46.58%)差异均有统计学意义(P值均<0.01);中小学校专职校医配备合格率在不同地区、城乡、学校类型、学校规模间差异也均有统计学意义(P值均<0.01).结论 我国中小学校专职校医配备尚不能达到国家要求,且存在显著的区域、城乡、学校类型及规模差异.需采取措施保证中小学校专职校医队伍建设.     

北京市中小学校医传染病防制知信行调查

目的了解北京市中小学校医对传染病知识、态度、行为情况。方法2007年5月，对北京市4个区310名中小学校医进行问卷调查。结果校医对传染病相关知识掌握不足，尤其对发热的概念只有50％的人掌握；校医基本能掌握常见传染病的传播途径，但对乙肝传播途径知晓率仅为67，42％；校医普遍认为做好学校日常传染病预防工作对维持正常的教学秩序是重要的；80％以上的校医存有晨午检记录和缺勤登记记录。结论有必要通过培训、改善工作条件等方式进一步完善中小学校传染病防治工作体系。     

北京西城区中小学传染病防控工作监测结果分析

目的了解北京市西城区学校传染病监测效果以及影响因素,为传染病早期预警监测提供依据。方法选取西城区10所有代表性的中小学校医10名,中小学保健所、疾病预防控制中心、地段保健科传染病防控人员8名,患传染病学生家长10名,进行深入访谈。同时对西城区所有中小学校医128名进行问卷调查,获取学校传染病监测过程中不同角色人员的态度、行为及建议。结果无论学校管理者、校医,还是学生家长均认可学校实施传染病监测的重要性,而班主任的重视程度相对偏低。由于工作量和时间限制,班主任无法有效地承担每日传染病监测工作。校医整体的专业水平有待提高。在学校实施传染病防控措施中,家长最关注的是学生被耽误学业,长时间陪护也存在一定困难。结论现有的学校传染病监测工作还存在不足。需加强班主任教育管理,强化晨午检的时效性;提高校医的专业技术水平;建立灵活有效的传染病隔离措施,减少家长和学生负担。     

中国中小学在职校医急救外伤处置技能及影响因素分析

了解中国中小学在职校医的分布特征、急救外伤处置技能情况及其影响因素,为提升校医的技能水平提供证据支持.方法 采用分层整群随机抽样方法,选取中国东、中、西部538名中小学在职校医作为研究对象,描述基本情况及8项急救外伤处置技能掌握情况,并分析影响因素.结果 我国中小学在职校医多为教育及其他专业背景人员兼职,女性占71.38%,年龄分布呈现枣核形状,本科及以上学历占50.96%,中级职称占50.74%,医学背景占33.46%.校医的急救外伤处置技能水平整体不高,尤其对气道异物阻塞处理方法、不同部位骨折固定处理方法的掌握情况较差,掌握人员仅分别占总人数的44.24%,44.80%.二分类Logistic回归分析结果显示,8项技能掌握情况均呈现东部优于中部优于西部地区,且工作年限、专业背景、有无编制、职称、工作性质和年龄是不同专业技能的影响因素.结论 中国中小学在职校医专业技能水平有待提升,且存在明显的地域差异.     

广州市中小学校校医配备现状

了解广州市中小学校医队伍建设与管理模式现状,为中小学校校医配置提供参考.方法 采取问卷调查(定量)与现场调查(定性)相结合的方法,以广州市中小学校作为调查对象,辖区内各选择2所小学、2所初中、2所高中共6所学校作为定性调查对象.结果 调查1 225所中小学校,其中专职和兼职校医689人(40.3%);中学(含职中)有253所学校配备专职校医,配置率为62.3% (253/406),小学仅有128所学校配备专职校医,配置率为16.1%(128/794),中学校医配备率高于小学,差异有统计学意义(x2=236.36,P<0.01);按600∶1校医配备要求,校医总配备合格率为44.3%.调查的1 323名校医、保健教师中,女性930人,占70.3%;卫生专业人员565名,卫生职称初级、中级、副高级及以上分别占52.04%,35.93%,1.60%;61.95%的卫生人员学历为大专及以下,硕士及以上仅占0.7%.83.6%学校认为现有校医的质量不能满足当前学校工作的需求;校医的配置机制不健全、单一的自主招聘模式是校医队伍建设的主要限制因素.结论 广州市中小学校医队伍建设现状不容乐观,配置模式单一.应加强探索多渠道配置机制,改善校医队伍建设.     

中国东西部地区中小学校教学环境与设备卫生状况比较

了解我国东西部地区中小学校教学环境和设备卫生现状与差异,为促进我国不同地区学校教学环境卫生均衡发展提供依据.方法 采用现况调查方法,对我国东西部7省市140所中小学校教学环境和设备卫生状况进行调查.结果 东部地区中小学校综合评价分为(70.295± 15.646)、卫生优秀学校率为17%,均高于西部地区的(50.598±13.740)和3%,差异均有统计学意义(t/x2值分别为7.908,8.788,P值均<0.05);东部地区中小学校教室人均面积、黑板反射比、采光系数、窗地面积比、课桌面平均照度、黑板面平均照度合格率以及课桌椅与学生身高符合率均高于西部地区(P值均<0.05).结论 学校教学环境与设备的卫生状况是当前学校卫生工作的突出问题.应加大对西部地区学校办学经费的投入,加强人员配备和培训,改善教学卫生硬件设施条件,同时加强学校预防性卫生监督工作.     

Family planning services at school-based health centers: findings from a national survey.

Although nearly 1000 school-based health centers (SBHCs) operate in the United States, little is known about SBHCs' sexual and reproductive health services. This study investigated reproductive and sexual health services delivery in SBHCs, specifically the types of services available in SBHCs. A 16-page, self-administered questionnaire asked center staff to identify the reproductive health services provided on site as well as which services were restricted and by whom. The results suggest that whereas most SBHCs provided at least one reproductive health service, most centers were restricted from providing contraceptive services, usually by school district policy.     

Obesity prevention in schools: current role and future practice of school nurses

OBJECTIVE: To determine responsibilities of school nurses in delivering obesity prevention services, assess opinions and beliefs about school-based obesity prevention and determine factors associated with school nurses supporting and providing obesity prevention services. METHOD: In fall 2005, a self-administered survey was mailed to 275 school nurses in Minnesota; 221 were returned (response rate=80%). RESULTS: Most (76%) school nurses supported the use of school health services (SHS) for obesity prevention. The likelihood of nurses supporting SHS for obesity prevention (p=0.009), as well as performing more child- (p=0.016) and school-level (p = < 0.001) obesity prevention tasks increased as perceived support for school-based obesity prevention from health care providers and school administrators, teachers and foodservice staff increased. Nurses supportive of school-based height, weight and BMI screening and parent notification were twice as likely to perform child-level obesity prevention tasks (p=0.021) and more than three times as likely to support using SHS for obesity prevention (p=0.005). CONCLUSION: Our study suggests considerable support among school nurses for school-based obesity prevention efforts and a growing interest in providing primary and secondary preventive care services in the school setting. Study findings also speak to the need for preparation, time and support from the school and health provider community.     

School-Based Health Centers and School Nurses: Cementing the Collaboration

ABSTRACT: As school health personnel respond to the changing needs of children, new models are being developed and traditional models are being reexamined. The role of the school nurse is expanding at the same time as school-based health centers are increasing in number. Partnerships between school-based health centers and school nurses are critical for the success of school-based health centers, and partnerships will enhance and expand roles for school nurses. This paper clarifies the role of each in three areas: collaboration, communication, and cooperation. In addition, obstacles to partnerships are examined. The goal of this collaboration is a shared vision for the continuum of school health services in which school nurse and school health center serve integral roles. Elements for successful collaboration between nurse and health center are reviewed, including clarifying roles, shared leadership and program ownership, cooperative training and continuing education, negotiating conflict, and most importantly, maintaining mutual support and respect.     

“互联网+”技术在区县级辖区妇幼卫生管理中的应用现状

[目的]掌握“互联网+”技术在区县级辖区妇幼卫生管理中的应用现状及存在的问题,为我国妇幼卫生信息化建设提供参考。[方法]通过国家妇幼卫生综合信息平台对1432所区县级妇幼保健机构“互联网+”技术在辖区妇幼卫生管理中的应用现状进行问卷调查。[结果]通过区域卫生信息平台实现辖区管理和服务功能中,比例最高的两项是孕产妇系统管理和儿童系统管理,分别为33.3%和31.8%,其次是高危孕产妇管理(27.7%)与高危新生儿管理(19.8%),4项功能均存在地区差异,东、中、西部比例依次降低(P<0.05)。我国区县级妇幼卫生信息平台建设比例为16.6%,东部地区区县级妇幼卫生平台建设比例为43.9%,高于中、西部地区(P<0.05)。12.0%的区县级妇幼保健机构开展了远程医疗服务,通过远程医疗服务与上级医疗机构合作的比例最高为11.5%,远高于区域内其它医疗机构。与社区卫生服务机构/乡镇卫生院合作情况存在地区差异,东、中、西部比例依次降低(P=0.01)。中部地区区县级机构通过远程医疗服务与孕产妇急救中心合作的比例为2.5%,高于东部和西部地区(P=0.02)。[结论]“互联网+”技术在区县级辖区妇幼卫生管理中的运用刚刚起步,区县级妇幼卫生信息化水平仍有待提高。     

Creating health-promoting schools in China with a focus on nutrition

This pilot project in Zhejiang Province, China, aimed at improving the nutrition and health status of students, school personnel and parents, and developing a model project for nutrition interventions for the development of health-promoting schools (HPS) in China. Three primary and three secondary schools participated. Interventions included establishing school-based working groups, nutrition training for school staff, distribution of materials on nutrition, nutrition education for students, student competitions, school-wide health promotion efforts and outreach to families and communities. Results of a pre- and post-intervention survey one and a half years apart showed improvements in nutrition knowledge, attitudes and behavior among all target groups. Primary school students at the pilot schools made the greatest knowledge gains in the areas of Chinese dietary guidelines (increased from 49.2 to 78.0%, p < 0.01) and adequate dietary principles (increased from 42.9 to 68.0%, p < 0.01). Scores of secondary school students who reported liking school lunches rose at pilot schools from 17.9 to 45.2% (p < 0.01). School staff at control schools who reported taking breakfast declined from 81.4 to 66.6% (p < 0.01), while staff who reported taking lunch at school increased in pilot schools from 87.5% at baseline to 93.9% (p < 0.01). The largest increases in nutrition knowledge among all target groups occurred among parents and guardians. At the pilot schools parents increased their knowledge in the areas of nutritional deficiencies (from 35.0 to 66.2%, p < 0.01) and nutrient-rich foods (from 38.8 to 66.8%, p < 0.01). Talks with target groups confirmed changes in attitudes and behavior, and school visits revealed improvements to school facilities and school health services, establishing of school policies and a positive school climate. This study suggests that nutrition can effectively serve as an entry point to establish HPS in China and that the HPS concept is feasible to improve the dietary knowledge, attitudes and behavior of students, parents and school personnel.     

Mental health and social services: results from the School Health Policies and Programs Study 2006

BACKGROUND: Schools are in a unique position not only to identify mental health problems among children and adolescents but also to provide links to appropriate services. This article describes the characteristics of school mental health and social services in the United States, including state- and district-level policies and school practices. METHODS: The Centers for Disease Control and Prevention conducts the School Health Policies and Programs Study (SHPPS) every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states and the District of Columbia and among a nationally representative sample of school districts (n=445). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n=873). RESULTS: Although states and districts generally had not adopted policies stating that schools will have mental health and social services staff, 77.9% of schools had at least a part-time counselor who provided services to students. Fewer schools had school psychologists or social workers. Consequently, counseling services were more common in schools than were psychological or social services. Few schools delivered mental health and social services through school-based health centers. Arrangements with providers not located on school property were more common. CONCLUSIONS: SHPPS 2006 reveals that linkages with the community need to continue and grow to meet the mental health needs of students. Efforts must be made to build systematic state agendas for school-based mental health, emphasizing a shared responsibility among families, schools, and other community systems.     

Mental health services in Sydney nursing homes

Abstract: Senior nursing staff of the 58 nursing homes in one health area of Sydney were interviewed concerning mental health services and staff education. One or more psychiatrically trained staff were employed in 45 per cent of the nursing homes. Most nursing homes received services from a psychiatrist or another mental health professional, but the average time per month provided by them to see residents was less than one hour in 18 (31 per cent), one to two hours in 16 (28 per cent), and three hours or more in only 11 (19 per cent). Forty-four (76 per cent) wanted more mental health services to be provided, especially for advice on management of disturbed behaviour. A substantial number of the nursing homes (at least 28 per cent) provided no ongoing education to their staff about dementia or other psychiatric problems. There is good reason to encourage greater use of mental health professionals in Sydney nursing homes; enhanced funding of area psychiatric services for elderly people is desirable to allow these services to be more readily available.     

Effects of an urban high school-based child care center on self-selected adolescent parents and their children

This study examined the effects of an urban high school-based child care center on parenting teens and their children enrolled during 1995-1998. Retrospective record review of 52 low-income, urban adolescent parents enrolled at the Celotto Child Care Center (CCCC) during the period of study was conducted from the CCCC and the high school records. Mean age of the student parents was 17 years (s.d. = 1.3) and mean grade level was 11.2 (s.d. = 1). Most parents were female (98%) and African American (62%). Children enrolled at CCCC had a mean age of 10 months (s.d. = 10.8). Students using the services of CCCC showed improvement in overall grade point averages, and 100% were educationally successful as defined by promotion to the next grade or graduating from high school. None of the students experienced a repeat childbirth during the period of CCCC enrollment. Ninety percent of children were up-to-date with pediatric health visits and immunizations. These results lend strong support to the importance of extending child care and social support services to teen parents, and for the implementation of high school-based child care centers as alternative sites for these critically important services.     

Implementing and maintaining school-based mental health services in a large, urban school district

The Dallas (Texas) Public Schools established the first school-based health center in the United States in 1969. In 1993 a partnership between two school principals, a school mental health professional, and the medical director of the county mental health center was the impetus for the first comprehensive school-based mental health center in Texas. In 1995 the programs joined together as Youth and Family Centers (YFCs) to provide physical health, mental health, and other support services to students and their families. The 10 strategically located school-based centers are directed by licensed mental health professionals employed by the district who lead a multidisciplinary team of physical health and mental health providers. Students served by the YFCs have fewer discipline problems, course failures, and school absences.     

School-Based Health Centers in the Context of Education Reform

ABSTRACT: The rapid proliferation of school-based health centers is taking place at the same time that school systems are seeking to improve their educational practices. Many different school reform models are being promulgated with modest success. Absence of connections between school reorganization and the provision of human services may lead to failure. The emerging community school model integrates quality education with effective health, mental health, and social services in "one stop" school centers that become student, parent, and community hubs