应对突发公共卫生事件的健康教育策略

突发公共卫生事件的发生,不仅危及社会经济发展和国家安全,而且严重影响相关人群的身心健康。正确的健康教育和健康促进策略,对于提高公众的自我防护意识和能力、维持正常的社会秩序、避免大范围的社会恐慌、迅速控制事态发展意义重大。本综述从突发公共卫生事件与健康教育的定义、国内外应对突发公共卫生事件的健康教育策略、不同阶段健康教育策略方面对应对突发公共卫生事件的健康教育策略进行阐述。     

突发公共卫生事件下青少年应激心理结构探析

目的 采用自由联想法分析一起突发公共卫生事件下青少年应激心理的结构,为开展心理危机干预提供科学依据。方法 采用分层整群抽样,对619名青少年进行有条件限定的自由联想法收集应激心理的描述语,并对839条描述语进行内容分析。结果 青少年应激心理结构包括应激生理症状、个人事件、社会事件、与我无关、事件归因、事件评价、疾病信息、情绪反应、行为反应、解决问题、寻求帮助和调整情绪等12个方面,但以应激内容为主;应激心理结构反映出青少年存在轻视疾病、应对活动不足等心理状态;并体现出女性、初中生、病例类型多学生应激反应较重的特点。结论 在突发公共卫生事件中的心理干预应侧重启动应对活动,根据应激心理特征开展有针对性的干预,重点关注应激青少年人群对疾病信息的需求,加强健康教育。     

我国突发公共卫生事件对大众心理影响初探

目的 评析我国突发公共卫生事件对大众心理的影响,探讨应对措施.方法 对2003～2006年发生的 4起重大突发公共卫生事件对大众心理的影响进行回顾和评析.结果 大众在突发公共卫生事件中各种心理反应受到事件本身性质及多项社会因素影响.结论 要妥善处理好突发公共卫生事件对大众心理的影响,需要从影响到大众心理的各项因素出发,多管齐下,积极应对,减小损失.     

我国卫生应急人员培训现状分析及培训模式研究

目的卫生应急人员培训是构建公共卫生应急体系,应对突发公共卫生事件的要素之一。方法我国卫生应急人员培训目前存在的一些困难,并从培训目的、培训对象、培训内容、培训方式、经费保障、效果评价等方面进行分析。结果对突发公共卫生事件应急人员培训模式进行初步探讨,建议加大对应急培训的财政支持力度,做好培训效果评价工作。结论以提高突发公共卫生事件应急准备和反应能力。     

突发公共事件中公众危机干预现状及需求分析

目的了解公众应对突发公共事件的各个阶段危机心理干预现状与需求,为有针对性地实施心理干预提供依据。方法采取多阶段随机抽样方法 ,在安徽省合肥市瑶海区、庐阳区按一定的年龄结构抽取15～60岁居民为调查对象。采用卫生部应急办"突发公共事件危机心理干预能力资源状况调查和政策研究"项目提供的《公众心理卫生状况及需求调查表》,由经过统一培训的调查员入户进行调查。结果 45.9%的调查对象对突发公共事件危机心理干预不了解,48.7%的人是通过媒体宣传获得心理援助知识的;57.8%的被调查者希望通过媒体宣传来获得心理援助;收到宣传材料是事件发生后公众各时间段都能接受的干预形式;缓解心理反应(50.4%)是被调查者主要希望获得的危机心理干预技能。结论不同类型事件、事件发生不同时间公众心理干预方式的需求不同,应针对不同需求实施具体的心理干预方式,使受到事件波及人群得到最有效的心理援助。     

学校医院如何应对突发公共卫生事件

[目的]近年来,突发公共卫生事件、各类已知、未知的传染病及其他各类危害人类健康的事件随时可能袭来。学校人群密集,是一个易于发生突发事件和造成传染病流行的场所,学校医院如何应对突发公共卫生事件逐步成为公共卫生学新的研究方向。[方法]阐述了突发公共卫生事件与应急预警的基本特征,介绍了学校医院的条件,同时对学校医院如何应对突发公共卫生事件进行了论述。[结果]学校医院应对突发公共卫生事件是其应该承担的责任和任务,学校医院应建设成能够适应社会快速反应的医院和保健站。[结论]学校医院健全应对突发公共卫生事件的反应机制是必要的,为医院可持续发展奠定更加良好的基础。     

北京市朝阳区城乡居民应对突发公共卫生事件知识与技能影响因素分析

目的 了解北京市朝阳区居民应对突发公共卫生事件知识与技能的影响因素,为制定有效的干预策略提供依据.方法 采用多阶段系统抽样的方法,选取北京市朝阳区城乡居民2000人进行问卷调查,对突发公共卫生事件应对知识与技能的影响因素进行多元线性回归分析.结果 82.7％的调查对象经历过突发公共卫生事件,朝阳区居民在伤寒、放射性事故方面知识与技能的知晓率相对较低,分别为19.9％和22.8％.多元线性回归分析显示,城市居民应对突发公共卫生事件知识与技能得分高于农村;越年轻者,应对突发公共卫生事件知识与技能得分越少;文化程度越低,应对突发公共卫生事件知识与技能得分越少.结论 北京市朝阳区居民应对突发公共卫生事件知识与技能水平有待提高,应加强对伤寒、放射性事故等方面的健康教育,并采取有效的措施开展农村地区、年轻人、低文化程度居民的防灾减灾宣传教育工作.     

浅谈突发公共卫生事件应对中健康促进工作的策略

突发公共卫生事件,是指一些突然发生的,可能或者已经造成社会重大传染病疫情、不明原因的群体性疾病或者造成大量人群食物中毒或者其他严重影响公众健康的紧急事件。在我国2003年颁布的《突发公共卫生事件紧急条例》中对其特征进行了定义:一是具有突发性;二是在公共卫生领域发生;三是严重危害公众健康。在面对突发公共卫生事件发生后,应该及时对事件进行分析、处置,开展广泛深入的健康教育和健康促进工作,可促进公众正确应对灾害,提高自我的防护意识和能力,可以对事件造成的损失进行补救,减少对社会、经济、政治和人民群众生命财产的损害,有利于维护公众健康和社会秩序。对于突发公共卫生事件,除了在发生之后及时应对以外,在平时要开展健康促进工作,对突发公共卫生事件进行预防,并且在其不可避免的发生时,将其危害降到最低。该文对突发公共卫生事件应对中健康促进工作进行探讨。     

国境口岸突发公共卫生事件的应对策略

突发公共卫生事件是指突然发生的,可造成或可能造成社会公众健康严重损害的重大传染病疫情、群体性不明原因疾病、重大食物和职业中毒、以及其他严重影响公众健康的事件。而公共卫生则是一种有组织的社会反应,这些社会反应的目的是促进人群的身体和心理健康,预防疾病、伤害和残疾,因此公共卫生的工作起点应该是整个人群或亚人群,从该人群或亚人群出发确定公共卫生问题和需要首先解决的问题,设计并实行干预措施。     

结合新冠肺炎疫情防控检视国内外心理应急管理

突发公共卫生事件易造成公众的心理和行为变化，甚至通过引发一定的社会问题给社会发展以及公众健康与安全带来极大损害。新型冠状病毒肺炎（简称“新冠肺炎”）疫情就是一场典型的突发公共卫生事件，检视突发公共卫生事件下的心理应急管理能力对维护社会稳定至关重要。通过对国内外心理应急管理进行综述，认为我国尚未建立完善的心理应急管理机制，此次新冠肺炎疫情为检视国内外心理应急管理提供了机会窗口。在比对国内外突发公共卫生事件心理应急管理模式和实践经验的基础上，分析当前国内心理应急管理存在的问题与不足，从法律法规和政策、体制机制以及心理应对策略三个方面，为构建心理应急管理体系提出建议和对策。     

Perceived health status and use of healthcare services among children and adolescents

BACKGROUND: The aim of the present study was to analyse the use of healthcare services according to health status in a population of children and adolescents, taking into account family socio-demographic characteristics and characteristics of the proxy respondent. METHODS: A total of 836 interviews of proxy respondents for children aged 5-14 years from the Barcelona Health Interview Survey carried out in 2000 were included. Dependent variables were visits to a healthcare professional, visits to the emergency room, and hospitalization. Independent variables were: report of medical conditions, health status of the child measured by the Child Health and Illness Profile-Child Edition, Parent Report Form (CHIP-CE/PRF), the educational level of the head of household, social class, child's healthcare coverage, and proxy-related variables [mental health status by means of the General Health Questionnaire-12 items version (GHQ-12), and other]. Logistic regression analysis was used to estimate prevalence ratio (PR) to compare the use of healthcare services among different categories of independent variables. RESULTS: Children having worse health status were more likely to have visited a healthcare professional [PR = 1.68; 95% confidence interval (95% CI) = 1.09-3.83], whereas children with a reported medical condition were more likely to have made a visit to the emergency service (PR = 1.47; 95% CI = 1.27-2.55) and were hospitalized more frequently (PR = 2.50; 95% CI = 1.12-5.57). Higher likelihood of visits to the emergency room was associated with children having both public and private coverage and a proxy respondent scoring 3 or higher on the GHQ-12. CONCLUSIONS: Use of healthcare services differed by health needs but not by social class. Double healthcare coverage and mental distress of the proxy respondent influenced the use of emergency services.     

Mental health and global well-being

A range of evidence-based, cost-effective interventions can be implemented in parenting, at schools, at the workplace and in older age to promote mental health and well-being. Such programmes need to be supplemented with actions to build mental health capital and promote resilience to manage and cope with the global risks that face humankind over the coming years. Actions need to connect mental and physical health and individuals need to be connected through health-promoting social networks; living environments need to be designed to support mental health and well-being; well-being indicators that include material living conditions, quality of life and sustainability can help drive healthy public policy. There is an urgent need to invest in skills training in decision-making, social interactions, building trust and cooperative behaviour that support the family of humanity as a whole as it faces the unprecedented stressors resulting from climate change.     

Who Would Pay Higher Taxes for Better Mental Health? Results of a Large‐Sample National Choice Experiment

Policy Points

•  Public funding for mental health programs must compete with other funding priorities in limited state budgets.
•  Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits.
•  Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size.
•  In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.

ContextThe direct and indirect impacts of serious mental illness (SMI) on health care systems and communities represents a significant burden. However, the value that community members place on alleviating this burden is not known, and SMI treatment must compete with a long list of other publicly funded priorities. This study defines the value of public mental health interventions as what the public would accept, either in the form of higher taxes or in reductions in nonhealth programs, in return for increases in the number of mental health program beneficiaries.MethodsWe developed and fielded a best‐practice discrete‐choice experiment survey to quantify respondents’ willingness to be taxed for increased spending among several competing programs, including a program for treating severe mental health conditions. A realistic decision frame was used to elicit respondents’ willingness to support expanded state budgets for mental health programs if that expansion required either cuts in the competing publicly financed programs or tax increases. The survey was administered to a general population national sample of 10,000 respondents.FindingsNearly half the respondents in our sample either chose “no budget increase” for all budget scenarios or had preferences that were too disordered to estimate trade‐off values. Including zero values for those respondents, we found that the mean (median) amount that all respondents were willing to be taxed annually for public mental health programs ranged between $156 ($99) per year for large‐population states and $343 ($181) per year for small‐population states. Respondents would accept reductions of between 1.6 and 3.4 beneficiaries in other programs in return for 1 additional mental health program beneficiary.ConclusionsOur results are consistent with findings that a substantial portion of the US public is unwilling to pay higher taxes. Nevertheless, even including the substantial number of respondents who opposed any tax increase, the willingness of both the mean and median respondent to be taxed for mental health program expansions implies that programs providing mental health services such as state Medicaid are underfunded.     

Social support factors and health among a senior center population in southern Ontario, Canada

Past research on senior centers has mainly focused on utilization, frequency, duration of attendance, participation or various activities and services. This study strives to go beyond previous research by examining social support factors and their relationship to mental and physical health across a senior center population in southern Ontario, Canada. Data were collected at two large senior centers in the Kitchener, Waterloo area. We used a self-administered survey among a sample of older participants (n=186). One-way ANOVA with post-hoc Duncan's multiple range tests, t-tests, and linear regression analyses were used to examine the influence of social support (friendship, caregiving and advice) on mental and physical health. The results indicated that caregiving is significantly related to physical health, how respondents feel in general, and happiness with personal life. Advice from others is significantly related to perceptions of having a life full of interesting things. Additionally, respondents who are volunteers perceive better health and social support than non-volunteers, those who eat at the center perceive better health and caregiving support, and those that started a new activity perceived better health and social support from friendships. Implications for social work practice, policy and future research are discussed.     

疾病预防控制管理者对公共卫生医师规范化培训态度及认知的调查研究

目的 了解疾病预防控制管理者对公共卫生医师规范化培训的态度及认知,为推动我国公共卫生医师规范化培训工作提供参考依据。方法 对314名省级和地市级的疾病预防控制管理者进行问卷调查。结果 调查对象对于开展公共卫生医师规范化培训,93.1%的认为有必要,90.8%的表示支持,92.6%的认为应由国家统一规定内容、形式、教材,81.3%的认为应由国家培训师资,73.2%的认为应由国家组织培训考核评估;培训内容认知排在前三位的是流行病学相关、卫生法律法规、行业标准和规范;有41.4%的调查对象认为新入职公共卫生专业人员达不到实际工作基本要求。结论 省市两级疾病预防控制管理者对开展公共卫生医师规范化培训形成普遍共识。培训工作应注重政策保障并先行试点,同时明确国家和地方职责和分工,建议在国家层面统一培训内容、形式、教材和组织师资培训,而考核评估等由国家总体部署和各地细化落实相结合,协调推进试点工作。     

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

A statewide Community Health Worker Employer Survey was administered to various clinical, community, and faith-based organizations (n?=?240) across a range of rural and urban settings in the Midwest. At least 80% of participants agreed or strongly agreed that items characterized as supervisory support were present in their work environment. Thirty-six percent of respondents currently employed CHWs, over half (51%) of survey respondents reported seeing the need to hire/work with more CHWs, and 44% saw the need for CHWs increasing in the future. Regarding CHW support, a majority of respondents indicated networking opportunities (63%), paid time for networking (80%), adequate time for supervision (75%), orientation training (78%), mandatory training (78%), ongoing training (79%), and paid time for training (82%). Open-ended responses to the question "In your organization, what needs could CHWs meet?" resulted in the largest number of respondents reporting mental health issues as a priority, followed by connecting people with services or resources, educating the public on preventive health, family support, and home care/visitations. Our findings suggest that respondents, who largely have supervisory or managerial roles, view workplace environments in Nebraska favorably, despite the fact that nearly two-thirds of respondents typically work well over 40 h per week. In addition, CHWs could help address mental and physical health needs in a variety of community and clinical settings through primary and secondary prevention activities, such as provision of health screenings, health and nutrition education, connecting people to resources and empowering community members through these activities and more.     

Prevalence, pattern and determinants of mental disorders in rural Bangladesh

OBJECTIVES: Very few studies have examined mental health morbidity in Bangladesh. This community-based study of rural Bangladesh in 2000-2001 estimated the burden of mental morbidity among rural people of working age. STUDY DESIGN AND METHODS: Community surveys were conducted with one respondent from each household of three selected villages in the service provision area of a non-profit public health organization. General Health Questionnaire 60 (GHQ-60) was used as a screening tool in Stage I, and clinical examination by a Western-trained psychiatrist was undertaken for concurrent validation in Stage II. RESULTS: The overall prevalence of psychiatric disorders in this rural area was 16.5%. Depressive disorders and anxiety disorders constituted about one-half and one-third of the total cases, respectively. A significantly higher prevalence of mental disorders was found in the economically poor respondents, those over 45 years of age, and women from large families. CONCLUSION: There is a high prevalence of psychiatric disorders in rural Bangladesh. These findings should aid the planning of locally relevant and appropriate mental healthcare programmes. There is an urgent need for a national mental healthcare policy that strengthens primary mental healthcare services.     

Maternal and Child Health Graduate and Continuing Education Needs: A National Assessment

Objectives: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. Methods: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. Results: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staff's need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. Conclusions: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.     

Social work student attitudes toward contraception and the HPV vaccine

The purpose of the current study was to examine social work student attitudes toward the social work profession's perspective on certain aspects of reproductive health in the United States: contraception, emergency contraception, and the Human Papillomavirus (HPV) vaccine. Students at a large, public, land grant university were surveyed to determine whether their personal attitudes were in line with the National Association of Social Workers (NASW) stance on reproductive health outlined in the NASW policy statement on family planning and reproductive health. The relationship between levels of religious activity and attitudes toward these aspects of reproductive health was also examined. Results suggest that almost all of the respondents support public funding for family planning. Furthermore, almost all students indicate willingness to refer clients for general contraception. However, results related to emergency contraception indicate that 72% of students disagree that it should be available for adolescents over the counter, even with parental consent, which is inconsistent with the NASW perspective. Sixty-four percent of students report believing that the HPV vaccine is unsafe. Further, as levels of religious activity increased, acceptance of some of these aspects of reproductive health decreased. Implications for social work practice, education, and directions for future research are discussed.     

Physical and mental health status of soldiers responding to the 2008 Wenchuan earthquake

Objective: While internationally major disasters occur frequently, for any one country they are unusual events. In this project we aimed to identify public health issues arising from the physical and mental health symptoms suffered by the soldier volunteers deployed in an emergency relief task during the Wenchuan earthquake. Methods: Health problems identified in other emergency volunteer populations guided the development of a questionnaire. A cohort of 1,187 soldier volunteers completed the questionnaire, which measured physical and mental health symptoms during their rescue mission. The results were compared with a population norm of soldiers, although baseline data of the respondents were unavailable. Results: Half the respondents reported suffering from skin and mucous membrane problems, followed by respiratory symptoms (38%), digestive (29%) and nervous (22%) symptoms. Despite a low response rate (53%) to the mental health component, nearly half (49%) of those who did respond reported mental health problems. The incidence of the above symptoms were significantly higher than the general soldier population. Conclusions: Health complaints were common in the soldiers, who had not received any formal training in rescue operations. Implications: Non‐professional rescue workers who are not appropriately prepared for the role may suffer more than their professional counterparts. Attention needs to be paid to the health and safety of non‐professional rescue workers, which has been ignored in most disaster management plans. These findings can be used to enhance the understanding of emergency response programs within and outside China, where this particular disaster occurred.