惠民医院的实施与监管

1 荆门市贫困人群的就医现状 1．1贫困人群基本医疗无保障据调查．荆门市城乡贫困人口134741人，其中市区内贫困人口为61063人（包括城市低保人员28629人、城市特困残疾人26000人、区属农村贫困救助对象6434人）。该群体中．市区人员基本处于无业、失业的状态，没有参加城镇职工基本医疗保险：区属农村人员因政策限制，均未参加新型农村合作医疗．基本医疗没有保障。     

数字排行

据中国卫生产业杂志社主编的2007年医疗卫生绿皮书——《中国医疗卫生发展报告》（第三卷）中公布的数字，自2005年3月中国正式启动城市医疗救助试点工作以来，到目前为止，中国已有1865个县（市区）启动了城市医疗救助试点，覆盖1440万城市贫困人口，试点县（市区）和贫困人群覆盖率分别达到65．16％和64．26％。     

贵州省贫困地区农村妇女基本生育健康服务的利用

目的：了解贵州省贫困地区农村妇女对基本生育健康服务的利用状况。方法：采用现况调查通过多阶段分层整群随机抽样，对195名育龄妇女进行入户问卷调查。结果：贵州省贫困地区农村育龄妇女产前检查率40．0％，住院分娩率11．8％，产后访视率15．9％，均远远低于2003年全国农村平均水平（产前检查率：85．6％，住院分娩率：62．0％，产后访视率：53．3％）。贵州省贫困地区农村妇女对基本生育健康服务需要量大且远远未被满足；基本生育健康服务利用各项指标非贫困人口均高于贫困人口。结论：建议在贵州省贫困地区农村加快建立健全健康保障制度和特困人口医疗救助制度，重视弱势人群的卫生保健，改善贫困人群的基本生育健康服务利用状况。     

长沙株洲两市590名吸毒者TTV感染现况调查

目的研究吸毒者TTV感染现况及其影响因素。方法采用现况调查的方法，随机抽取湖南省某男性戒毒所和某女性戒毒所中的吸毒者共590人，用问卷方式调查吸毒者有关资料，并用ELISA法测定其血清中TTV—IgG，用SPSS10．0进行数据统计分析。结果吸毒者TTV感染率为24．7％（146／590），高于一般人群TTV感染率（0．63％～16．4％）；女性吸毒者TTV感染率34．3％（104／303）显著高于男性吸毒者14．6％（42／287），两者之间差异有显著性（P〈0．05）；静脉注射组和非静脉注射吸毒组TTV感染率分别为26．9％和21．0％，两组间差异有显著性（P〈0．05）；扎耳孔也是吸毒者感染TTV的影响因素，扎耳孔者和未扎耳孔者TTV感染率分别为33．7％和16．1％，差异有显著性（P〈0．05）。结论吸毒者是TTV感染的高危人群，吸毒者TTV感染率高于一般人群；女性吸毒者TTV感染率显著高于男性吸毒者，静脉注射吸毒者TTV感染率显著高于非静脉注射吸毒者，吸毒者作为TTV感染的高危人群，对其进行监测及有效的管理和控制，对于降低TTV感染并防止其对家庭和社会人群的传播具有重要的临床及流行病学意义。     

病毒性肝炎患者中TLMV DNA检测

[目的]用PCR方法检测临床肝炎患者中TLMV DNA，以初步了解临床肝炎与TLMV的关系。[方法]提取血清中DNA，采用巢式PCR方法，检测血清中TLMV DNA扩增产物。[结果]一般人群、输血员的TLMV DNA阳性率分别为8．33％（6／72）和8．04％（9／112）；急性肝炎和慢性肝炎的TLMV阳性率分别为25．0％（5／20）和19．1％）18／94）。肝炎患者TLMV DNA阳性率与一般人群和输血员比较，二者差异有显著性。[结论]TLMV与临床肝炎呈相关性，TLMV在临床肝炎中的作用有待于深入探讨。     

宁波市农村贫困人口卫生服务研究

目的：了解宁波市农村地区贫困人口的卫生服务现状，为制定有效缓解农民因病致贫、因病返贫的措施提供依据。方法：以宁波市辖区内六区、五县的农村贫困家庭居民为研究对象，采用多阶段分层整群随机抽样的方法抽取样本。结果；49．2％的贫困户认为自己的贫困是疾病损伤所致，贫困人口中有近八成的人没有任何医疗保障，人均收入中位数仅为560元。人均医疗卫生药品支出占生活消费支出的53．0％。其卫生服务需要量较一般人群大而实际卫生服务利用较低。结论：慢性病和残障给贫困人口造成了严重的健康损害和沉重经济经负担，而缺乏医疗保障，高额的医疗费用又限制了其对医疗服务的利用。为缓解农村人口“因病致贫，因病返贫”的现状。应加快农村医疗保健体制改革，建立和完善新型农村合作医疗制度。     

邹城市人群艾滋病感染分布及传播危险因素分析

目的：了解邹城市艾滋病病毒（HIV）在人群中的感染情况，评估艾滋病流行传播的高危人群，分析其传播危险性，为防治艾滋病（AIDS）提供科学依据。方法：2005—2009年对普通人群艾滋病感染情况筛查和高危人群多项次艾滋病感染情况的专题调查。结果：普通人群中未检出HIV感染者，外来妇女、羁押人员和供血员HIV感染率分别为0．43％、0．12％、0．44％．外来妇女、羁押人员、供血员、性服务人员、MSM人群、性病病人梅毒抗体阳性率分别为1．42％、0．92％、0．33％、3．88％、4．76％、8．22％。结论：HIV感染者主要集中在外来妇女和羁押人员中，外来妇女成为本地人感染HIV主要因素；HIV感染者流窜盗窃犯罪，吸毒与性乱行为同时存在，将成为传播艾滋病性病最危险的人群；性服务人员、男性同性恋者、性病病人有较高的梅毒感染率，将会成为艾滋病向一般人群传播的中介人群。     

不同人群感染丙型及庚型肝炎病毒危险性分析

目的 研究不同人群感染丙型肝炎病毒（HCV）及庚型肝炎病毒（HGV）的危险性并探讨其传播途径。方法 采集不同人群的血清，运用酶联免疫吸附试验（ELISA）及荧光定量聚合酶链式反应（FQ—PCR）检测抗-HCV、抗-HGV及HCV—RNA、HGV—RNA。结果 一般人群、医护人员、普通孕妇、乙型肝炎病人、血液透析（HD）病人抗-HCV的阳性率分别为0．89％（58／6468），2．93％（5／171），0．93％（17／1836），11．5％（47／410）和51．4％（54／105）。抗-HGV的阳性率为0．6％（3／500），0（0／171），2．5％（6／240），9．3％（13／140）和14．3％（5／105）；母婴传播率HCV为16．7％；HGV为25％。血液透析（HD））病人有无输血史HCV感染率差异有统计学意义（X^2=7．72，P〈0．01）。结论 有血液暴露史者是HCV及HGV感染的高危人群；血液及母婴传播是重要的传播途径。     

新疆不同人群血清中TTV病毒流行病学调查

目的 了解新疆地区不同民族，不同人群中TTV－DNA病毒的感染情况及流行病学特征。为进一步研究新疆人群中TTV－DNA病毒的分布，分子生物学性状及临床诊断奠定基础。方法 应用微板－核酸杂交PCR－ELISA技术对采集到的血样进行了TTV－DNA检测，同时进行肝功能及其他各型肝炎的检测。结果 本次共检测了不同人群的血要201人份，TTV－DNA的阳性率为12．93％（26／201）。民族与性别分布，汉族为13．04％（15／155），维吾尔族为12．79％（1／186），女性17．31％（9／52），明显高于男性11．41％（17／149）。在不同人群中，已排除甲－庚型肝炎的单纯转氨酶增高者TTV－DNA阳性率为21．05％（8／38），HIV阳笥人群中TTV－DNA阳性率为18．36％（9／49）；一般肝炎病人阳性率为13．64％（9／66），透析人群及正常对照人群中未检出阳笥。结论 TTV－DNA的阳性率为12．93％（26／201），不同民族和性别的阳性率不同。     

北京市崇文区外来从业人员HIV和HBsAg感染现状调查

目的为了解北京市崇文区外来从业人员乙肝、艾滋病流行现状及相关性，为政府制定和调整乙肝艾滋病防控策略提供科学依据。方法用EIJSA方法检测辖区建筑工人和从业体检人员血清中的HIV和乙肝表面抗原（HBsAg）。结果380名外来从业人员中HIV全部为阴性，HBsAg阳性者44人，总感染率为11．58％，一般人群平均水平为8．2％；已婚组感染率（14．34％）高于未婚组（6．62％）。结论崇文区乙肝防控重点人群应该是外来流动人口，应采取健康教育和预防接种相结合的综合防控措施，同时建议恢复婚前体检工作。     

大连市老年人社会心理需求调查

目的了解大连市老年人的社会心理需求。方法选择大连市区内800名60岁以上老年人进行问卷调查（内容包括社会人口学特征、心理需求与满意度、生活经济状况、自理情况、养老意愿、医疗保健需求等）。结果共回收问卷790份,回收率98．8％。在社会人口学特征方面,接受调查的老年人平均年龄为（68．5±7．4）岁。其中男性378人,平均年龄（68．7±6．3）岁;女性412人,平均年龄（70．2±7．9岁）。有独立经济收入者706人,占89．4％;无独立经济收入者84人,占10．6％。有劳动保险、社会保障和公费医疗者702人,占88．9％;自费者86人,占10．9％。在社会心理状态方面,关心国家大事者578人,占73．2％;对目前生活比较满意者602人,占76．2％。在养老意愿方面,要求家庭养老者462人,占58．5％;同意到养老机构者112人,占14．2％。社会心理问题表现为,空巢老年人252人,占31．9％;独居老人88人,占11．1％;感到孤独老人217人,占27．5％;担心身体不好者726人,占91．9％;经济困难者252人,占31．9％;无人照料者33人,占4．2％;医药费用感到高者474人,占60．O％。患高血压者387人,占49．0％;患冠心病者253人,占32．0％。在就诊选择上,有626人到省、市级医院,占79．2％。结论我市已经进人老龄化社会,不同老年群体的社会心理需求不尽相同。因此,政府应考虑老年人的不同需求,加强老年关怀,完善养老体系建设;加强老年保健,完善社区卫生服务;加强老年心理疏导,关注老人精神需求。     

城市社区空巢与非空巢老人卫生服务需要与利用比较——基于山东省济南市的抽样调查

目的：对城市社区空巢与非空巢老人卫生服务需要、利用进行比较,为制定相关卫生政策提供依据。方法：抽取济南市某社区60岁及以上空巢老人324名,非空巢老人210名,利用自制问卷进行调查。结果：空巢老人与非空巢老人两周患病率分别为62.0%和49.0%,差异具有统计学意义;空巢老人与非空巢老人慢性病患病率分别为84.3%和72.4%,差异具有统计学意义。空巢老人与非空巢老人两周就诊率分别为17.3%和21.4%,两周未就诊比例分别为38.2%和32.3%;经济困难是空巢老人应就诊未就诊的主要原因。空巢老人住院率为19.8%,应住院未住院比例为29.3%;非空巢老人住院率为14.8%,应住院未住院比例为19.5%,经济困难是空巢老人应住院未住院的最主要原因。结论：空巢老人卫生服务需要量高于非空巢老人,卫生服务利用率低于非空巢老人,经济困难是抑制该群体卫生服务利用的主要原因。     

Living in poverty in America today

No statistician, social scientist or tarot card reader is needed to attest that the gap between the rich and poor in America is increasing. Further, most Americans don't care that much about it. There are also more rich people today living in the U.S. and there are more people living in poverty. Between 2000 and 2002, the number of Americans living in poverty increased by nearly 3 million to 34.6 million. Of these, 12% (or about one half a million persons) are living extreme poverty and many are children, with 16.7% likely to be poor (National Association of Social Workers, 2003).     

The impact of the economic recession on well‐being and quality of life of older people

The importance of economic well‐being is recognised in the recent UK Government policy. Older people may be particularly vulnerable to economic fluctuations as they are reliant on fixed incomes and assets, which are reducing in value. Within the literature, little is understood about the impact of the current economic downturn on people’s general quality of life and well‐being and, in particular, there is little research on the financial experiences and capability of the older age group, a concern in light of the ageing UK population. This article reports a qualitative research study into the nature of older peoples’ vulnerability by exploring their perceptions of the impact of the economic recession on their well‐being and quality of life. It explores specifically a group of older people who are not the poorest within the ageing population, but who may be described as the ‘asset rich‐income poor’ group. Key themes relate to the impact of the recession on the costs of essential and non‐essential items and dimensions of mental, physical and social well‐being. Implications for health and social care practice in meeting the needs of older people during times of economic recession are then explored. The paper adds to the debate by demonstrating that the recession is having adverse consequences for older people’s quality of life in terms of economic, mental and social well‐being, although there is also evidence that some of them are equipped with certain resilience factors due to their money management and budgeting skills.     

学龄儿童家长铅中毒知识-态度-行为的调查分析

目的:了解和掌握学龄儿童家长儿童铅中毒知识、态度、行为现状,为制定合理的健康教育规划提供基础材料。方法:采用随机整群抽样方法,在大理市城区16所小学随机抽取350名家长进行问卷调查,测评其对儿童铅中毒的认识、态度、行为知晓率。结果:学龄儿童家长对工业性铅污染源的认识较清楚(66.1%～83.0%),但对生活中一些不易察觉铅污染源认识存在不足(56.9%～83.9%)。掌握铅污染源、铅在体内转运转化知识较多者主要是父母的文化层次和家庭经济收入较高者,多数家长对儿童铅中毒健康教育持赞成态度。结论:学龄儿童家长对铅中毒知识了解不够,亟待加强教育。     

Is globalization good for your health?

Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries.     

The impact on health and risk factors of the diarrhoea epidemics in the 1998 Bangladesh floods

The 1998 flood in Bangladesh ravaged approximately 60% of the land and affected over 30 million people. The aim of this study is to examine the impact of the flood on the health of the communities affected and to explore factors associated with episodes of diarrhoea.We conducted structured interviews with 517 people in two districts that had been affected in October 1998, when the flood water level was at its peak. Of the 517 respondents, 98.3% developed health problems or found that existing health problems were exacerbated. Many perceived that their general health condition was 'much worse' (16.9%) or 'worse' (64.3%). The most prevalent condition was fever (63.6%), followed by respiratory problems (46.8%), diarrhoea (44.3%), and skin problems (41.0%). Only 1.0% and 6.7% of the respondents treated water before drinking, by boiling and chlorination, respectively, although water collected from tube-wells (93.2%) and rivers (6.0%) was perceived by 75.0% of the respondents to be contaminated.Factors associated with developing or worsening diarrhoea were as follows; the number of family members, poor economic status, a lack of distribution of water purification tablets, the type of water storage vessels, not putting a lid on the vessel, no use of latrines, perceived change of drinking water, food scarcity, and worries about the future. In logistic regression analysis, men, poor economic status, lack of distribution of water purification tablets, and the type of water storage vessels had a significant association with diarrhoea.The 1998 Bangladesh flood had a substantial impact on the health of communities. Diarrhoea was associated with socioeconomic status, water handling and household sanitation. There ought to be more emphasis on health education in the pre-disaster period in order to empower communities against floods.     

Socioeconomic conditions of elderly people in Kosovo: a cross-sectional study

ABSTRACT: BACKGROUND: Kosovo is the newest state in Europe facing a particularly difficult socioeconomic and political transition. The available evidence on socioeconomic conditions and quality of life of elderly people in Kosovo is scarce notwithstanding the ageing trend due to lowering of fertility rates and a higher life-expectancy. In this context, the aim of our study was to assess the socioeconomic conditions of elderly people in post-war Kosovo. METHODS: A cross-sectional study was conducted in Kosovo in January-March 2011 including an age- sex-and residence (urban vs. rural)-stratified sample of 1,890 individuals (83.5% response) aged 65 years and over. A structured questionnaire included assessment of socio-demographic and socioeconomic characteristics including educational level and self-perceived poverty. Binary logistic regression was used to assess the association of self-perceived poverty with socio-demographic and socioeconomic factors. RESULTS: The educational level in this representative sample of elderly people in Kosovo was quite low, particularly among women. About 47% of respondents perceived themselves as poor, or extremely poor (41% of men and 52% of women). In multivariable-adjusted models, self-perceived poverty was higher among older women, low educated individuals, urban residents, and elderly individuals living alone. CONCLUSIONS: Findings from this study indicate that the socioeconomic situation of the elderly population in Kosovo is rather challenging. Demographic trends coupled with the economic and political transition raise serious concerns about increasing needs for socioeconomic support of elderly people in Kosovo. Specific policies and actions should be considered by a number of stakeholders, including government and civil society in transitional Kosovo.     

Poverty and health sector inequalities

Poverty and ill-health are intertwined. Poor countries tend to have worse health outcomes than better-off countries. Within countries, poor people have worse health outcomes than better-off people. This association reflects causality running in both directions: poverty breeds ill-health, and ill-health keeps poor people poor. The evidence on inequalities in health between the poor and non-poor and on the consequences for impoverishment and income inequality associated with health care expenses is discussed in this article. An outline is given of what is known about the causes of inequalities and about the effectiveness of policies intended to combat them. It is argued that too little is known about the impacts of such policies, notwithstanding a wealth of measurement techniques and considerable evidence on the extent and causes of inequalities.     

The Black diaspora and health inequalities in the US and England: does where you go and how you get there make a difference?

The relatively poor health of Black American people in the US and Black Caribbean people in England is a consistent finding in the health inequalities literature. Indeed, there are many similarities between the health, social, economic and demographic profiles of these two groups. However, there is evidence that Caribbean people in the US are faring considerably better. This paper explores differences in the social and economic position of Black American, Black Caribbean and white people in the US and Black Caribbean and white people in England, how these relate to ethnic inequalities in health, and may be underpinned by differences in patterns and contexts of migration. We use similar surveys from the US and England to explore these questions. The US data were drawn from the National Survey of American Life and the English data were drawn from the Health Survey for England and a follow up study. Findings show the advantaged health position of Caribbean American people in comparison with both Caribbean people in England and Black American people. Multivariate analyses indicate that these differences, and the differences in health between Black and white people in the two countries, are a consequence of social and economic inequalities.