Proximal and Distal Determinants of Access to Health Care among Hispanics in El Paso County, Texas

In the United States, having health insurance is an important determinant of health care access and individual health outcomes. Nationwide, a significant proportion of the population does not have health insurance. Hispanics, in particular, are less likely than non-Hispanics to have insurance. A framework was established to examine the relationships between the determinants of insurance coverage and health care affordability in El Paso County, Texas. Data from the 2005 Behavioral Risk Factor Surveillance System were used to examine the relationships described by this framework. The sample included 653 adults, of those 477 self-identified as Hispanic or Latino. In El Paso County, almost half of adult Hispanics lack any type of health insurance coverage, three times the rate of non-Hispanics. Among Hispanics, the lack of health insurance was strongly associated with reduced affordability of health care. Employment status, income, and age were found to have significant associations with insurance coverage and health care affordability. Sex and education level were relevant, yet distal determinants of these outcomes. Ongoing conversations about health care reform should take into account the patterns of coverage within the Hispanic population. Knowing how economic and social factors affect coverage is necessary to inform policy that can effectively alleviate disparities experienced by Hispanics.     

Simulation in surgical training: educational issues and practical implications

BACKGROUND: Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework. SIMULATORS: Simulators can provide safe, realistic learning environments for repeated practice, underpinned by feedback and objective metrics of performance. Using a simple classification of simulators into model-based, computer-based or hybrid, this paper summarises the current state of the art and describes recent technological developments. Advances in computing have led to the establishment of precision placement and simple manipulation simulators within health care education, while complex manipulation and integrated procedure simulators are still in the development phase. EVALUATION: Tension often exists between the design and evaluation of surgical simulations. A lack of high quality published data is compounded by the difficulties of conducting longitudinal studies in such a fast-moving field. The implications of this tension are discussed. THE WIDER CONTEXT: The emphasis is now shifting from the technology of simulation towards partnership with education and clinical practice. This highlights the need for an integrated learning framework, where knowledge can be acquired alongside technical skills and not in isolation from them. Recent work on situated learning underlines the potential for simulation to feed into and enrich everyday clinical practice.     

孕产期健康教育与产褥期母婴保健知识及护理能力关系

目的:探讨孕产期母婴健康教育对其产褥期保健护理能力的影响,为制订围生期健康教育模式提供依据。方法:对555例产后42天回医院检查的产妇进行保健知识和护理能力问卷调查。内容包括:产前接受健康教育的情况,产前检查情况,产褥期母婴保健知识、行为、护理能力等,并对在孕期开始接受系统健康教育与非系统健康教育两组进行比较。结果:孕期系统健康教育组比非系统健康教育组,母亲、婴儿保健知识知晓率高,母亲自我护理、婴儿护理能力强,两组比较有明显差异(P<0.05,P<0.01)。两组计划生育知识缺乏。结论:为提高产褥期保健知识、护理能力,必须从怀孕前开始做好系统的围生期健康教育。健康教育应深入到社区,提供个体化、迅速便捷的护理技能指导。     

武汉市社区老年人健康相关问题调查分析

目的了解武汉市社区老年人口的健康需求,寻求符合城市老年居民生活方式和老年社区卫生服务基本功能需求的健康教育策略.方法采取系统随机抽样的方法对武汉市2463名老年人进行了问卷调查.结果武汉市社区老年人健康状况不够理想,这与社区老年人文化素质较低、卫生知识缺乏、存在较多不良行为、健康教育与健康促进开展得不够、社区卫生服务机构对老年健康管理不力等因素有关.另外经济因素起着很重要作用.结论社区老年卫生服务应以建立适应当前需要的新型老年卫生服务体系、构建新的"医患关系"、开展多种卫生服务形式为突破口,加强健康教育,形成适合于武汉市社区老年人卫生服务特色.     

How to deliver specialized nutritional support.

Integrating specialized nutritional support into long term care facilities will continue to be a multidisciplinary process, involving the education and training of a number of members of the health care team. And as the dynamics of the current health care environment shape the way in which specialized nutritional therapy is provided, standards and protocols for nutritional assessment, enteral and parenteral therapy and staff education will be essential for cost-effective, quality patient care. Specific issues relating to these standards have been discussed--each facility should then develop its own framework for nutritional support, based on individual needs.     

The case for educating health care students in professionalism as the core content of interprofessional education

BACKGROUND: Professional teams are becoming more central to health care as evidence emerges that effective teamwork enhances the quality of patient care. Currently, health care professionals are poorly prepared by their education for their roles on the team. In parallel, there are increasing demands from consumers for health care professionals to serve the interests of society and patients through engaging in effective professional partnerships. Professionalism for health care providers is now being defined as a commitment to standards of excellence in the practice of the profession that are designed primarily to serve the interests of the patient and to be responsive to the health needs of society. Yet, there are multiple barriers impeding the development of professionalism beyond a uni-professional frame of reference. METHOD: Incorporating teamwork and professionalism into health care professional curricula at pre-registration level is proving to be challenging. These 2 areas of learning are brought together in this paper through a discussion of the role of interprofessional education in preparing all health care professional students for the workforce. CONCLUSION: Interprofessionalism is presented as a pre-registration curriculum framework that includes values shared by all health care professionals, which should be learned in order to more adequately prepare students for working in health care teams. It will be argued that interprofessional education provides appropriate methods by which to learn interprofessionalism, and that this will ultimately contribute to overcoming uni-professional exclusivity.     

上海市浦东新区科教兴医的3年策略行动方案研究思路

文章主要介绍上海市浦东新区科教兴医3年策略行动方案的研究背景、研究框架、研究方法与研究经验。作者提出科教兴医策略行动方案的研究需在明确科教兴医目的与内外环境分析的基础上。确定科教兴医策略行动方案的目标，然后再制定策略行动方案；作者还讨论了制定科教兴医行动方案的成功关键因素。     

学龄期女学生对月经了解程度现状调查

目的了解学龄期女学生的月经知识、态度及行为，为月经保健提供背景资料及建议，更好的促进月经健康。方法在某小学中整群抽样五年级女学生78人，通过发放调查问卷来分析学龄期女学生对月经的了解程度，由学生集中填写独立完成。结果学龄期女学生对月经了解程度很低，其生殖健康知识主要来源于大众媒体、学校教育和家庭教育、相关的书籍杂志和同伴交流。结论学龄期女学生的生殖健康知识缺乏，家庭、学校和社会等因素对其生殖健康知识的获取有较大影响，因此家庭、学校和社会应共同努力加强学龄期女学生的生殖健康教育，使其正确面对自己的成长。     

The Chinese health care regulatory institutions in an era of transition

The purpose of this paper is to contribute to a better understanding of Chinese health care regulation in an era of transition. It describes the major health care regulatory institutions operating currently in China and analyzes the underlying factors. The paper argues that in the transition from a planned to a market economy, the Chinese government has been employing a hybrid approach where both old and new institutions have a role in the management of emerging markets, including the health care market. This approach is consistent with the incremental reform strategy adopted by the Party-state. Although a health care regulatory framework has gradually taken shape, the framework is incomplete, with a particular lack of emphasis on professional self-regulation. In addition, its effectiveness is limited despite the existence of many regulatory institutions. In poor rural areas, the effectiveness of the regulatory framework is further undermined or distorted by the extremely difficult financial position that local governments find themselves in. The interpretations of the principle of 'rule of law' by policy makers and officials at different levels and the widespread informal network of relations between known individuals (Guanxi) play an important role in the operation of the regulatory framework. The findings of this paper reveal the complex nature of regulating health care in transitional China.     

骨科病区实施优质护理服务的体会

目的开展以病人为中心、高质量的优质护理服务,提高患者满意度。方法实行护理分组管理,针对患者知识缺乏,功能锻练欠了解,重点进行健康宣教及基础护理。结论我科室通过开展优质护理服务,取得了一定成绩,患者的满意度得到了大幅度提高。