心力衰竭临床决策支持系统临床应用效果分析

目的系统总结国内外心力衰竭临床决策支持系统临床应用现状与效果，为我国开展相关研究提供参考。方法检索中英文数据库中心力衰竭临床决策支持系统相关文献，检索时限为建库至2021年4月。采用Cochrane RoB工具、JBI清单、CASP清单等工具评价文献质量。结果共纳入27篇文献。心力衰竭临床决策支持系统在协助临床诊断、识别早期风险、协助调整用药方案、提高患者自我管理能力、提高医护患对指南的依从性和临床决策效率等方面具有积极影响。结论心力衰竭临床决策支持系统在临床实践中发挥了积极作用，但在系统内容设计、适用对象和服务范围、评价工具方面仍需完善。     

中国高龄老年人体质指数适宜范围与体重管理指南（T/CNSS 021—2023）

体质指数（BMI）是全球公认反映身体健康情况的重要指标,现行相关BMI标准指南主要适用于儿童和成年人,未见80岁及以上高龄老年人的BMI标准和体重管理指南。本标准给出了中国高龄老年人BMI适宜范围和体重管理的指导建议,主要内容包括年龄计算和BMI适宜范围、BMI测量指标、体重管理等。本标准适用于各级医疗卫生机构及医养结合服务机构工作人员对高龄老年人BMI水平的评价和体重管理工作的开展。     

将气候变化适应能力纳入公共卫生实践——利用适应性管理提升适应能力和增强应变能力

[背景]气候变化被认为会造成一系列健康影响,其中有些影响已显而易见.针对气候变化做出相应的公共卫生策略调整已势在必行,但如何提升公共卫生系统的适应能力与应变能力则少有著述. [目的]探讨适应能力不足的可能原因,总结可能超出公共卫生应对能力的气候变化对健康的挑战,思考提升公共卫生适应能力的实践改革.[方法]以公共卫生对气候变化的适应能力、社会学习和显示动态复杂性的社会经济体系管理为重点,进行大规模跨学科文献评述. [讨论]关于公共卫生应如何适应气候变化有两种不同观点.两种观点的区别在于气候变化是否从根本上放大了现有灾害,因而需要加强现有公共卫生的功能,或者说气候变化直接造成其特有.的危害,需要制定新型的处理策略.在有些情况下,气候敏感性对健康的威胁显然超出了公共卫生的适应能力.应对这些威胁需要进一步加强制度学习、创新管理策略以及研发新型改良工具.适应性管理可能是一种有用的方法,这个迭代框架接纳不确定性,使用模型并结合实践不断改进.本文对其在极端高温天气下都市环境中的应用于以阐述. [结论]提升公共卫生应对某些气候之健康威胁的能力是必要的.集中力量提高特定地区的适应能力,促进制度学习,采取适应性管理以及研发相应的促进工具为优先重点,可以提高当地公共卫生系统对气候变化的应变能力.     

基层医疗卫生机构应对突发公共卫生事件政策工具研究

目的 从政策工具视角分析基层医疗卫生机构应对突发公共卫生事件相关政策中的不足并提出提升政策工具有效性的建议。方法 选取2003年—2021年间中央层面发布的基层医疗卫生机构应对突发公共卫生事件相关政策，运用内容分析法从应急管理过程、基本政策工具、系统论视角，对政策文本进行编码、归类并分析政策工具使用情况。结果 政策工具维度中，供给型、需求型政策工具分别占比58.1%、2.5%,呈现重供给轻需求现象；应急管理维度中，事前管理占比76.25%,而事中、事后管理仅占13.13%和10.63%;系统论维度中，系统内外部子模分别占比79.28%和20.63%。政策工具—应急管理过程维度分析结果表明，事前管理过程中使用最多的是供给型政策工具，需求型与环境型政策工具在整个应急管理过程中使用都较少；政策工具—系统论维度交叉分析结果显示，内部子模相比于外部子模使用了更多的政策工具，其中供给型政策工具使用频率最高；系统论—应急管理过程维度交叉分析结果显示，整个基层医疗卫生机构应对突发公共卫生事件系统中，内外部子模都倾向于做好事前管理，占比达70%。结论 我国基层医疗卫生机构应对突发公共卫生事件政策体系建设...     

国外基层医疗卫生机构应急管理及对我国的启示

目的比较和分析国外应对突发公共卫生事件时基层医疗卫生机构的应急反应,分析其职责、应急管理体系建设经验,提出符合我国实际的基层医疗卫生机构突发公共卫生事件应对的制度化建议。方法基于文献分析,系统回顾国内外应对突发公共卫生事件时基层医疗卫生机构的职责、应急管理体系的建设经验。结果我国基层医疗卫生机构在专业技术人才、长效投入、防控基础建设、部门协调方面仍有提升空间。结论未来需结合国际经验,从提高基层医疗卫生机构突发公共卫生事件软硬件建设、调整卫生应急经费投入、优化空间布局与应急设置、加强医防融合、优化应急防控体系组织协调机制等方面,优化基层医疗卫生机构突发公共卫生事件协同应急防控管理建设。     

气候变化影响下的医疗卫生部门可持续采购策略

概述了气候变化对人类健康的影响,分析了医疗卫生部门影响气候变化和全球健康的原因,并从资源开采、生产制造、运输分配、使用和废弃管理等方面详细阐述了医疗卫生部门应对气候变化的相关采购策略。     

一个中国化医学临床指南评价工具的研发

目的:开发一个适合我国医疗实践实际的本土化临床指南评价工具。方法:在比较国外各种医学临床指南评价工具的基础上,根据AGREE工具并采用Delphi法进行了专家咨询和分析。结果:开发出一个适合我国情况的本土化临床指南评价工具。结论:开发出的首个临床指南评价工具,对于今后我国临床指南的开发制定具有一定指导意义。     

预防婴幼儿意外窒息指南/共识的质量评价及内容分析

目的 评价有关预防婴幼儿意外窒息的循证指南及共识文献，为预防意外窒息提供依据。方法 系统检索指南发布的主要网站、专业学会网站和电子文献数据库中有关婴幼儿意外窒息的指南文献，并追溯查阅相关参考文献。检索时间为建库至2021年7月31日。应用指南研究和评估工具Ⅱ（AGREE Ⅱ）及JBI循证卫生保健中心专家共识评价标准分别对循证指南和专家共识文献进行质量评价，总结分析各指南中有关预防婴幼儿意外窒息的相关建议。结果 筛选后共纳入6篇文献，最终纳入2篇循证指南、4篇专家共识。2篇循证指南经AGREE Ⅱ评价后，其范围与目的、参与人员、严谨性、清晰性、应用性与独立性6个领域标准化百分比得分分别为88.89%、86.12%、76.52%、86.12%、77.08%、91.67%，均为A级；组内相关系数（ICC）均＞0.75，一致性较高。4篇专家共识各条目的评价结果一致，均为“纳入”。最终归纳形成32条预防婴幼儿意外窒息的推荐建议，包括睡眠环境、用物管理、饮食管理、培训教育、组织政策五个方面。结论 纳入的6篇文献总体质量较好，评价分析后所得到的预防婴幼儿意外窒息的推荐建议可为卫生保健人员开展健康教育提供依据。     

卫生系统应对气候变化脆弱性减缓评估基线调查

目的了解卫生管理人员对气候变化的观点、态度和建议,评价卫生系统脆弱性和适应性,探索气候变化与健康相关研究方法。方法召开座谈会,采用参与式进行评价的方式,应用H表格,对回答结果进行分值量化和分析评估。结果被调查卫生管理人员认为气候变化背景下人群健康的脆弱性严重,卫生系统适应气候变化的障碍也比较严重,对卫生系统持续、有效应对气候变化所带来的健康风险尚未达到比较有信心的程度,认为目前适应气候变化,保护公众健康的措施可持续性一般。结论有些明显受气候影响的健康威胁所提出的挑战已超越了公共卫生的应对范畴,应建立多级防护系统,进行多学科、多领域综合研究,积极应对气候变化对人群健康的威胁。     

2012年红河州基层医疗卫生机构慢性病防控能力调查

目的了解红河州当前基层医疗卫生机构慢性病防控能力和应对情况,为政府制定相关政策和防控策略提供依据。方法利用2012年全国慢性病预防控制能力调查表收集红河州基层医疗卫生机构调查数据,用SPSS16.0进行描述性分析。结果调查应答率100%,红河州基层医疗卫生机构从事公共卫生服务人员占在岗人员总数的20.23%,基本公共卫生服务经费占财政拨款经费比例中位数为42.68%,在调查的11项设备中平均配置7.17项。基层医疗卫生机构开展了培训指导、慢性病防控知识宣传普及、慢性病患者及其高危人群发现和管理工作,在调查的10本国家现行慢性病工作规范平均持有2.46本,在调查的6个宣传日中平均开展宣传3.19个,开展高危人群随访管理、患者自我管理和双向转诊的基层医疗卫生机构的比例分别为8.10%、11.04%和27.92%。开展过慢性病项目和慢性病社区康复的基层医疗卫生机构的比例分别为1.30%和1.95%。结论红河州基层医疗卫生机构慢性病防控能力较弱,急需加强慢性病防控能力建设,健全和完善基层医疗卫生机构"六位一体"服务功能。     

Climate Change's Role in Disaster Risk Reduction's Future:Beyond Vulnerability and Resilience

A seminal policy year for development and sustainability occurs in 2015 due to three parallel processes that seek long-term agreements for climate change, the Sustainable Development Goals, and disaster risk reduction.Little reason exists to separate them, since all three examine and aim to deal with many similar processes, including vulnerability and resilience. This article uses vulnerability and resilience to explore the intersections and overlaps amongst climate change, disaster risk reduction, and sustainability. Critiquing concepts such as "return to normal"and "double exposure"demonstrate how separating climate change from wider contexts is counterproductive. Climate change is one contributor to disaster risk and one creeping environmental change amongst many, and not necessarily the most prominent or fundamental contributor. Yet climate change has become politically important, yielding an opportunity to highlight and tackle the deep-rooted vulnerability processes that cause "multiple exposure"to multiple threats. To enhance resilience processes that deal with the challenges, a prudent place for climate changewould be as a subset within disaster risk reduction. Climate change adaptation therefore becomes one of many processes within disaster risk reduction. In turn, disaster risk reduction should sit within development and sustainability to avoid isolation from topics wider than disaster risk. Integration of the topics in this way moves beyond expressions of vulnerability and resilience towards a vision of disaster risk reduction's future that ends tribalism and separation in order to work together to achieve common goals for humanity.     

Addressing climate change through health promotion in Australia

Climate change is arguably the biggest global health threat of the 21st Century. While the spread of vector‐borne diseases and the health impacts of extreme weather events dominate discussions about health and climate change, there are also a range of other issues that are central to the health promotion community. Concerns such as food security; mental health; Indigenous health; and water quality are increasingly familiar. It is also undeniable that a shared vision of most health promoters to achieve environmental sustainability and to promote health equity is challenged by the threat of climate change. Health professionals are well positioned to address this threat, but action needs to be swift and sustained.     

Devices for the prevention of TB transmission. Considerations for proper application

Healthcare facilities throughout the country are confronted with the task of preventing the transmission of tuberculosis among their patients and staff. On October 12, 1993, The Centers for Disease Control and Prevention published the Draft Guidelines for Preventing the Transmission of Tuberculosis in Health Care Facilities, and this is scheduled for final publication before year's end. The pending CDC guidelines are comprehensive and include engineering recommendations which are applicable to all settings in which health care is provided. Facilities that do not intend to use conventional construction or renovation to accomplish TB guideline compliance may consider using some type of environmental control device. These devices typically utilize ultraviolet germicidal irradiation (UVGI) and/or high efficiency particulate air filtration (HEPA), each of which is recognized as a viable TB environmental control. TB environmental control measures for specific areas within a healthcare facility should be based on a careful assessment of the actual risk of TB transmission in that setting.     

Impact of extreme weather events and climate change for health and social care systems

This review, commissioned by the Research Councils UK Living With Environmental Change (LWEC) programme, concerns research on the impacts on health and social care systems in the United Kingdom of extreme weather events, under conditions of climate change. Extreme weather events considered include heatwaves, coldwaves and flooding. Using a structured review method, we consider evidence regarding the currently observed and anticipated future impacts of extreme weather on health and social care systems and the potential of preparedness and adaptation measures that may enhance resilience. We highlight a number of general conclusions which are likely to be of international relevance, although the review focussed on the situation in the UK. Extreme weather events impact the operation of health services through the effects on built, social and institutional infrastructures which support health and health care, and also because of changes in service demand as extreme weather impacts on human health. Strategic planning for extreme weather and impacts on the care system should be sensitive to within country variations. Adaptation will require changes to built infrastructure systems (including transport and utilities as well as individual care facilities) and also to institutional and social infrastructure supporting the health care system. Care sector organisations, communities and individuals need to adapt their practices to improve resilience of health and health care to extreme weather. Preparedness and emergency response strategies call for action extending beyond the emergency response services, to include health and social care providers more generally.     

Knowledge, attitudes and behaviours related to climate change in Alberta, Canada: implications for public health policy and practice

Climate change has received recent extensive media attention (e.g., Kyoto Protocol) and is currently on the international public health agenda. The purpose of this study was to survey knowledge, attitudes and behaviours related to climate change in the province of Alberta, Canada. A random sample of 600 Alberta households, using proportional quotas based on the Canada Census of the Alberta population, was surveyed on knowledge, attitudes and behaviours related to climate change using a computer-assisted telephone interviewing protocol. Albertans are highly concerned, particularly about health problems related to the environment and air pollution; yet are only moderately informed about a variety of environmental issues. While the great majority of Albertans appear to be engaged in environmental behaviours at home, fewer consider energy efficiency when purchasing consumer goods. An even smaller percentage makes environmentally conscious transportation decisions. To encourage the population to make recommended environmental behaviours, mass media approaches may do well to target the specific beliefs that were deemed salient (e.g., promote the association between environment issues and health). The public health sector has a major role in working with inter-sectoral groups to address this significant public health issue.     

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience

Background: Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems.Objectives: We explored possible explanations for the lack of work on adaptive capacity, outline climate–health challenges that may lie outside public health’s coping range, and consider changes in practice that could increase public health’s adaptive capacity.Methods: We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity.Discussion: There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health’s adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting.Conclusions: Increasing public health capacity will be necessary for certain climate–health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.     

Community of practice: an effective mechanism to strengthen capacity in climate change and health

SettingClimate change is one of the greatest threats to global health in the twenty-first century and has recently been declared a health emergency. The lack of effective dissemination of emerging evidence on climate change health risks, effects, and innovative interventions to health professionals presents one of the greatest challenges to climate action today.InterventionTo identify and address the knowledge gaps at the intersection of health and climate change, the Canadian Coalition for Global Health Research (CCGHR) established a Working Group on Climate Change and Health (WGCCH). WGCCH is evolving organically into a community of practice (CoP) that aims to elevate knowledge brokering on climate change and health and expand to global multi-, inter-, and transdisciplinary realms.OutcomesTo date, the WGCCH established a regular webinar series to share expert knowledge from around the world on intersections between climate change and health, developed short summaries on climate change impacts on broad health challenges, supported young professional training, and enhanced climate health research capacity and skills through collegial network development and other collaborative projects that emerged from CoP activities.ImplicationsThis paper proposes that WGCCH may serve as an example of an effective strategy to address the lack of opportunities for collaborative engagement and mutual learning between health researchers and practitioners, other disciplines, and the general public. Our experiences and lessons learned provide opportunities to learn from the growing pains and successes of an emerging climate change and health-focused CoP.     

“双碳”背景下的空气污染和气候变化流行病学研究进展与展望

气候变化是21世纪人类面临的重大健康挑战, 空气污染也是全球重要的公共卫生问题。我国提出2030年前实现碳达峰、2060年前实现碳中和的"双碳"目标, 不仅会对我国空气污染和气候状况产生深远影响, 也会全面影响人群健康。空气污染和气候变化流行病学是环境流行病学的重要分支, 本文将围绕"双碳"目标背景下的空气污染和气候变化流行病学研究现状和未来趋势展开论述, 以期为后续更好地开展环境与健康研究提供思路和建议。     

Wastewater irrigation and environmental health: implications for water governance and public policy

Climate change is a large-scale and emerging environmental risk. It challenges environmental health and the sustainability of global development. Wastewater irrigation can make a sterling contribution to reducing water demand, recycling nutrients, improving soil health and cutting the amount of pollutants discharged into the waterways. However, the resource must be carefully managed to protect the environment and public health. Actions promoting wastewater reuse are every where, yet the frameworks for the protection of human health and the environment are lacking in most developing countries. Global change drivers including climate change, population growth, urbanization, income growth, improvements in living standard, industrialization, and energy intensive lifestyle will all heighten water management challenges. Slowing productivity growth, falling investment in irrigation, loss of biodiversity, risks to public health, environmental health issues such as soil salinity, land degradation, land cover change and water quality issues add an additional layer of complexity. Against this backdrop, the potential for wastewater irrigation and its benefits and risks are examined. These include crop productivity, aquaculture, soil health, groundwater quality, environmental health, public health, infrastructure constraints, social concerns and risks, property values, social equity, and poverty reduction. It is argued that, wastewater reuse and nutrient capture can contribute towards climate change adaptation and mitigation. Benefits such as avoided freshwater pumping and energy savings, fertilizer savings, phosphorous capture and prevention of mineral fertilizer extraction from mines can reduce carbon footprint and earn carbon credits. Wastewater reuse in agriculture reduces the water footprint of food production on the environment; it also entails activities such as higher crop yields and changes in cropping patterns, which also reduce carbon footprint. However, there is a need to better integrate water reuse into core water governance frameworks in order to effectively address the challenges and harness the potential of this vital resource for environmental health protection. The paper also presents a blueprint for future water governance and public policies for the protection of environmental health.     

Environmental sustainability in the national health service in England

Health care providers should seek to minimise the environmental damage caused by their activities and to use scarce natural resources wisely. In particular, they should aim to make no contribution to climate change. Well-designed buildings which incorporate nature will contribution to the health of patients, Staff and visitors. A checklist is provided for environmentally sustainable NHS services. Faster progress requires leadership of cultural change and a much greater corporate commitment from the Department of Health.