不同社区卫生服务中心妇幼医疗预防保健服务质量的比较分析

目的了解不同来源和所有制的社区卫生服务中心妇幼医疗保健功能的完成情况,分析造成差异的原因。方法对40家城区社区卫生服务中心的妇幼医疗预防保健服务所涉及的预防、医疗、保健、康复、健康教育、计划生育技术服务等6个方面完成情况进行自行评分,运用Ridit方法对得分进行统计分析。结果与平均分(标准组)相比,由街道医院(一级医院)转型的社区卫生服务中心,医疗、康复服务得分和总得分低;全民所有制形式社区卫生服务中心,医疗、康复、计划生育服务得分和总得分高,差异均存在显著的统计学意义。结论政府要严格街道医院转为社区卫生服务中心的准入标准,注重加强其医疗技术力量和设备建设。全民所有制形式的社区卫生服务中心服务质量高,有能力开展更多的社区妇幼医疗保健服务项目。     

哈尔滨、长沙、上海妊娠期女性口腔保健意识及行为比较

目的：探讨妊娠期女性口腔保健意识及行为，为加强妊娠期女性口腔保健工作提供依据。方法调研哈尔滨、长沙、上海三地妊娠期女性口腔保健意识及行为方式，并对调查结果进行分析。结果三地妊娠期女性口腔保健相关知识掌握情况尚可，对于龋病及牙周病相关问题的调研中，能够答对半数及以上的受访者分别占50．17％及46．79％。而三地妊娠期女性口腔保健行为习惯有待提高：仅有3．78％的妊娠期女性达到每日3次刷牙，13．29％的妊娠期女性每日使用1次以上的牙线，27．34％的妊娠期女性有漱口水使用习惯。三地牙周病相关知识掌握、刷牙、牙线使用和漱口水使用情况均有显著性差异（χ2值分别为12．010、18．311、9．975、9．828，均P＜0．05）。结论妊娠期女性口腔保健工作至关重要，需要加强孕妇口腔教育，减轻口腔医疗负担，强化孕期女性口腔保健，提升女性妊娠期口腔健康情况。     

Perspectives on disparities in depression care

Depression is a major public health problem and a leading cause of disability worldwide. Compounding the high rates of morbidity and mortality and treatment challenges associated with depression are the tremendous disparities in quality of mental health care that exist between the majority of the population and those of racial and ethnic minorities. Although more study data are available on depression care for African Americans than for other groups, racial and ethnic minorities overall are less likely than whites to receive an accurate diagnosis, to receive care according to evidence-based guidelines, and to receive an antidepressant upon diagnosis. Multiple factors contribute to these disparities, among them socioeconomic and cultural issues and prejudices among patients and health care providers. Closing the gap that exists between what depression care is and what depression care could be begins with clinicians' recognizing the relevance of culture to care. Opportunities exist within the broader context of medical education, including continuing medical education (CME), to prepare health care professionals to address the myriad issues related to managing depression.     

Discussion of Sensitive Health Topics with Youth During Primary Care Visits: Relationship to Youth Perceptions of Care

PurposeYouth have concerns about sensitive health topics, such as drugs, sex, and mental health, and many wish to discuss those concerns with a primary care provider. Research has not determined whether the discussion of sensitive health topics during primary care visits is independently associated with youth perceptions of care. This study examined whether the discussion of sensitive health topics during primary care visits was associated with youth's perceptions of the provider and of participation in treatment.MethodsDirectly after visits to 54 primary care providers in 13 geographically diverse offices and clinics, youth age 11–16 years old (N = 358) reported whether the visit included the discussion of mood, behavior, getting along with others, drugs, tobacco, alcohol, sexuality, birth control, parent mood, or family problems. Youth also reported whether the provider understood their problems, eased their worries, allowed them to make decisions about treatment, gave them some control over treatment, and asked them to take some responsibility for treatment. Providers reported confidence in their ability to offer counseling for nonmedical concerns and their beliefs and attitudes toward treating nonmedical concerns.ResultsYouth had more positive perceptions of the provider and were more likely to report taking an active role in treatment when the visit included the discussion of a sensitive health topic. Results from multivariate random effects logistic regression suggested that youth were more likely to report that the provider understood their problems (OR = 3.62, CI = 1.57–8.31), eased their worries (OR = 2.13, CI = 1.06–3.92), allowed them to make decisions about treatment (OR = 2.71, CI = 1.44–5.10), gave them some control over treatment (OR = 2.51, CI = 1.32–4.71), and asked them to take some responsibility for treatment (OR = 2.00, CI = 1.04–3.86) when the visit included the discussion of one or more sensitive health topics. The odds of each of these outcomes were also higher when the visit included the discussion of a greater number of sensitive topics. Youth also had more positive perceptions of female providers. Youth demographics, mental health status, and other provider characteristics were unrelated to youth perceptions of care.ConclusionsThe discussion of sensitive health topics during primary care visits may have a positive impact on youth perceptions of care. Future research is needed to understand the relationship between the discussion of sensitive health topics and health outcomes among youth.     

The homeless alcoholic: who cares?

Two homeless alcoholics, males aged 58 and 40 years, suffered from multiple health problems. Sleeping outdoors, excessive drinking and incompetence refrained them from seeking proper assistance. The patients were assessed on many occasions at primary care services provided in shelters in Amsterdam, at police stations and in the streets. They were also frequently admitted to shelter infirmaries, alcohol clinics and general hospitals. Despite substantial individual health damage, community costs and extreme care consumption, coercive treatment was not applied to prevent the death of the first patient and to stabilise the situation of the second. It is stated that a specific group such as homeless alcoholics can hardly be treated except during moments of crisis. Coercive treatment should be applicable in order to stabilise these patients so as to prevent early mortality among the alcoholic homeless with comparable health problems. Outreach primary care services for the alcoholic homeless should actively cooperate with addiction and mental health services in providing adequate care.     

妇女围绝经期症状及保健需求调查

目的:了解上海妇女围绝经期症状发生情况、对围绝经期的认识及围绝经期的保健需求,以指导干预。方法:以社区为基础进行抽样,采用入户面访的方式进行问卷调查。结果:平均绝经年龄(49.96±3.13)岁,围绝经期症状发生率为62.37%。50~和55~岁年龄组症状发生率分别为61.99%和62.85%。9.5%的人认为有必要进行定期的妇科检查,只有32.52%的人近两年做过妇科检查,对各种妇女保健知识需求选择“是”的均在70%以上,有52.13%的人希望医生来居委会提供服务。结论:妇女围绝经期症状发生比例较高,保健意识还有待提高,对社区的围绝经期卫生保健服务及有关知识需求较高。     

杭州经济技术开发区流动人口卫生知识需求调查

目的了解杭州经济技术开发区流动人口的卫生知识需求,为开展相应卫生服务及疾病预防控制工作提供依据。方法采取随机整群抽样的方法,对杭州经济技术开发区下属的下沙镇和区内厂矿企业中外来流动人口1819人,进行问卷调查。结果被调查人员的卫生知识获取渠道:84.99%的人从广播、电视中获取卫生知识,65.70%的人卫生知识来自卫生科普书籍和宣传资料,51.25%的人来自朋友介绍,29.91%的人来自卫生咨询活动和知识讲座,23.64%的人来自互联网络。卫生知识需求情况:分别有73.45%和71.85%的人希望获得家庭保健知识和营养卫生知识,71.14%的人希望获得传染病防治知识,其他顺位依次为生理卫生知识、季节性疾病防治知识、心理卫生知识、慢性病防治知识、性传播疾病防治知识、妇幼保健知识、家庭应对子女传授的健康知识、预防农药中毒知识、地方病及遗传病防治知识。卫生知识获取方式:71.14%的人希望从电视中获得卫生知识,其他顺位依次为广播、卫生科普报刊、医药卫生书籍、卫生宣传画及小册子、卫生咨询活动、卫生知识讲座、卫生文艺宣传、卫生宣传墙报、手机短信、医院健康教育处方、互联网络、卫生科教电影或幻灯片。结论流动人口卫生知识获取途径、卫生知识需求、卫生知识获取方式需求受所从事工作、性别及文化程度影响较大,应针对调查实际需求,加强对流动人口的健康教育和行为干预。     

U.S. medical students choice of careers and its future impact on health care manpower

During the last 10-15 years, the health care system of this country has faced major challenges, among them, spiraling increases of health care costs, physician manpower maldistribution, excessive production of subspecialists, shortages of primary care physicians (family practice, general internal medicine, and general pediatrics), and lack of access to health care, predominantly among the poor and disadvantaged populations. As a way of shedding light on some of these challenges, the authors conducted a study among junior medical students from the University of Texas Medical School at Houston which focused on some of the factors that might influence medical students' choice of careers. In this article, the authors review the most salient findings for some of the problems that currently plague the health care system of this nation. Certainly, the outcome of this study has important educational and health service delivery implications not only in the United States but abroad as well, particularly among developing nations.     

湖北省更年期和老年期妇女卫生保健服务利用状况

目的 为了解我省更年期和老年期妇女卫生保健利用情况，以便更好的为我省更年期和老年期妇女提供及时有效的卫生保健服务。方法 于2001年8月至2001年12月通过整群抽样方法对我省5市(县)城乡7075名更年期和老年期妇女进行了卫生保健服务利用状况调查。结果 我省更年期和老年期妇女卫生保健知识知晓率为8．1％(574／7075)，不知道为46．5％(3289／7075)，防病检查1年1次为6．1％(出30／7075)，2年1次为3．7％(263／7075)，2年以上1次为3．2％(229／7075)，87.0％(6135／7075)未能定期检查。84．6％(5989／7075)的妇女有病能及时治疗。激素替代疗法率为1．7％(118／7075)。补钙率为5．4％(384／7075)。结论 我省更年期及老年期妇女卫生保健知识知晓率低，不能定期进行防病检查，卫生保健服务利用还有待进一步加强。     

长沙高校女大学生生殖保健相关认知行为调查

目的了解长沙在校本科女大学生生殖保健知识的知晓情况及态度行为,为高校开展健康教育课程提供依据。方法采取自行设计的生殖保健认知调查表在长沙高校中随机抽取3所高校的480名女大学生进行调查。结果女大学生中仅有56.4%（251）的人会主动了解生殖保健知识,有90.3%（402）的人认为自己的生殖系统很健康,而27.2%（121）的人观察到白带的异常,62.5%（278）的人感觉到有外阴瘙痒或灼热感。对乳房健康关注的人只有32.8%（146）,仅有7%的人知道乳房自检的方法。结论长沙高校女大学生对生殖保健知识知晓率普遍较低,需加大力度宣传生殖保健知识。     

Using diffusion of innovation theory to encourage the development of a children's health collaborative: a formative evaluation

Lack of access to medical treatment and preventive care affects children's immediate well-being and has potential consequences for their physical and mental health as adults. The study reported in this article was designed as the first step in planning and implementing a communitywide collaborative to work on improving medically underserved children's access to health care. The authors used a two-stage, census-based telephone survey to identify organizations that had contact with medically underserved children and to assess the status of the communication network among them. Although there was no evidence of a functioning network among the organizations surveyed, the results indicate that many organizations would participate in a network and suggest possibilities for developing an organizational network aimed at improving children's access to health care.     

Performing Black womanhood: a qualitative study of stereotypes and the healthcare encounter

The US health system remains fraught with racial, gender, and class biases that lead to health care inequities. Although Black middle-class women are rarely studied in the context of health care disparities, they continue to face stereotyping and differential treatment. I argue that Black middle-class women are aware of pervasive stereotyping which leads them to emphasize specific class and cultural resources, i.e. cultural health capital, to mitigate discrimination. Based on in-depth interviews of 19 middle-class African-American women and two focus groups, the study explores stereotyping, bias and the use of cultural health capital as a strategy to mitigate them. Respondents overwhelmingly endorsed the importance of implementing these strategies, noting they were necessary to avoid differential treatment. The findings highlight pervasive stereotypes Black women face in health care settings and in general. Finally, the findings refocus our attention to the durability of race and gender discrimination across socioeconomic status and point to fundamental social inequities as determinants of health care disparities.     

藏区生殖保健服务网络现状调查

目的:了解大香格里拉地区生殖保健服务网络的现状,以探索适宜区域情况的服务模式。方法:运用定量调查和定性研究相结合的方法进行调查。结果:大香格里拉地区生殖保健服务网络呈现3种模式,模式之间存在较大差异。3种服务模式普遍存在服务机构不完善、服务人员缺乏、技术服务水平低等问题。结论:该地区生殖保健基本公共服务非均等化问题突出,基本公共服务严重不足。建议根据不同地区的实际情况构建和完善服务体系,整合服务资源,创新管理机制,在服务活动与内容协同等方面探索适宜的生殖保健服务模式。     

Using Diffusion of Innovation Theory to Encourage the Development of a Children's Health Collaborative: A Formative Evaluation

Lack of access to medical treatment and preventive care affects children's immediate well-being and has potential consequences for their physical and mental health as adults. The study reported in this article was designed as the first step in planning and implementing a communitywide collaborative to work on improving medically underserved children's access to health care. The authors used a two-stage, census-based telephone survey to identify organizations that had contact with medically underserved children and to assess the status of the communication network among them. Although there was no evidence of a functioning network among the organizations surveyed, the results indicate that many organizations would participate in a network and suggest possibilities for developing an organizational network aimed at improving children's access to health care.     

The Individual and Organizational Role of Physicians in Mitigating the Biological,Psychological and Social Health Consequences of Displacement

The number of Internally Displaced People is growing globally with a significant number travelling to countries such as Canada. These individuals have unique health care needs that are significantly impacted by several social determinants of health, which provides a challenge to the physician as they must address the biological, psychological and social factors in order to effectively improve the health of this population. The physician must work at the individual, national, and international levels and collaborate with other health care workers in order to effectively address these complex health care issues. Some recent strategies that show promise in targeting these complex care issues include knowledge sharing among medical professionals, specialized treatment approaches including treatment through telemedicine as well as political advocacy. The application of strategies such as these, along with increased awareness and commitment from physicians, will work to improve health care and prevent negative health outcomes in this growing population.     

江苏省扬州市部分医务人员吸烟行为及控烟知识现状调查

目的对江苏省扬州市医务人员的吸烟行为和控烟知识现状进行调查,为今后在医务人员群体中实施控烟干预提供依据。方法采用问卷调查的方法,对扬州市4家医疗机构605名直接从事医务工作的人员进行问卷调查。结果医务人员人群总吸烟率为16.03%,现在吸烟率为11.57%;烟草危害的知晓率为73.61%,7种吸烟相关疾病的知晓率为71.00%,6种被动吸烟相关疾病的知晓率为77.60%;对医疗机构控烟认同率为83.63%;43.46%的医务人员获得过控烟方面的知识培训,能为病人制定戒烟计划的有1.69%;能对病人在门诊和病房提供健康教育的有31.40%。结论医务人员人群烟草相关知识掌握相对不足,应当进一步加强医务人员控烟知识和技能的健康教育和培训,改变其吸烟行为,同时也更好地推动社会控烟工作。     

上海市黄浦区某社区城市老年人心理健康干预效果评价

目的 对上海市黄浦区某社区城市老年人心理健康干预进行效果评价。方法 在黄浦区某社区对94名有心理卫生问题的老年人进行干预前后的配对t检验，并设对照组和心理健康组。干预的方法主要有心理健康和老年保健知识讲座，心理剧治疗，支持性心理咨询。用SCL-90量表和老年人心身健康调查表进行有关因素分析。结果 干预组和对照组比较，P〈0．01。干预前后配对t检验，P〈0．01，干预效果显示较低年龄组（60～69岁）比较高年龄组（70～79岁）干预效果好，男性比女性干预效果好。结论 心理健康和老年保健知识讲座，心理剧治疗，支持性心理咨询对社区城市老年人心理健康干预有效。     

花都市小学生的口腔保健知识,态度,行为调查

目的 了解小学生的口腔保健知识、态度、行为。方法 在广东省花都市新华镇第二小学用随机整群抽样的方法对３５５名１～６年级的学生进行问卷调查。结果 约３／４的学生,尤其是高年级学生,在口腔保健知识方面得到高分。大部分学生重视口腔保健。全部学生每天刷牙,但多数人刷牙的方法不正确;患龋齿的学生中多数未到医院诊治;没有一个学生定期接受口腔检查。结论 大部分小学生掌握一定的口腔保健知识、关心自己的口腔健康,全     

User fee exemption policies in Mali: sustainability jeopardized by the malfunctioning of the health system

In Mali, where rates of attendance at healthcare facilities remain far below what is needed, three user fee exemption policies were instituted to promote access to care. These related to HIV/AIDS treatment, as of 2004, caesarean sections, since 2005, and treatment of malaria in children under five and pregnant women, since 2007. Our qualitative study compared these three policies, looking at their implementation provisions, functioning and outcomes. In each healthcare facility, we analysed documentation and carried out three months of on-site observations. We also conducted a total of 254 formal and informal interviews with health personnel and patients.While these exemptions substantially improved users' access to care, their implementation revealed deep dysfunctions in the health system that undermined them all, regardless of the policy studied. These policies provoked resistance among health professionals that manifested in their practices and revealed, in particular, the profit-generation logic within which they operate today. These dysfunctions reflect the State's incapacity to exercise its regulatory role and to establish policies that are aligned with the way the health system really works.     

Herbal Remedies Used by Selected Migrant Farmworkers in El Paso, Texas

CONTEXT: Little is known about the use of complementary and alternative medicine among the approximately 1.6 million migrant farmworkers in the United States. PURPOSE: To evaluate the use of medicinal plants and natural remedies among a convenience sample of 100 migrant farmworkers living temporarily in a migrant worker center in El Paso, Texas. METHODS: A structured interview instrument was designed to elicit information about reasons for medicinal herb use, form in which herbs were ingested, serious side effects experienced, location of purchase, effectiveness of treatment, and use of allopathic medications. FINDINGS: The majority of workers used herbal remedies or other natural products because they believed them to be more effective than pharmaceuticals and because of tradition. Most learned about herbal remedies from a relative, primarily from their mother, and the majority who used herbal remedies believed them to be very helpful in treating specific illnesses. No adverse reactions to any herbal remedy were reported. The majority of participants did not inform their physician about their use of herbal remedies. According to the literature, potential adverse interactions between herbal remedies used and allopathic medications included gastrointestinal irritation, renal toxicity, and hypoglycemia. CONCLUSIONS: Health care providers must be knowledgeable about the use of herbal remedies among migrant farmworkers. By showing an understanding of and sensitivity to the use of these remedies, health care providers will be able to conduct more comprehensive health assessments of migrant workers and their families and provide them with more culturally competent care.