The impact of home safety promotion on different social strata in a WHO safe community

OBJECTIVES: Few studies have investigated the impact of home safety promotion programmes on different social strata. The aim of this study was to investigate the distribution of effects of a community-based home safety programme on home injury rates among families with different connections to the labour market. METHODS: A quasi-experimental design was used, with pre- and post-implementation registrations covering the total populations below 65 years of age in the programme implementation area (population 41,000) and in a neighbouring comparison municipality (population 26,000) in Osterg?tland County, Sweden. RESULTS: In the intervention and comparison areas, households in which the adults were not vocationally active displayed the highest rates of home injury. After 6 years of programme activity, the home injury rates for males and females in all social status categories displayed a decreasing trend in the intervention area. The opposite was true for the comparison area, i.e. the incidence of injury increased, with the exception of females in non-vocationally active households. The decline in injury rates in the intervention area was statistically significant for males and females in the employed category and for males in the non-vocationally active category. Changes in injury rates in the comparison area were not statistically significant. CONCLUSION: The programme was partially successful in that it reduced the injury rate in non-vocationally active households, but it did not influence the injury rate in the employed households. The study design did not allow for conclusions regarding why the post-intervention injury rates remained higher in non-vocationally active households. Further research on the association between the incidence of home injury and socio-economic factors is warranted.     

Increased hip-fracture incidence in the county of Osterg?tland, Sweden, 1940-1986, with forecasts up to the year 2000: an epidemiological study.

The incidence of hip fractures in the county of Osterg?tland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.     

新医改后患者和医务人员满意度研究——以上海为例

目的:研究新医改实施后,医务人员的工作满意度和患者满意度情况。方法:采用问卷调查法,对上海地区8家社区卫生服务中心和4家综合性医院的医务人员和患者进行调查。结果:共回收有效问卷1 001份,其中患者问卷499份,医务人员问卷502份。医务人员和患者的总体满意度都较好。患者对行政监管、就医环境、服务态度和服务能力方面的满意度较好,对药品供应、医疗费用方面的满意度较低。医务人员对工作回报的满意度最低,对医院内工作环境的满意度水平最高。社区卫生服务中心的医务人员和患者的满意度普遍比综合医院好。结论:上海地区的医务人员和患者的总体满意度较好。今后应进一步加强知识宣传,优化诊疗流程,控制医疗费用,改善医疗执业环境和工作待遇。     

Risk factors for disability pension in a population-based cohort of men and women on long-term sick leave in Sweden

BACKGROUND: Knowledge on predictors of disability pension is very limited. The aim was to assess the importance of sick-leave diagnosis and socio-demographic variables as risk factors for disability pension among individuals on long-term sickness absence and to compare these factors by gender and over time. METHODS: A prospective population-based cohort study in Osterg?tland County, Sweden, included 19,379 individuals who, in 1985-87, were aged 16-60 years and had a new spell of long-term sickness absence lasting > or =56 days. Follow-up was done in two time frames: 0-5 and 6-10 years after inclusion. The risk of disability pension in relation to sick-leave diagnosis and socio-demographic factors was assessed by Cox proportional hazard regression analysis. RESULTS: In 5 years, after inclusion, 28% of the cohort had been granted disability pension. Those with higher age, low income, previous sick leave, no employment and non-Swedish origin had higher risk of disability pension, while those with young children had lower risk. Considering the inclusion diagnosis, the pattern differed between men and women (P < 0.001). Among men, those with mental disorders had the highest risk and among women those with musculoskeletal disorders. Except for income, the effect of which was reversed over time, the overall pattern of disability pension predictors remained 6-10 years after inclusion but was attenuated. CONCLUSION: Besides socio-demographic risk factors, the sick-leave diagnoses constitute an important both medium and long-term predictor of disability pension among both men and women on long-term sickness absence.     

城乡基层医疗卫生机构基本公共卫生服务居民满意度研究:以湖北省为例

目的:分析湖北省城乡居民对基本公共卫生服务的满意度及影响因素,为改善我国基本公共卫生服务质量提供政策依据。方法:根据经济发展情况选取湖北省武汉、黄冈、荆州地区共12家基层医疗卫生机构,对就诊居民进行满意度问卷调查,测量居民对基本公共卫生服务的可及性、舒适性、安全性和有效性的满意状况。结果:城乡居民对基本公共卫生服务的满意度得分为71.62分,总满意率为73.44%。城乡居民对基本公共卫生服务具体指标满意度最高的为就诊方便性(83.03%)和隐私保护(80.25%),满意度最低的指标为医疗技术(61.61%)和设备设施(64.53%)。Logistic回归分析结果显示,基本公共卫生服务的可及性、舒适性、安全性对社区居民满意度影响较大,性别及年医疗支出对居民满意度也有一定的影响。结论:城乡居民对基本公共卫生服务总体满意度处于一般水平,有待提升;城市平均满意度高于农村,农村地区存在较大的提升空间;基本公共卫生服务应进一步强化质量建设,促进城乡基本公共卫生服务均等化发展。     

Evidence of a non-linear influence of patient age on satisfaction with hospital care.

BACKGROUND: Patient age is the main socio-demographic factor influencing patient satisfaction with care but the nature of the relationship between age and patient satisfaction is controversial. OBJECTIVE: This study aims to clarify whether the association of age with satisfaction is linear or shows some other configuration. METHODS: Data were obtained from two different satisfaction studies conducted in 27 short-stay teaching hospitals. Study 1 included 1547 inpatients, who completed the EQS-H questionnaire at the time of discharge. Study 2 included 7624 inpatients interviewed by phone at home after discharge, who answered the SAPHORA questionnaire. On the basis of the results of the exploratory analysis, three models for adjustment of age on satisfaction were compared: a simple linear model, a five-group step function and a linear model with a change in slope. RESULTS: The most suitable model for adjusting patient age to satisfaction scores for quality of medical and nursing care, whether for the EQS-H or the SAPHORA scale, was not a linear relationship: patient age was linearly and positively correlated to satisfaction before 65 years and negatively thereafter. Adjustment of patient age to accommodation and premises satisfaction scores proved to be different, closer to a linear relationship. CONCLUSION: These results suggest considering the patient age variable as a non-linear factor for adjusting satisfaction scores, in particular in relation to care. Further studies are needed to confirm the evidence of a threshold around 65 years beyond which satisfaction scores for the quality of medical and nursing care decrease.     

广东部分城市地中海贫血患者家属认知及医疗保障满意度调查分析

目的了解广东省重型β-地中海贫血患者家属地中海贫血相关知识认知程度、态度及对医疗保障水平的满意度,探讨其相关因素。方法采用自制问卷,典型抽取广州、深圳和佛山三市的重型β地中海贫血患者家属,共273人。结果患者家属地中海贫血知识平均得分为（6．24±1．70）分,不同年龄、文化程度和职业的患者家属认知得分不同,差异有统计学意义（均有P〈0．05）。其中,认知合格率为62．6％,对地中海贫血医疗保障水平满意度为41．4％。多因素Logistic回归分析结果显示,文化程度是患者家属认知合格率唯一的相关因素。结论患者家属的认知程度较好,但对地中海贫血的医疗保障水平满意度不高。     

Meeting patient's expectations in primary care consultations in Lithuania.

OBJECTIVE: Patient satisfaction with health care services is considered an important factor of health care. Although research on patient satisfaction has become standard in Western Europe, in countries such as Lithuania the concept of patient satisfaction is still a relatively new one. This study aimed to investigate how the meeting of patients' expectations is related to increased satisfaction with medical consultation. STUDY DESIGN: The methodology used by Williams et al. in the UK was applied to the Lithuanian health care setting. Forty physicians from 22 primary health care centres attending courses on general practice at Vilnius University were recruited for the study. Every third adult patient coming to a practice during a 5-day period was invited to participate in the study. In all, 609 patients coming to meet their physician regarding health problems were included in the study sample. The patients were asked to complete three standardized questionnaires: the Patient Intentions Questionnaire prior to the consultation, and the Expectations Met Questionnaire and Medical Interview Satisfaction Scale after the consultation. Cronbach's alpha statistic was used for the validation of the questionnaires and principal components analysis was used to determine the factors of patient expectations. RESULTS: The response rate was 78%. ANALYSIS: of 460 sets of questionnaires revealed that satisfaction with medical consultation is higher among patients who have a greater number of expectations met. Physicians' success in meeting different types of patient expectations also had different influences on patient satisfaction. The most important expectations to be met were "understanding and explanation", followed by expectations of "emotional support", while "getting information" was less important. CONCLUSIONS: The most frequently reported expectations on the Patient Intentions Questionnaire were for "getting information" and "understanding and explanation" of the patients' health problem items, and the least mentioned were for emotional support items. Patients with more expectations met were found to have significantly higher scores on the satisfaction index. Satisfaction with the consultation is best predicted by meeting the patient's expectations for understanding and explanation, and for emotional support. Providing desired information to the patient as well as meeting the patient's expectations for diagnostic procedures and treatment is less associated with patient satisfaction.     

Estimating disease prevalence using a population-based administrative healthcare database

AIMS: In Osterg?tland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames. METHODS: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999-2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n approximately 415,000). RESULTS: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses. CONCLUSIONS: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.     

湖南省农村卫生适宜技术服务满意度分析

目的：了解湖南省农村卫生适宜技术推广使用情况，评价患者接受卫生适宜技术服务的满意度。方法：采用横断面研究对390名接受过适宜技术服务的患者进行满意度问卷调查。利用spss13.0对数据进行录入分析，用均数和频数进行统计描述，计算Cronbach＇s α信度系数以分析问卷内部一致性；采用非条件Logistic回归分析患者满意度的影响因素。结果：患者对治疗效果、医疗信息、医疗费用等8个方面的满意率在72．5％～96.4％之间，总的满意率为72.8％。患者满意度的影响因素有文化程度、疾病严重程度及支付方式。该问卷各条目与总得分的Cronbach＇s α信度系数在0.79～O．81之间，总的Cronbach＇s α信度系数为0.82。结论：河南省农村卫生适宜技术推广应用效果较好，患者对所接受的适宜技术满意度较高。