社区卫生建设的新阶段:全科医生必需承担起社区健康管理使命

本文讨论了我国社区卫生和健康管理的现状,指出了社区卫生服务的重要抓手是社区健康管理,以疾病治疗为主医疗模式应转向以预防和健康管理为主医疗模式;本文认为社区卫生建设经过多年发展现在已进入新阶段,全科医生培养和健康管理是新阶段社区卫生建设的两个基本点,而基于全科医学的生命周期健康管理模式是我国社区卫生的理想模式,全科医生应承担起时代赋予的社区健康管理使命。     

健康俱乐部在社区

社区卫生服务在我国起步时间不长,但发展迅速。以社区卫生服务中心为主、社区卫生服务站为辅,以居民为对象、以家庭为单位、以社区为范围、以需求为导向的社区卫生服务体系框架正逐步形成。服务形式从医院走向社区,进入家庭,服务内容从单纯的以疾病为中心转向健康干预。     

健康促进医院在社区卫生服务中心开展的几点思考

在社区卫生服务中心从"以病人为中心"的医院模式向"以健康为中心"的健康服务中心转变过程中,健康促进医院的创建工作为社区卫生服务中心的改革和发展提供了一定的帮助,提高了员工的健康教育观念,进一步完善了医疗服务功能,提升了社区卫生服务中心的健康服务水平。     

运用质量管理体系认证 提升医院管理水平

随着三医联动改革和多元化办医机制的引入，对医院的医疗服务提出了更高的要求。一级医疗机构正从单一的医疗为主，等病人上门为主逐渐转制为社区卫生服务中心，变医护人员走出医院、走向社区、走进家庭、为所在社区提供有效、价廉、便捷、连续的综合卫生服务，形成了集预防、保健、医疗、康复、健康教育和计划生育技术指导六位一体的社区卫生服务新模式。为了更好地开展社区卫生服务，探索和总结出一套科学的、规范的、行之有效的管理模式，     

社区口腔健康促进模式构建和发展策略探讨

社区卫生服务是由全科医生为主体的卫生组织或机构所从事的一种社区定向服务[1]。社区卫生服务应以整个社区人群为对象,以预防为主,加强整个社区的健康保健。目的是把服务模式从医疗为主转变为以保护和促进社区健康为主;把服务对象从以患者为主体扩大为以社区全体人群为主体;把服务内容从以治疗为主扩展为预防、治疗、保健、康复、健康教育和计划生育指导等多个方面。这种服务目的、服务对象、服务内容的转变,无疑会给社区居民的健康带来     

构建医院托管社区新模式的思考

医院托管社区卫生服务中心后,可以加强了医院与社区卫生服务中心的双向转诊工作,实现了医疗资源共享,医院的优质医疗资源直接辐射到社区,中心可以充分利用医院的技术、管理资源优势,在较短时间内提升社区卫生服务中心的服务质量和医疗水平,更好地为社区居民健康服务,同时也为医院拓展了发展空间。     

社区健康管理中全科医师团队的作用

社区卫生服务中心的服务模式由全科医师为主向全科医师团队的过渡,就是深化社区卫生改革,构建中国特色的社区卫生模式。全科医师团队作为社区健康服务的基本执行单位,要转变服务理念,在社区健康管理中需要充分发挥作用,立足于基本医疗服务,做好健康档案、健康教育以及慢性病管理等工作,达到促进居民健康的目的。     

健康档案体系建设对医院经济发展及效益的影响

随着医改不断深入,推进和大力发展社区卫生服务势在必行.以综合性医院为依托,以科学的社区健康档案网络体系为纽带,社区卫生服务中心和社区卫生服务站充分发挥了社区卫生服务的作用,满足了社区居民对医疗服务的需求,及时为居民提供医疗保健卫生服务,方便了群众,提高了居民的生活质量.而且拥有强劲实力的三级综合医院通过社区卫生服务,利用医院的技术、设备、人力资源,全面提升了医院的形象,开拓了医院的医疗市场,提高了医院经济效益和社会效益.     

社区卫生全科服务团队中护理人员素质要求

社区卫生全科服务团队是一种社区卫生服务新模式,由全科医师、社区护士和预防保健人员组成,以主动上门服务为主,为社区家庭成员尤其是慢性病患者提供健康教育、预防、保健、康复、医疗和计划生育技术指导等综合服务。团队中社区护士在深入社区,服务居民,促进居民的健康水平提高方面有着非常重要的作用。社区护理不同于医院的护理,因为社区护理以促进和维护健康为中心,面向整个社区人群,社区护士要有高度的自主性,并且还需同其他相关人员密切合作,单独完成各种角色的工作任务,正由于社区护理工作范围广,覆盖面大,     

大型三甲医院与政府联合举办社区卫生服务中心运作模式分析

大型三级甲等医院与区政府联合举办社区卫生服务中心,缓解医院门诊压力,解决居民看病难问题,同时为出院患者提供延续治疗服务。此模式社区卫生服务中心业务用房和医疗设施设备的配置均由地方政府免费提供,交由医院独立经营管理,服从地方卫生主管部门的行业管理。该中心成立三年以来,随着知晓率不断提升,业务工作量逐年呈现大幅度上升,相当于成都相似规模其它社区卫生服务中心的3倍以上,病人满意度大于99%。三甲医院与区政府联合举办社区卫生服务中心,高水平的基本医疗技术赢得了社区居民的高度信任,极大的提高了中心的知名度,促进了公共卫生服务的开展;公共卫生服务的有序开展进一步提升了中心基本医疗业务的知晓率,促进居民选择就近就医,真正实现了分级诊疗。     

广东省农村初保10年审评结果分析

文章运用多元方差分析等方法分析了广东省农村初保１０年审评结果及其年度变化趋势。结果发现，各个指标的分值完成率存在着不均衡性，初保得分与地理环境和经济水平有关。本文揭示，广东省广大农村地区的初级卫生保健经过１０年的努力，已取得显著的成绩，与此同时，由于初级卫生保健所固有的复杂性、动态性、艰巨性和长期性以及广东省内的地区差异，经济差异及进度的不同，广东省的广大农村地区卫生工作在可见的未来，仍需以初级卫生保健为卫生工作的龙头，在不断完善已取得的成绩基础上，将初级卫生保健不继引向深入。     

Health care delivery practices in the rural part of the Yavatmal district regarding IUD insertion

A cross-sectional survey of Cu T users in a rural area of the Yavatmal district was carried out using stratified sampling, to identify interventions that can improve intrauterine device (IUD) service provision processes and their acceptance. The average age at Cu T insertion was 23.8 years. Cu T acceptance with one child was 55.5%. 80.8% of Cu Ts were inserted within 10 days of menstruation, while there were no post-partum Cu T insertions. 51.8% Cu Ts were inserted in PHC's. At the time of the survey, 48.2% users already have their Cu T removed. Only 22.7% couples utilized some alternate contraception after Cu T removal. Post-discontinuation contraceptive use was lower in a tribal area. 30% Cu T acceptors received less than two health checkups. 78.8% (58.1% in a tribal area and 84.9% in a non-tribal area) beneficiaries received information about Cu T from health workers. Only 6.6% Cu T acceptors received specific advice of checking the Cu T string. Utilization of private facility was more common among tribals. Reach of health service regarding Cu T need to be improved in tribal areas. Health service providers need to be more proactive, especially about utilization of the immediate post-partum period for Cu T insertion, clients counseling, and follow up of users.     

Client anxiety from awareness of personal HIV risk and relation to taking HIV test at public health centers in Japan]

Clients taking HIV antibody tests at public health centers (PHCs) in Japan were surveyed in autumn of 1995 centered on 17 PHCs selected by a snow-ball sampling method in domestic PHCs. The anonymous self-administered questionnaires were given out by PHC's medical doctors or public health nurses after receiving informed consent of this survey's objectives following HIV post-test counseling. A total of 250 questionnaires were collected (71.8%). Valid questionnaires were 233 (67.0%) and 62.7% (146 people) were male, 37.3% (87 people) were female, with differences in mean age by sex being significant (p < .001). The greatest motivating factor for getting HIV testing was concerning secondary infection to partners and extreme anxiety relating to one's own possible infection. This motivating factor was greater than having experienced previous HIV infectious high-risk behavior (i.e. condomless sex). Repeat (more than twice) visitors totaled 49 (21.0%), with 75% having experienced HIV infectious high-risk behavior since the last HIV test. "Having being advised or having received from partners or friends" affected decision making to get tested. About half of subjects vacillated before coming to the PHC for taking anonymous the HIV antibody test. Through multiple-logistic regression analysis factors causing vacillation were: greater self-awareness of possibility of having HIV infection and the fact that HIV infected people must retire from their work (or studies) despite their current health condition being fine. While HIV medical/clinical treatment progress continues, the stigma toward HIV/AIDS and the resulting discrimination is not changing in terms of the general citizen's knowledge and attitudes. This result will likely curtail HIV antibody testing behavior.     

A tuberculosis outbreak in a mental hospital

PURPOSE AND METHODS: We experienced a tuberculosis outbreak in a mental hospital and discussed preventive measures for nosocomial tuberculosis infection. RESULTS: There are 18 mental hospitals within the administrative area of Hachioji public health center (PHC). A Total of 18 pulmonary tuberculosis cases were diagnosed in one of these hospitals between December 1995 and November 1998. They were all inpatients and two of them had history of tuberculosis. Fifty-two persons became candidates for isoniazid (INH) chemoprophylaxis as a consequence of the first extraordinary health examination. Chest radiographs of the inpatients had not been taken regularly in this hospital. Our recognition of the tuberculosis outbreak was delayed by omission of not only the case notification from the doctor who had diagnosed tuberculosis but the information from the PHC that had received the application of public subsidy for medical treatment. All cultured bacilli from 8 patients were susceptible to INH, rifampicin, streptomycin and ethambutol. Restriction fragment length polymorphism (RFLP) analysis of 4 strains, which we could have obtained, demonstrated an identical pattern. CONCLUSIONS: To prevent tuberculosis outbreaks in mental hospitals, we should consider these problems as follows; 1) Physical conditions of inpatients should be observed carefully and suitable physical checkups on inpatients with tuberculosis symptoms should be carried out by mental hospitals. 2) The doctor who had diagnosed a patient as having tuberculosis must send the case notification to the nearest PHC. 3) The PHC that received the information should investigate the case carefully and notify all related PHC's. 4) Extraordinary health examinations should be done appropriately by leadership of the PHC. 5) RFLP analysis of the tubercle bacilli is very useful to probe the source and route of infection. 6) Criteria for chemoprophylaxis for more than middle-aged persons should be established.     

The Influence of the Common Cold on Self-Rated Health: A Population-Based Study

ObjectiveStudies on the association between self-rated health and acute conditions are sparse. The aim of this study was to examine whether individuals respond to acute conditions (such as the common cold) in health ratings as well as the effect of chronic conditions (using the Charlson comorbidity score) on self-rated health.MethodsThe national representative survey data was linked with the claims data from the Taiwan National Health Insurance for 13,723 adults ≥ 18 years. Ordered logistic regressions with fractional polynomials were estimated to determine the relationship between the frequency of common cold episodes and the Charlson comorbidity score on self-rated health. The interactions between these two variables and the baseline age were tested.ResultsSelf-rated health worsens with the increased frequency of both common cold episodes and the Charlson comorbidity score. Both variables have a non-linear relationship with self-rated health. Younger individuals put heavier weight on acute health conditions than their older counterparts.ConclusionIndividuals respond to questions regarding their self-rated health based on their acute health condition along with chronic condition. Thus the information on self-rated health depends on the timing the information is collected, and whether at that time the individual experienced acute health conditions or not.     

家庭健康循环视角下的健康代际传递研究——基于CHNS 2015的实证分析

目的:基于家庭健康循环视角与家庭生态系统理论,探究健康状况、健康行为及健康认知的代际传递,为制定精准健康促进政策提供依据。方法:基于2015年CHNS数据,采用多分类Logistic、有序Logistic以及OLS模型探讨母亲主客观健康状况,健康行为及认知对子代主客观健康状况,健康行为及认知的影响。结果:母亲BMI显著影响子代BMI,母亲超重或肥胖,则子代超重、肥胖的相对风险高;母亲自评健康显著影响子代自评健康;母亲饮食得分与锻炼得分显著影响子代饮食得分与锻炼得分;母亲健康认知显著影响子代的健康认知。结论:健康状况、行为及认知均显著代际传递,建议开展亲子健康促进行动,并建设健康家庭环境。     

Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies.     

Self-rated health in persons with spinal cord injury: relationship of secondary conditions, function and health status

Objective  Self-rated health is used frequently as a measure of health in the general population, and increasingly with persons with disabilities. However, its meaning and its relationship with other measures of self-reported health (health status and secondary conditions) are not well understood for this group. The purpose of the present study was to use a conceptual model to examine the structure of self-rated health with persons with spinal cord injuries. Methods  A US sample of 270 adults with mobility impairment stemming from spinal cord injury (SCI) provided data on three measures of self-reported health that differ in degree of subjectivity: physical problems common to SCI, four domains of health status from the SF-36, and a single item on self-rated health. Data were compared with the norm sample of the SF-36. The conceptual model was tested using path analyses. Results  SF-36 scores were lower on three of four domains compared with the norm sample. The conceptual model analyses indicated that 35% of variance in self-rated health is accounted for through direct relationship with physical secondary conditions common to persons with SCI and as mediated through SF-36 domains of Role Physical and Vitality. The SF-36 domain of Physical Function was statistically unrelated to self-rated health. Conclusion  The conceptual model of self-rated health was verified in a sample of persons with SCI. Importantly, the SF-36 domain of Physical Function does not relate to self-rated health for this group. Its inclusion in measures of self-reported for disability populations creates difficulty without apparent benefit.