全国结核病防治机构人力资源调查分析

目的 了解全国结核病防治机构人力资源现况,为进一步加强各级人力资源建设提供依据。方法 2007年9-10月国家结控中心将设计的调查表下发至各级结核病防治机构进行填写,各级结核病防治机构逐级汇总并上报,最后由国家结控中心对上报的数据进行核实、汇总和分析。 结果 全国共有结核病防治专职人员26 064人,有专业技术职称人员22 591人,人员数量和质量均比2005 年有一定的提高。结论 虽然人员的绝对数量有一定提高,但是人员配置达到规范要求的结核病防治机构较少,高学历、高职称的人员相对缺乏,部分机构人员梯队建设还有待提高,并需要一定数量的熟悉临床的结核病防治专业人员。     

Older women in Australia: ageing in urban,rural and remote environments

Objective: To explore differences in quality of life and health service use for older women living in urban, rural and remote areas of Australia. Methods: 8387 women aged 70–75 years when enrolled in the Australian Longitudinal Study on Women's Health completed mailed surveys in 1996, 1999 and 2002. Results: Women living in urban, rural and remote areas reported few differences in health and had similar changes in health‐related quality of life (SF‐36) over time. Most SF‐36 subscale scores declined over time, with steeper drops between the ages of 73–78 years and 76–81 years. The use of health services, need for informal care and provision of care to others increased over time. Urban participants used more general practitioner, specialist and allied health services, whereas non‐urban women used more community services and alternative health practitioners. Conclusion: Despite similar health problems, health service use differs significantly across urban, rural and remote areas of Australia.     

Physical abuse among depressed women

OBJECTIVE: To provide estimates of physical abuse and use of health services among depressed women in order to inform efforts to increase detection and treatment of physical abuse. DESIGN: Retrospective assessment of abuse and health services use over 1 year in a cohort of depressed women. SETTING: Statewide community sample from Arkansas. PARTICIPANTS: We recruited 303 depressed women through random-digit-dial screening. MEASUREMENTS AND MAIN RESULTS: Exposure to physical abuse based on the Conflict Tactics Scale, multi-informant estimate of health and mental health services. Over half of the depressed women (55.2%) reported experiencing physical abuse as adults, with 14.5% reporting abuse during the study year. Women abused as adults had significantly more severe depressive symptoms, more psychiatric comorbidity, and more physical illnesses than nonabused women. After controlling for sociodemographic and severity-of-illness factors, recently abused, depressed women were much less likely to receive outpatient care for mental health problems as compared to other depressed women (odds ratio [OR] 0.3; p=.013), though they were more likely to receive health care for physical problems (OR 5.7, p=.021). CONCLUSIONS: Because nearly all depressed women experiencing abuse sought general medical rather than mental health care during the year of the study, primary care screening for physical abuse appears to be a critical link to professional help for abused, depressed women. Research is needed to inform primary care guidelines about methods for detecting abuse in depressed women. This research was supported by the National Institute of Mental Health funded grants MH48197 and MH54444 to the University of Arkansas and grant MH53817 to the University of Pittsburgh.     

How robust are district health systems? Coping with crisis and disasters in Rutshuru,Democratic Republic of Congo

background Since the eighties, the North Kivu Province socio-economic environment has been deteriorating. This province also faced an influx of Rwandan refugees in July 1994. The objective of the paper is to show how a rural health district has been able to adjust and maintain its medical activities under unfavourable conditions. method Performances of the local health system were assessed through the analysis of routine medical data collected in the Rutshuru Health District (RHD) between 1985 and 1995. Specific data collected during the Rwandan refugee crisis measured the workload of RHD due to the refugees. results For 11 years, health infrastructures have remained accessible and functional in RHD. The curative utilization and preventive coverage rates increased. Obstetrical activities were intensified from a quantitative as well as from a qualitative point of view. Between July and October 1994, the RHD treated 65 000 cases of various pathological conditions in Rwandan refugees settled outside the camps. This corresponds to 9.3% of consultations for Rwandan refugees settled on RHD's territory and represents a 400% increase in the curative workload for the RHD health services. Human and financial resources remained at a very low level, especially when compared with those available in the camps through relief agencies. conclusion The RHD was severely affected by various stresses but its services managed to provide significant and efficient response to these crises. Health district systems may constitute an effective tool to provide health care under adverse conditions.     

Reducing geriatric outpatient waiting times: Impact of an advanced health practitioner

Objective

To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context.

Methods

A pre‐ to postintervention design was used to determine impact over a five‐year period (2008–2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one‐way ANOVA and post hoc Tukey tests to determine effects on patient waiting times.

Results

Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%.

Conclusion

Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.     

北京社区老年人群高血压防治现况的综合评价

目的:综合评价北京老年人群高血压防治现况。方法:在宣武区、海淀区和通州区各选择1～2个社区，分别代表北京市城区、城乡结合部和农村。对调查社区60岁以上的老年人按20％的比例抽样，人户调查。结果:农村地区老年人高血压患病率最高，为64．3％，城乡结合部次之，为61．0％，城区最低，为53．4％；而农村老年人高血压的知晓率、药物与非药物治疗率、控制率、血压测量率、高血压及相关疾病的知识得分远低于城区和城乡结合部。在钙离子拮抗剂、血管紧张素转换酶抑制剂、β受体阻滞剂、利尿剂和复方降压药这几类降压药中，复方类降压药物是老年人高血压患者的首选药物，特别是在农村和城乡结合部，分别达88．5％和83．7％。决定患者使用何种抗高血压药物的主要因素是疗效、医嘱和价格。社区卫生服务中心在高血压防治中发挥了主要作用，电视和广播是老年人获得健康知识和信息的主要来源。结论北京市农村老年人高血压防治工作急待加强，通过电视和广播加强健康教育是有效而重要的手段。     

African American church participation and health care practices

BACKGROUND: While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices. OBJECTIVES: To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships. DESIGN: A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood. MEASUREMENTS: Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions. RESULTS: Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5). CONCLUSION: Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations.     

Effect of the Japanese preventive-care version of the Minimum Data Set – Home Care on the health-related behaviors of community-dwelling, frail older adults and skills of preventive-care managers: A quasi-experimental study conducted in Japan

Aim:   To determine whether the Japanese preventive-care version of the Minimum Data Set-Home Care improves the health-related behaviors of older adults and the skills of preventive-care managers.
Methods:   Municipal preventive-care managers were instructed on the use of the Japanese preventive-care version of the Minimum Data Set – Home Care and asked to employ it in their interactions with clients during the intervention period (intervention group). The health-related behaviors of older adults (maintenance of self-care and consumption of a balanced diet) were assessed by self-rating methods. The skills of the preventive-care managers were assessed by considering the number of and variations in the needs of the clients, as reflected in the care plans formulated by the managers.
Results:   The clients' self-care levels were higher in the intervention group than in the control group ( P  < 0.05). A greater number of needs, as reflected in the care plans, were noted in the intervention group than in the control group ( P  < 0.05), and the variation in the assessed needs was greater in the former than in the latter.
Conclusion:   This study suggests that the Japanese preventive-care version of the Minimum Data Set – Home Care may improve the skills of preventive-care managers, and consequently, the health-related behaviors of frail older clients.     

Access to biologic medicines for the treatment of rheumatic diseases: lessons from Australia

In order to ensure that our patients have access to effective new rheumatic medicines, it is crucial that the issues affecting access are identified and addressed adequately. Patients in Australia are privileged to have subsidized access to new biologic medicines via the national formulary, known as the Pharmaceutical Benefits Scheme. Access to these expensive medicines was an important achievement by various stakeholders in overcoming several major issues. In this paper, we discuss these challenges associated with publicly funded access to biologicals for rheumatic diseases and the strategies that have been taken to overcome them.     

Trends in hospitalization for heart failure in Scotland 1980-1990

Heart failure is a growing public health problem in industrializedcountries with ageing populations. Scotland has a relativelystable population of approximately 5 million and a well describedsystem for recording details of hospitalizations (Scottish HospitalIn-Patients Statistics-SHIPS). We have examined SHIPS data forhospitalizations for heart failure in Scotland 1980–1990.Discharges for heart failure as the primary diagnosis increasedby almost 60%, from 1.30 to 2.12/1000 population in this period(as either primary or secondary diagnosis the rate increasedfrom 2.51 to 4.24/1000). Seventy-eight percent of dischargeswere in persons aged 65 years and 48% of discharges were male.Heart failure (primary diagnosis) accounted for almost 4% ofall general (internal) medicine discharges. In-patient casefatality was 18% in 1990. Mean duration of in-patient stay onInternal Medicine wards was approximately 11 days. The number of hospitalizations for heart failure is now almostidentical to those for myocardial infarction. These trends mirrorthose recently reported from the United States. Heart failureis an increasingly common and costly cause of hospitalizationin Scotland. Approaches which can reduce this burden on thehospital service require urgent attention.     

Informal Social Support for HIV Medical Care

Abstract

The purpose of this paper is to explore the relationship of availability of HIV-related information and emotional support necessary to obtaining appropriate medical care. Multivariate models control for use of professional case management, mental health services, and drug treatment services. Study data were obtained from the first two rounds of interviews from the New York City Community Health Advisory and Information Network (CHAIN). Household information support and professional ancillary services were significantly associated with entry into appropriate medical care. Among participants in appropriate care at the baseline, only professional services were significantly associated with continuity of care.     

State-level spending on health care and social services for people living with HIV/AIDS in the USA: a systematic review

Every year for the past decade, approximately 50,000 people have been diagnosed with HIV or AIDS in the USA, and the incidence of HIV/AIDS varies considerably from state to state. Studies have shown that health care services, most notably treatment with combination antiretroviral therapy, can help people living with HIV/AIDS (PLWHA) live healthier, longer lives, and prevent the spread of HIV from person to person. In addition, social services, such as housing support and provision of meals, have also shown to be important for helping PLWHA adhere to antiretroviral treatment and maintain contact with health care providers for improved health outcomes. Although spending on health care and social services for PLWHA varies across the USA, the relationship between state-level spending on these services and HIV/AIDS-related outcomes is not clear. We therefore conducted a systematic review of peer-reviewed literature to identify studies that explore state-level spending on health care services and/or social services for PLWHA and HIV/AIDS-related health outcomes in the USA.     

Driving distance as a barrier to glycemic control in diabetes

BACKGROUND: Despite advances in treatment of diabetes, many barriers to good glycemic control remain. OBJECTIVE: To determine the relationship between glycemic control and the driving distance from home to the site of primary care. DESIGN: Cross-sectional analysis of data from the Vermont Diabetes Information System. PARTICIPANTS: Nine-hundred and seventy-three adults with diabetes in primary care. The mean age was 64.9 years, 57% were female, and 18.4% used insulin. MEASUREMENTS: Hemoglobin A1c, shortest driving distance from a patient's home to the site of primary care calculated by geographic software, self-reported gender, age, education, income, marital status, race, insurance coverage, diabetic complications, and use of insulin and oral hypoglycemic agents. RESULTS: Controlling for social, demographic, seasonal, and treatment variables, there was a positive, significant relationship between glycemic control and driving distance (beta=+0.07%/10 km, P<.001, 95% confidence interval [CI]=+0.03, +0.11). Driving distance had a stronger association with glycemic control among insulin users (beta=+0.22%/10 km, P=.016, 95% CI=+0.04, +0.40) than among noninsulin users (beta=+0.06%/10 km, P=.006, 95% CI=+0.02, +0.10). CONCLUSION: Longer driving distances from home to the site of primary care were associated with poorer glycemic control in this population of older, rural subjects. While the mechanism for this effect is not known, providers should be aware of this potential barrier to good glycemic control.