重庆市12岁儿童口腔健康状况及影响因素的多水平分析

目的 了解重庆市12岁儿童口腔健康状况及个体和背景水平上的影响因素,为制定和完善重庆市儿童口腔健康干预政策提供参考依据.方法 利用2015年《重庆市儿童口腔疾病综合干预项目效果评估》调查数据,采用多水平logistic回归模型,对儿童口腔健康状况及影响因素进行分析.结果 重庆市12岁儿童的龋患率为45.5％ (922/2 025),儿童的口腔健康情况在学校水平呈现聚集性(Ωu=0.412,P=0.091,α=0.1).多水平logistic回归分析发现,性别、每周进食糖果/巧克力1次及以上、是否同意“口腔健康对自己的生活很重要”是影响12岁儿童龋患情况的个体变量,所在学校的城乡差异是影响12岁儿童龋患情况的背景变量(P＜0.05,α=0.05).结论 儿童的性别、口腔健康认知、行为习惯和儿童所在学校间的城乡差异是影响重庆市12岁儿童龋患率的重要因素,应有针对性地开展儿童口腔疾病综合防治工作.     

Post-acute care for children with special health care needs

Background

Almost all studies of post-acute care (PAC) focus on older persons, frequently those suffering from chronic health problems. Some research is available on PAC for the pediatric population in general. However, very few studies focus on PAC services for children with special health care needs (SHCN).

Why policymakers should care about “big data” in healthcare

The term “big data” has gotten increasing popular attention, and there is growing focus on how such data can be used to measure and improve health and healthcare. Analytic techniques for extracting information from these data have grown vastly more powerful, and they are now broadly available. But for these approaches to be most useful, large amounts of data must be available, and barriers to use should be low. We discuss how “smart cities” are beginning to invest in this area to improve the health of their populations; provide examples around model approaches for making large quantities of data available to researchers and clinicians among other stakeholders; discuss the current state of big data approaches to improve clinical care including specific examples, and then discuss some of the policy issues around and examples of successful regulatory approaches, including deidentification and privacy protection.     

Impact of new efficacy information on sales of antihypertensive medicines in Japan and Sweden

Objectives

The generic substitution of medicines has been introduced in Europe since the 1990s to increase price competition and the use of cheaper equivalents. Patent expiry is assumed to be associated with changes in sales patterns, particularly when combined with generic substitution. Other changes have been observed when prescribers obtain new information on drug safety and efficacy of medicines. This article examines to what extent patent expiry and new medical information on efficacy influence the pharmaceutical sales patterns of antihypertensive medicines in Japan and Sweden.

珠海市居民慢性病患病情况及其影响因素分析

目的 了解珠海市居民慢性病患病情况及其影响因素,为该地区慢性病的防治和管理提供参考依据。方法 采用多阶段随机抽样方法,对珠海市7个区县的3 205名15岁及以上常住居民进行问卷调查和体格检查。结果 珠海市居民自报慢性病总患病率为27.6%,患病顺位居前三位的慢性病依次是高血压（16.7%）、糖尿病（4.1%）、冠心病（3.5%）。多因素非条件Logistic回归分析显示,高血压患病的危险因素有年龄≥35岁、超重、肥胖和参加体育锻炼,保护因素有中等文化水平及饭菜口味清淡（均有P<0.05）;糖尿病患病的危险因素有年龄≥50岁、人均月收入≥1 000元、超重、肥胖（均有P<0.05）;冠心病的危险因素为年龄≥50岁,保护因素为每日蔬菜摄入量≥300 g（均有P<0.05）。结论 高血压、糖尿病、冠心病是珠海市居民的主要慢性病,相关部门在做好慢性病管理的同时,应开展针对性的健康教育与社区干预,是今后慢性病预防控制的重点工作。     

吉林省5岁以下儿童出生缺陷影响因素病例对照研究

目的 探讨吉林省5岁以下儿童出生缺陷发生的主要影响因素,为制订出生缺陷综合防控策略提供科学依据。方法 以吉林省5岁以下儿童出生缺陷抽样调查中明确诊断的379例出生缺陷儿为病例组,按1:1比例抽取正常儿童379例作为对照组。使用SPSS 21.0软件进行统计学分析,主要采用描述性分析、单因素和多因素Logistic回归分析。结果 多因素分析显示,母亲职业为工人（OR=4.328,95%CI:1.416~13.227,P=0.010）和家务（OR=2.602,95%CI:1.311~5.163,P=0.006）、母亲孕前/孕期患病（OR=4.074,95%CI:1.413~11.746,P=0.009）、母亲在缺陷儿出生前有不良妊娠结局（OR=2.640,95%CI:1.696~4.110,P<0.001）、母亲孕早期发烧（>38℃）（OR=8.924,95%CI:2.856~27.889,P<0.001）可能是出生缺陷的危险因素;孕前增补小剂量叶酸和进行产前唐氏筛查可能是影响出生缺陷的保护因素（均有P<0.05）。结论 孕前及孕早期干预,避免危险因素及增补叶酸,对预防出生缺陷具有重要意义。     

妊娠晚期孕妇抑郁与睡眠质量的相关性研究

目的 了解妊娠晚期孕妇抑郁和睡眠质量的现况及其影响因素,探讨妊娠晚期孕妇抑郁与睡眠质量的相关性。方法 选择中卫市2所医院535名符合调查要求的孕妇进行问卷调查,采用匹兹堡睡眠质量指数量表（pittsburgh sleep quality index,PSQI）和抑郁自评量表（self-rating depression scale,SDS）评定孕妇睡眠质量及抑郁。结果 535名孕妇抑郁检出率为34.2%,睡眠障碍的检出率为20.6%。有抑郁的孕妇睡眠障碍检出率（29.0%）高于无抑郁的孕妇（16.2%）,差异有统计学意义（χ2=12.018,P=0.001）。PSQI总分和SDS得分呈正相关（r=0.680,P<0.001）。文化程度低、夫妻关系差、有孕期并发症、睡眠障碍是妊娠晚期孕妇抑郁的危险因素。有孕期并发症、担忧孩子健康、抑郁是妊娠晚期孕妇睡眠障碍的危险因素。结论 妊娠晚期孕妇睡眠质量与抑郁呈正相关,应采取综合性干预措施改善妊娠晚期孕妇的抑郁情绪和睡眠质量。     

基于IMB模型的年轻MSM安全套使用及其影响因素

目的 探索年轻男男性行为者（young men who have sex with men,YMSM）安全套使用的正负向影响因素,并评价艾滋病干预服务的预防效果。方法 于2017年6月~2018年2月通过滚雪球抽样方式,对中国西部的重庆市、四川省、广西省726名15~29岁的YMSM进行现况调查,问卷内容来源于信息-行为-技巧模型（information motivation behavioral skills model,IMB）,并利用Amos 17.0软件构建扩展的IMB模型。结果 在过去的半年,59.64%的年轻MSM每次肛交性行为均用安全套,57.71%的YMSM整个性行为过程一直使用安全套。扩展IMB模型拟合程度良好。YMSM使用安全套的影响因素包括行为技巧、预防行为代价、接受艾滋病干预服务、预防信息、预防动机、文化程度、月可支配收入,总效应系数分别为0.417、-0.366、0.258、0.141、0.159、0.053、0.020。结论 艾滋病干预服务促进YMSM使用安全套,而预防行为代价抑制预防行为。今后干预工作应对YMSM开展风险教育,重视预防行为代价以及预防知识掌握不全情况,并适当增加干预服务力度和范围。     

昭觉县成年HIV/AIDS接受抗病毒治疗后生存分析

目的 了解凉山州昭觉县成年获得性免疫缺陷综合征（acquired immunodeficiency syndrome,AIDS）患者接受抗病毒治疗后的生存状况,并探讨其影响因素。方法 采用回顾性队列研究方法,以昭觉县2005年1月1日~2017年3月20日入组参加抗病毒治疗的成年HIV/AIDS为研究对象,收集其生存死亡信息,采用生存分析方法对研究对象进行生存时间及其影响因素的分析。结果 截止观察日止,2 216例研究对象中仍在治疗者1 528人（68.95%）,因艾滋病死亡者222人（10.02%）,平均生存时间为17.64月,中位生存时间13月,治疗时间少于12月者99人（44.59%）。第1~5年的累计生存率为0.93、0.90、0.88、0.86、0.85。Cox比例风险回归模型分析显示,年龄、基线CD4+T细胞计数、初始治疗方案、入组治疗时是否存在艾滋病相关疾病或症状是影响生存时间的因素（均有P<0.05）。结论 昭觉县艾滋病抗病毒治疗降低了艾滋病死亡率,延长了患者的生存时间;在抗病毒治疗过程中存在多种因素影响对患者生存状况,及早发现HIV感染者并及时纳入治疗能有效提高高效抗逆转录病毒疗法（highly active antiretroviral therapy,HAART）治疗成效。     

Why equity in health and in access to health care are elusive: Insights from Canada and South Africa

Health and access to health care vary strikingly across the globe, and debates about this have been pervasive and controversial. Some comparative data in Canada and South Africa illustrate the complexity of achieving greater equity anywhere, even in a wealthy country like Canada. Potential bi-directional lessons relevant both to local and global public health are identified. Both countries should consider the implications of lost opportunity costs associated with lack of explicit resource allocation policies. While National Health Insurance is attractive politically, Canada's example cannot be fully emulated in South Africa. Short- and medium-term attempts to improve equity in middle-income countries should focus on equitable access to insurance to cover primary health care and on making more use of nurse practitioners and community health workers. In the longer-term, attention is needed to the economic and political power structures that influence health and health care and that ignore the social and societal determinants of sustainable good health locally and globally. This long-term vision of health is needed globally to achieve improvements in individual and population health in a century characterised by limits to economic growth, widening disparities, continuing conflict and migration on a large scale and multiple adverse impacts of climate change.