医改前后陕西省农村家庭灾难性卫生支出及其影响因素研究

目的:分析新医改前后农村家庭灾难性卫生支出的变化,探讨发生灾难性卫生支出的影响因素。方法:利用陕西省第4次和第5次卫生服务调查数据,以灾难性卫生支出发生率、平均差距和相对差距为测量指标,采用Logistic回归模型分析发生灾难性卫生支出的影响因素。结果:与2008年相比,2013年灾难性卫生支出发生率和平均差距均有下降,相对差距略有上升。当灾难性卫生支出界定标准为40%时,灾难性卫生支出发生率从19.43%降为17.29%,平均差距从3.14%降为2.93%,相对差距则从17.15%上升为17.55%。家庭灾难性卫生支出发生与家庭成员是否患有慢性病、是否有住院利用、是否有65岁及以上老人等因素显著相关。结论:建议加强农村老年居民的慢性病防治工作,同时进一步提高新农合保障水平。     

漯河市农村妇女宫颈癌防治知识调查

目的：了解漯河市农村妇女对宫颈癌防治知识知晓情况,为宫颈癌防治工作提供依据。方法：2013年3月至4月在漯河市随机抽取6007名年龄为21～65岁已婚农村妇女进行问卷调查。结果：6007例农村妇女对宫颈癌防治知识的总体知晓率为23．4％,其知晓率与年龄和文化程度有关,差异有统计学意义（ P ＜0．05）。结论：漯河市农村妇女宫颈癌防治知识知晓率偏低,应采用适合农村妇女的宣教方式对其进行宫颈癌知识宣教。     

我国农村长期护理保险制度的构建研究

农村作为我国经济社会发展的薄弱地区,理应在社会保障制度上给予更高的关注。长期护理保险制度能从生活照料和医疗护理方面保障老年人的晚年生活质量,化解我国农村老年人因失能、失智带来的社会风险。本文从分析农村长期护理保险制度开展的必要性出发,结合农村长期护理保险制度实施的困境,对长期护理保险制度在农村筹资、服务给付等几方面提出具体建议,旨在加快农村地区长期护理保险制度建设的征程。     

“春苗计划”昭通站管理人员培训版块的效果评价：一个案例研究

背景　农村地区基层医疗卫生机构和人员培训是实现“健康中国2030”战略的重要一环,与庞大的培训数量相比,针对实施效果的评估却极为有限。目的　分析和总结“春苗计划”昭通站基层医疗卫生机构管理人员培训版块的实施效果。方法　以2015年6月—2016年12月参加“春苗计划”昭通站培训的乡镇卫生院或社区卫生服务中心管理人员为研究对象（n=150）。培训分昭通面授（5 d）和上海实训（2周）两阶段实施。定量分析昭通面授学员的考核成绩,定性分析上海实训学员的实训报告。结果　150例参培学员的平均年龄为（38.6±6.8）岁,男 130例（86.7%）。147例参培学员完成了昭通面授培训前和培训后的笔试,培训后平均成绩高于培训前〔（65.9±8.8）分比（57.0±8.3）分,t=11.945,P0.05）。以信息饱和为原则,共定性分析13份实训报告,结果显示：上海实训拓宽了参培人员的管理思路,且参培人员表示将结合昭通实际情况学以致用。结论　“春苗计划”昭通站拓宽了中国农村地区基层医疗卫生机构管理人员的培训形式,取得明显效果的同时也具有借鉴意义。建议拟在农村地区开展的同类培训项目,应充分结合当地实际需要设计培训方案,并提供基于实践的培训机会。     

2018年延安市农村妇女宫颈癌相关知识认知调查

目的 为延安市农村妇女宫颈癌的综合防治提供科学依据。方法 于2018年1至3月按经济富裕和落后分别随机抽取一个县,其中宜川县随机抽取9个乡镇295名农村妇女,吴起县随机抽取3个乡镇200名农村妇女;自编宫颈癌相关知识认知量表,共33个条目,包括:基本情况、宫颈癌认知、HPV的认知、妇科筛查及认知等,由经过培训的医学专业人员入户一对一进行调查。结果 延安市农村妇女对宫颈癌的认知得分较低,对宫颈癌相关认知的知晓率为19.6%～82.4%,对HPV的知晓率为6.1%～32.5%,13%的女性认为妇科检查不重要,14%以上的女性未做过妇科检查,不同经济状况、不同职业、不同文化程度认知率比较,差异有统计学意义(χ²=7.054、10.797、25.135、39.976、54.849、5.613、15.619、19.997、103.617,均P＜0.05)。结论 延安市农村女性宫颈癌的认知度很低,健康教育和定期筛查是最有效的措施。     

Distribution of Third Molar Impactions Among Rural and Urban Dwellers in the Age Group of 22–30?years in South India: A Comparative Study

Objectives

(1) To collect the data related to distribution of third molar impactions among rural population by clinical and radiological examinations. (2) To collect the information on distribution of third molar impactions among urban population by clinical and radiological examinations. (3) To compare the patterns of distribution of third molar impactions among rural and urban residents with respect to type of impaction, arch, gender and age.

Method

A cross-sectional study was conducted in Dharwad district of Karnataka state located in South India involving 630 rural and 270 urban subjects as per demographic profile of India. A two stage sampling procedure was adopted in the selection of the sample.

Statistical Analysis

Data was analyzed using STATISTICA-6.0. χ² test was used to explore the association between different variables and third molar impactions. A P ≤ 0.05 was considered statistically significant.

Results

14.92% of rural subjects and 27.40% urban subjects were reported to be suffering from third molar impactions.

Conclusions

The overall prevalence of third molar impactions among the study subjects was found to be 18.67%. A significant association was noticed between the ‘different arches’ and distribution of third molar impactions in both rural and urban population. Subjects with vertical impactions were found to be most common in both the groups.     

The general surgery workforce shortage is worse when assessed at county level

Background

Multiple studies have documented a significant decrease in the general surgery workforce in the United States, both rural and urban, for the past 3 decades. This 11-year study evaluates the Texas general surgery workforce at both the state and local level in 2002 and 2012.

Methods

Data were obtained from the Texas Medical Board, the United States Census Bureau/Texas State Library and Archives Commission, and the Texas Department of State Health Services for 2002 and 2012. A benchmark target of 7 general surgeons per 100,000 population was used.

Results

During the study period, the Texas population increased 21%, and actively practicing physicians increased 44%. All surgical specialists increased by 26%. General surgeons increased 4%; however, the number of general surgeons per 100,000 population decreased 14% (from 6.7 to 5.8/10⁵). Using the total Texas population for 2012, an additional 329 general surgeons are needed by benchmark standards. However, when analyzed by individual county population, 449 additional general surgeons are needed in the individual counties. These effects were greater in the nonmetropolitan areas of Texas where per capita general surgeons decreased by 21%.

Conclusions

The absolute increase in Texas general surgeons over the past decade has not kept pace with an increase in the Texas population. The general surgery workforce deficit based on the Texas state population underestimates the local workforce shortage, particularly in the nonmetropolitan areas of Texas.     

ATLS adherence in the transfer of rural trauma patients to a level I facility

Background

Injury sustained in rural areas has been shown to carry higher mortality rates than trauma in urban settings. This disparity is partially attributed to increased distance from definitive care and underscores the importance of proper primary trauma management prior to transfer to a trauma facility. The purpose of this study was to assess Advanced Trauma Life Support (ATLS) guideline adherence in the management of adult trauma patients transferred from rural hospitals to a level I facility.

Methods

We performed a retrospective analysis of all adult major trauma patients transferred ≥50 km from an outlying hospital to a level I trauma centre from 2007 through 2009. Transfer practices were evaluated using ATLS guidelines.

Results

646 patients were analyzed. Mean age was 40.5 years and 94% sustained blunt injuries with a median Injury Severity Score (ISS) of 22. Median transport distance was 253 km. Among all patients, there were notable deficiencies (<80% adherence) in 8 of 11 ATLS recommended interventions, including patient rewarming (8% adherence), chest tube insertion (53%), adequate IV access (53%), and motor/sensory exam (72%). Patients with higher ISS scores, and those transferred by air were more likely to receive ATLS recommended interventions.

Conclusions

Key aspects of ATLS resuscitation guidelines are frequently missed during transfer of trauma patients from the periphery to level I trauma centres. Comprehensive quality improvement initiatives, including targeted education, telemedicine and trauma team training programmes could improve quality of care.     

吉林省农村人群碘营养水平及甲状腺功能调查

2009年4月从吉林省磐石市宝山、明城、烟筒山3个乡抽取8～10岁儿童100名,并从其家庭巾抽取18 ～45岁成人100名.另外,抽取孕妇、哺乳妇女及其0～2岁婴幼儿各50名.调查显示,居民户盐碘中位数为30.2 mg/kg,水碘为2.8 μg/L;依据世界卫生组织对人群尿碘巾位数的评价标准,学龄儿童( 196.5 μg/L)、孕妇(198.5 μg/L)、哺乳妇女(224.9 μg/L)以及婴幼儿(209.0 μg/L)的尿碘巾位数均处于适宜水平,仅成人(269.0 μg/L)达到了“超需要量”水平;B超测量学龄儿童甲状腺肿大率为1.8％.各类人群甲状腺功能异常率均较低,以亚临床甲状腺功能亢进(2.1％)、亚临床甲状腺功能减退(1.5％)、甲状腺功能亢进(1.2％)为主.亚临床甲状腺功能减退主要在成人(2.7％)、孕妇(1.7％)、哺乳妇女(1.8％)中流行,亚临床甲状腺功能亢进主要发生在学龄儿童(4.5％)及哺乳妇女(3.6％)人群中.提示当前吉林省农村地区居民碘营养水平对其甲状腺功能没有产生明显不良影响.     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.