城乡基层医疗人员对气候变化及其健康风险认知的差异

目的探究基层医疗人员对气候变化及其健康风险认知的城乡差异。方法采用分层随机整群抽样,抽取广东省21家城区和10家乡镇基层医疗卫生机构的医疗人员进行问卷调查,收集其基本信息和对气候变化及其健康风险的认知情况,通过卡方检验、秩和检验和logistic逐步回归分析探究气候变化认知的城乡差异。结果 63. 8%(468/733)的基层医疗卫生人员认同气候变化正在发生,55. 4%(406/733)的人认为气候变化主要归因于人类活动。城区卫生人员对气候变化正在发生的认同程度高于乡镇,而城区与乡镇对气候变化发生原因的认知差异不明显。城区人员在高温热浪的健康风险认知上略高于乡镇,而对于气候变化与传染病关联的认知略低于乡镇,但差异不具有统计学意义。乡镇人员识别气候变化脆弱人群的能力略高于城区,差异具有统计学意义。此外,职称级别越高越能感知气候变化健康风险;临床医生相比于护士和公共卫生人员更认同气候变化正在发生且更能识别其发生原因。结论城区基层医疗卫生人员在气候变化正在发生的认同程度上略高于乡镇,但是乡镇医疗卫生人员比城区的更能识别脆弱人群。城区与乡镇基层医疗卫生人员对气候变化及其健康风险认知均不容乐观,应积极采取措施提升风险认知以增强其应对气候变化健康风险的能力。     

脆弱人群甲型H1N1流感防制知识和行为调查

目的了解广东省农民(工)、失业下岗人员、离退休人员等脆弱人群甲型H1N1流感防制知识知晓情况和健康行为形成情况,探讨下一阶段针对脆弱人群的防制措施。方法采用随机抽样的方法抽取调查对象,运用自行设计的调查问卷对调查对象进行调查。结果广东省农民、农民工、离退休人员等脆弱人群甲型H1N1流感基本知识平均知晓率为57.0%,对人感染甲型H1N1流感后传染期知晓率最低(32.9%)。咳嗽遮掩口鼻等6项健康行为平均形成率为49.3%,其中聚餐时总是使用公筷的比例仅为13.6%。不同脆弱人群甲型H1N1流感防制基本知识知晓率和健康行为形成率差异有统计学意义(P<0.05)。甲型H1N1流感发生前后,脆弱人群健康行为形成率有差异,甲型H1N1流感发生后脆弱人群健康行为形成率显著高于甲型H1N1流感发生前。结论广东省农民(工)、失业下岗人员、离退休人员等脆弱人群甲型H1N1流感基本知识掌握程度低,健康行为形成比例不高,在面对脆弱人群进行健康教育时,要更多采用分众传播、大众意见领袖和参与式传播方法。     

扬州市城乡抽样人群脑卒中患病率及危险因素调查

目的对扬州市城区和乡镇抽样人群脑卒中患病率及其危险因素暴露特点进行比较分析,为扬州地区开展脑卒中防控提供依据。方法按照第六次人口普查数据,采取整群抽样方法在扬州市城区(东关区)和乡镇(湾头镇)分别抽取≥40岁常驻居民(至少居住半年以上)4 846人为研究对象,采用统一设计的调查表对抽样人群脑卒中患病情况及危险因素暴露情况进行调查。结果扬州市城区和乡镇社区人群脑卒中患病率分别为3.0%和4.5%;乡镇人群高血压病、超重和吸烟的暴露率均高于城区,而城区人群心脏病、缺少锻炼的暴露率高于乡镇,糖尿病、血脂异常和卒中家族史的暴露率在城乡之间无显著差异。结论扬州市乡镇社区人群脑卒中患病率明显高于城区,可能与乡镇较高的高血压、超重和吸烟暴露率有关。     

高血压患者对基层卫生机构的公共卫生服务利用和满意度

目的调查基层高血压患者对医疗卫生机构开展高血压基本公共卫生服务的满意度情况,为进一步完善基层医疗卫生管理提供依据。方法采用分层多阶段随机抽样方法,抽取城区和乡镇参加基本公共卫生服务高血压管理满1年的35岁及以上700例高血压患者进行体格检查,并以调查问卷形式,调查患者对基层卫生服务利用及满意度。结果乡镇高血压患者通常以村卫生室和乡镇医院就诊为主,分别占49.5%和35.0%,而城区患者以社区卫生服务中心和县级及以上医院为主,分别占44.0%和38.8%,差异有统计学意义(P0.01)。对社区卫生服务机构的总评分为(6.22±2.75)分,城区[(7.61±2.47)分]高于乡镇[(5.05±2.42)分],差异有统计学意义(P0.01),服务态度评价得分最高,为(1.17±0.61)分,血压控制效果评价得分最低,为(0.75±0.66)分,各维度评分城区均高于乡镇,差异均有统计学意义(P0.01)。结论被纳入管理的高血压患者对基层卫生服务机构卫生服务满意度尚可,利用度有待进一步提升。     

2015年深圳市医疗卫生人员对气候变化的认知及其影响因素调查

目的 了解深圳市医疗卫生专业人员对全球气候变化的关注、认知情况及影响因素,为相关决策提供科学依据。 方法 2015年底,采用分层随机整群抽样方式,抽取深圳市医院、疾控中心、卫生监督所等医疗卫生单位共786名专业技术人员,对其人口学特征、气候变化的关注、气候变化相关知识的认知、获取气候变化相关知识的途径、参与适应气候变化工作的态度及应对气候变化的意愿与行为等进行问卷调查,采用logistic回归对关注度、认知情况及其影响因素等进行分析。 结果 深圳市医疗卫生专业人员气候变化知晓率为88.8％,关注度为49.4%,其中55~岁年龄组(关注率77.8%)和医院工作人员(关注率60.2%)关注度较高;获取相关知识的主要途径为网络(84.0％)、电视(75.3％)、报纸(66.9％)、书籍(52.7%);影响气候变化认知因素为曾经是否主动获取气候变化及其对健康影响相关知识(OR=1.934, OR95%CI:1.053~2.745)、对气候变化的了解程度(OR=1.630, OR95%CI:1.100~2.451)。 结论 深圳市医疗卫生专业人员对气候变化的知晓率较高,但关注度相对不足。应加强气候变化相关知识宣传和培训。     

云南省乡镇卫生院发展现状及对策分析

[目的]分析云南省乡镇卫生院发展现状、当前存在的主要问题与不足,并针对性提出对策建议。[方法]采用文献法查阅相关资料,开展实地调查,最后进行描述性统计分析。[结果]云南省基层医疗卫生机构服务基础仍然薄弱,农村居民选择乡镇卫生院就诊的比例降低,乡镇卫生院基本医疗服务功能弱化,国家和省级利好政策没有用好用足。[结论]党委政府要依法履行发展医疗卫生健康事业的职能职责,配强配齐县级卫生健康行政部门和乡镇卫生院领导班子及其“一把手”,切实提升乡镇卫生院医疗卫生人员服务能力和水平,推行乡镇卫生院差异化功能定位和分类管理。     

北京市热浪相关症状的初步调查

目的了解与热浪相关的主要症状,揭示有症状人群的人群特征,进而识别热浪的脆弱人群,为制定合理有效的适应性政策提供科学依据。方法于2013年7月在北京市西城区和顺义区开展热浪症状的问卷调查,采用多阶段分层抽样,采用入户调查形式,实际获取样本量为1 228人;调查内容为热浪相关症状及人群特征(居住区域、性别、年龄、患慢性病以及职业)。结果全部调查人群中,共有710人经历过热浪,其中385人曾在热浪期间出现相关症状,约占全部调查人群的31.4%。热浪期间出现较多的症状依次为头晕、头疼等,心情烦躁、易怒等,失眠、多梦等,心跳过速、血压升高等,恶心、呕吐、食欲不振等。城区(西城区)与郊区(顺义区)有症状人群的比例差异无统计学意义(P0.1);女性有症状者的比例高于男性;≥65岁人群高于65岁以下人群;患慢性病人群高于非慢性病人群;离退休人员和企事业单位人员的比例高于一般人群(均P0.1)。结论北京市曾在热浪期间出现症状的人群比例较高,女性、老人、慢性病患者、离退休人员和企事业单位人员是热浪的脆弱人群,应重点保护。     

社会办基层医疗卫生机构疫情防控风险量化评估实践研究

目的 设计一套适用于社会办基层医疗卫生机构的疫情防控风险量化评估体系,并用于风险评估实践。方法 以天津市社会办基层医疗卫生机构为研究对象,首先利用头脑风暴法、文献荟萃法和专家咨询法识别社会办基层医疗卫生机构疫情防控风险要素,形成风险评估体系的基本框架,然后利用层次分析法计算各风险要素权重,设计量化评分指标用于评估实践。根据评估结果利用加权秩和比法划分社会办基层医疗卫生机构风险等级。结果 共识别出风险要素25个,分为“未落实首诊负责制”“未严格落实预检分诊管理”“未规范处理医疗废物”“医院感染防控管理混乱”“未规范进行住院病房陪护与探视管理”“机构人员健康监测与定期核酸检测执行不到位”“机构培训演练不到位”7大类。量化评估体系针对25个风险因素共设计出单项选择类指标8项及多项选择类指标17项。研究结果显示,高风险等级机构29个,中风险等级机构125个,低风险等级机构30个。结论 本研究构建了一套适用于社会办基层医疗卫生机构的疫情防控风险量化评估体系,研究结果可用于社会办基层医疗卫生机构分类管理。     

山东省基层医疗卫生机构人员满意度调查研究

[目的]了解山东省基层医疗卫生机构人员满意度。[方法]采用问卷调查,对基层医疗卫生机构人员进行调查,共调查社区卫生服务中心71人,乡镇卫生院276人。[结果]基层医疗卫生机构人员不满意比例较高的是培训机会和晋升标准,对于医院的设备条件满意度较高。[结论]相关部门应当加强和改善基层医疗卫生机构人员的激励因素,提高基层医疗卫生机构人员的满意度。     

山区基层医疗卫生人员职业倦怠状况调查

目的了解山区基层医疗卫生人员职业倦怠情况,探讨其影响因素,为制定干预措施提供科学依据。方法采取分层整群抽样的方式,对561名基层医疗卫生人员运用职业倦怠调查问卷(MBI-GS)进行调查。结果发生职业倦怠和倦怠倾向的比例高达58.5%,其中35.55%有一定程度的情绪衰竭现象,20.64%有一定程度的消极怠慢现象,54.64%的医疗卫生人员专业低效能感较高;女性专业低效能感显著高于男性;35岁以上高于其他年龄组,本科学历情感衰竭显著高于中专和高中以下学医疗卫生人员,中专和高中以下学历组专业低效能感显著高于本科学历组;公共卫生专业医疗卫生人员消极怠慢和专业低效能感显著高于其他专业;工作年限在20年以上组专业低效能感高于其他工作年限组。结论山区基层医疗卫生人员是职业倦怠的高发群体。基层医疗机构应建立人文关怀体系,在基层医疗卫生人员中实施干预,对其惊醒引导,提高其抗倦怠能力。     

Attraction and retention of qualified health workers to rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria

INTRTODUCTION: A shortage of health workers is a major problem for Nigeria, especially in rural areas where more than 70% of the population live. At the primary care level, trained community health officers provide services normally reserved for doctors or medical specialists. The community health officers must therefore be supported and motivated to provide effective quality healthcare services. This study aimed to determine factors that will attract and retain rural and urban health workers to rural Nigerian communities, and to examine differences between the two groups. METHODS: A cross-sectional survey measured health workers' work experience, satisfaction with, and reasons for undertaking their current work; as well as reasons for leaving a work location. Data were also gathered on factors that attract health workers to rural settings and also retain them. RESULTS; Rural health workers were generally more likely to work in rural settings (62.5%) than their urban counterparts (16.5%). Major rural motivators for both groups included: assurances of better working conditions; effective and efficient support systems; opportunities for career development; financial incentives; better living conditions and family support systems. The main de-motivator was poor job satisfaction resulting from inadequate infrastructure. Rural health workers were particularly dissatisfied with career advancement opportunities. More urban than rural health workers expressed a wish to leave their current job due to poor job satisfaction resulting from poor working and living conditions and the lack of career advancement opportunities. CONCLUSIONS: Motivational factors for attraction to and retention in rural employment were similar for both groups although there were subtle differences. Addressing rural health manpower shortages will require the development of a comprehensive, evidence-based rural health manpower improvement strategy that incorporates a coordinated intersectoral approach, involving partnership with a range of stakeholders in rural health development.     

Urban Health Inequities and the Added Pressure of Climate Change: An Action-Oriented Research Agenda

Climate change will likely exacerbate already existing urban social inequities and health risks, thereby exacerbating existing urban health inequities. Cities in low- and middle-income countries are particularly vulnerable. Urbanization is both a cause of and potential solution to global climate change. Most population growth in the foreseeable future will occur in urban areas primarily in developing countries. How this growth is managed has enormous implications for climate change given the increasing concentration and magnitude of economic production in urban localities, as well as the higher consumption practices of urbanites, especially the middle classes, compared to rural populations. There is still much to learn about the extent to which climate change affects urban health equity and what can be done effectively in different socio-political and socio-economic contexts to improve the health of urban dwelling humans and the environment. But it is clear that equity-oriented climate change adaptation means attention to the social conditions in which urban populations live—this is not just a climate change policy issue, it requires inter-sectoral action. Policies and programs in urban planning and design, workplace health and safety, and urban agriculture can help mitigate further climate change and adapt to existing climate change. If done well, these will also be good for urban health equity.     

New York state case manager survey: Urban and rural differences in Job activities,job stress,and job satisfaction

The impact of stress in the workplace on employees' well-being and effectiveness has been increasingly recognized in recent years. The purpose of this research was to study the quality of working life of case managers in urban and rural community mental health programs in New York State. The objectives were to describe specific job activities and examine differences in the perceptions of job stress and job satisfaction. Urban case managers attributed greater job stress intensity and frequency than did rural workers to stressors relating to collaborating and coordinating services. Urban case managers reported higher levels of perceived job stress due to organizational support deficits than did rural workers. No differences were found for the 2 groups on job pressure stressors. The significance of the findings for mental health agencies is discussed.     

湖南省2001-2006年学校卫生经常性监督合格率情况动态分析

目的分析湖南省2001-2006年学校卫生经常性监督合格率情况的变化,为开展学校卫生监督提供依据。方法对来源于湖南省各市州卫生监督机构2001-2006年各年上报的年报表进行统计分析。结果2001-2006年,学校卫生经常性监督合格率为58.65%。学校卫生经常性监督分项合格情况,教室人均面积、课桌椅、黑板、教室照明、教室微小气候、环境噪音、厕所、生活饮用水、学校食品卫生、传染病管理的合格率分别为55.76%、41.89%、53.94%、54.31%、51.75%、51.99%、44.56%、59.38%、57.22%、49.39%。从2001-2006年,教室人均面积、课桌椅、黑板、教室照明、厕所、生活饮用水、学校传染病管理经常性监督合格率均是市高于县,中学高于小学;教室微小气候县高于市,小学高于中学;环境噪音县高于市,中学高于小学;学校食品卫生市高于县,而中小学无差异。结论尽快修订《学校卫生工作条例》,争取各级政府领导的重视与支持,多部门协调配合,加大对学校卫生尤其是农村中小学校的卫生监督力度,使学校的卫生设施符合要求,学校卫生经常性监督合格率才能大幅度提高。     

Preventive health behavior among black and white women in urban and rural areas.

The relationship of race to preventive health behavior among women is examined using data from the 1985 National Health Interview Survey. We find that black women are less likely to engage in primary prevention behaviors such as exercising, non-smoking and maintaining a favorable weight. However, black women are more likely to engage in secondary prevention behaviors such as receiving a Pap test or a breast exam. These findings are surprising as they indicate a change in secondary prevention behavior among black women. The racial differences in exercising, maintaining a favorable weight and receiving a Pap test or a breast exam cannot fully be explained by the differing levels of socio-economic status, measured by education and income. However, the higher percentage of smoking among black women is due to their lower levels of education. Urban/rural residence modifies the effect of race on smoking and receiving a Pap test. Black women in urban areas are most likely to be smokers. Almost no difference exists between white women in urban and rural areas concerning their likelihood of receiving a Pap test, we find that black women in urban areas are much more likely to be screened for cervical cancer than black women in rural areas.     

Deliberate self-harm in rural and urban regions: a comparative study of prevalence and patient characteristics

In countries like the U.K., people living in urban regions are more likely to suffer poor physical and mental health than rural populations, and to have increased rates of psychiatric disorder. Urban/rural differences in suicidal behaviour have most frequently focussed on variations in the occurrence of suicide. We have investigated rates of deliberate self-harm (DSH) in urban and rural districts of Oxfordshire, England, and compared characteristics of DSH patients resident in these two areas. Information was collected on 6833 DSH episodes by 4054 persons aged 15 years and over presenting to the local general hospital between 2001 and 2005. We found that urban DSH rates were substantially higher than rural rates amongst both males and females aged between 15 and 64 years. This relationship was sustained even when socio-economic deprivation and social fragmentation were taken into account. There was little difference between urban and rural rates for patients aged 65 years and over. Urban DSH patients were more likely to be younger, non-white in ethnic origin, unemployed, living alone, to have a criminal record, to have previously engaged in DSH, and to report problems with housing. Rural DSH patients were more likely to suffer from physical illness, and to have higher suicide intent scores. Results of studies such as this can help identify where resources for preventive initiatives should be primarily directed and also what types of individuals may be at most risk in different areas. However, since variation by area will in part be due to differences at the individual level, further research utilising multi-level modelling techniques would be useful.     

Urban/Rural Differences in Decision Making and the Use of Advance Directives Among Nursing Home Residents at Admission

CONTEXT: Advance directives promote patient autonomy and encourage greater awareness of final care options while reducing physician and family uncertainty regarding patient preferences. PURPOSE: To investigate differences in decision making authority and the use of advance directives among nursing home residents admitted from urban and rural areas. METHODS: A total of 551,208 admission assessments in the Minimum Data Set were analyzed for all residents admitted to a nursing facility in 2001. Using the Rural Urban Commuting Areas (RUCA) methodology and ZIP code of primary residence before admission, these residents were classified into 4 urban/rural areas. FINDINGS: Residents from rural areas were significantly more likely to have executed a durable power of attorney for health care or for financial decisions than residents admitted from the other areas, with the largest differences observed between residents admitted from urban and rural areas. Almost 6 residents in 10 from urban areas had no advance directives in place at admission compared with only 4 residents in 10 admitted from rural areas. CONCLUSIONS: Health providers and social workers in both rural and urban areas should advise patients about the value of advance directives.     

The impact of preschool education component of ICDS on mental and cognitive development of children

The aim of this evaluation was to assess the impact of nonformal preschool education of the mental and cognitive development of rural and urban children from the Ludhiana Integrated Child Development Services (ICDs) district, Punjab, India; comparisons were made with non-ICDs attenders. 30 anganwadi community workers (AWWs) with ICDs were randomly selected equally from a total of about 200 workers in urban and rural blocks. 360 children aged 3-6 years; equally divided among urban and rural areas, were selected; 180 of these children, equally divided between urban and rural areas, were controls of nonattenders of preschool. Information about cognitive and mental development was obtained from AWWs records and interviews, parents, and a cognitive ability test. Mean test scores among rural ICDS attenders aged 3-4 years of age were 73.77 compared with 67.33 for nonattenders. The scores for rural ICDs attenders 4-5 years old was 95.60 vs. 82.20 for nonattenders. For the 5-6 year old group, scores for rural ICDs attenders were 104.23 compared with 93.27 for nonattenders. The scores were statistically significant for score differences for all age groups in the rural population and the urban population. Urban ICDS attenders scored 73/87 compared with 65.57 for nonattenders aged 3-4 years. Urban ICDS attenders aged 4-5 years scored 92.97 compared with 83.23 for nonattenders. Urban ICDS attenders aged 5-6 years scored 105.03 compared with 92.57 for nonattenders. There were no significant differences between rural and urban attenders or nonattenders for any age group. There was a significant (p .001) correlation between age and cognitive ability: rural attenders, r = .81; rural nonattenders, r = .78; urban attenders, r - 84, urban nonattenders r = 86. The findings supported previous studies, by, for instance, Adhish et al. on cognitive differences between children in ICDs and non ICDs villages. Place of residence was not found to be related to mental development. There was an increase in the cognitive development with the advancement of age.     

Preventive services for rural and urban African American adults

BACKGROUND: Studies have shown that African Americans and rural patients receive fewer preventive services than other patients. OBJECTIVE: To compare the use of preventive services by African Americans in urban and rural settings to determine if race and rural residence were additive risks for not obtaining preventive services. METHODS: Three hundred African American patients seeking care in family practices in South Carolina were surveyed about preventive health care. RESULTS: Rural and urban African Americans were equally likely to know about preventive services and be up-to-date on receiving these services. In both practices, those with lower incomes were less likely to be up-to-date. Patients seen in the urban setting were more likely to receive counseling regarding exercise and smoking than those in the rural practice (87% vs 71%, P = .003). CONCLUSIONS: For both urban and rural African American patients with access to primary care physicians, preventive service use is high. The best predictor of poor compliance with preventive service recommendations was low income, suggesting that a lack of access to care is the primary reason why rural and African American populations do not receive adequate preventive health care.     

The Health of Caregiving Grandmothers: A Rural‐Urban Comparison

Purpose: The purpose of this study was to compare the characteristics of rural versus urban caregiving grandmothers along with their physical and mental health status. Methods: A secondary analysis of data produced from the first wave of a longitudinal study of 485 Ohio grandmothers was conducted. Health status was measured using the SF‐36 Health Survey and the 20‐item CES‐D depression scale. Rural‐urban classification was made using Rural Urban Commuting Area (RUCA) codes based on resident ZIP codes, identifying 97 rural and 388 urban grandmothers in the sample. Findings: The rural and urban grandmothers were similar in age, educational level and employment status; however, 90% of the rural grandmothers compared with 60% of the urban grandmothers were white. Rural grandmothers were most likely to have traditional nonresidential relationships with their grandchildren. Approximately 38% of both the rural and urban grandmothers served as primary caregivers for their grandchildren, but a lower percentage of rural grandmothers lived in multigenerational homes. There was no significant difference between the rural and urban grandmothers in relation to physical or mental health. Among rural grandmothers, primary caregivers had significantly lower levels of mental health compared with the other caregiver groups. Conclusions: These findings suggest that rural and urban grandmothers have similar levels of physical and mental health, despite differences in demographics and caregiving arrangements. Health promotion efforts with rural caregiving grandparents are indicated, addressing both mental and physical health.