The health of urban Aboriginal people: insufficient data to close the gap

The Australian Government has committed to reducing Indigenous disadvantage, including closing the life-expectancy gap within a generation, and to halving the gap in mortality rates for children under 5 years of age within a decade. Sixty per cent of the health gap between Indigenous and non-Indigenous Australians is attributable to the health of Indigenous people living in non-remote areas of Australia. We conducted a brief review of recent Australian original research publications on the health of the 53% of Indigenous people who live in urban areas, and found that data are sparse; there were only 63 studies in the past 5 years (11% of all articles about Indigenous health during this period). Although Indigenous Australians living in remote areas experience greater health disparity, the government will not achieve its aims without paying due attention to the non-remote-living population. More research is required, and particularly research that actually tests the impact of policies and programs.     

Overseas-trained doctors in Aboriginal and Torres Strait Islander health services: many unanswered questions

Aboriginal and Torres Strait Islander health services are heavily dependent on overseas-trained doctors (OTDs). These OTDs are increasingly from countries with variable English language and educational equivalency compared with locally trained doctors. Aboriginal and Torres Strait Islander health services create particular demands for all doctors, such as negotiating "cultural domains" and acknowledging the contribution of Aboriginal health workers. Little is known about the roles and experience of OTDs in health service provision in Indigenous communities. Barriers to effective research into the experience of OTDs include privacy legislation and a lack of standardised data. Researching the narratives of OTDs in Indigenous health services offers an opportunity to explore the diversity and complexity of the cultural interfaces in health service provision.     

Nutrition-related disorders in Indigenous Australians: how things have changed

Awareness of a serious Indigenous health problem in Australia did not emerge until the 1960s and 1970s. Much attention was focused at the time on poor pregnancy outcomes, high infant and young child mortality rates, and childhood malnutrition and impaired growth, often associated with high infectious disease burdens. Although that situation has improved somewhat, Indigenous infant and child health is still poor compared with that of other Australian children. Over recent decades, there has been a rapid rise among Indigenous people of nutrition-related "lifestyle" disorders such as obesity, cardiovascular disease, type 2 diabetes mellitus and chronic renal disease and their complications. This epidemic of disabling and often fatal chronic diseases in Indigenous Australians is also occurring in disadvantaged groups in many other countries. Control of this potentially disastrous epidemic must become a much higher priority in Indigenous health programs. Governments must commit to this task in cooperation and collaboration with Indigenous organisations and communities.     

Barriers to health care for children. How's Florida doing?

Three primary barriers, financial, system, and knowledge, must be overcome to ensure quality health care for all children. Attempts to identify strengths and weaknesses in Florida's child health care system are directed at removing these barriers. Strengths include: an Institute of Child Health Planning, a legislative proposal to link child health insurance to school enrollment, several populous cities supporting good medical facilities and the availability of health care for all children. Areas of weakness include: lack of medical resources in underserved areas, disproportionate spending on health care for elderly versus young, and lack of identified financial resources to pay for school-linked health insurance.     

健康教育对儿童少年精神病患儿父母心理健康状况的影响

目的:探讨健康教育对儿童少年精神病患儿父母心理健康状况的影响。方法:对112例儿童少年精神科住院的患儿父母,在接受常规健康教育的基础上,施以团体的父母健康教育,观察6周。于健康教育前后采用症状自评量表评定临床心理健康状况,并与国内常模进行对比分析。结果:入组患儿父母健康教育前症状自评量表总分及躯体化、强迫症状、抑郁、焦虑、恐怖、偏执、精神病性因子分均显著高于国内常模(P<0.05或0.01);健康教育后症状自评量表总分及强迫症状、抑郁、焦虑、恐怖、偏执、精神病性因子分均较健康教育前有显著性下降(P<0.05或0.01);且总分及各因子分与国内常模比较均无显著性差异(P>0.05)。结论:健康教育能有效提高儿童少年精神科住院患儿父母的心理健康水平,有利于促进儿童少年精神病患儿的康复。     

Challenges in health and health care for Australia

The next Australian Government will confront major challenges in the funding and delivery of health care. These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services. The search for effective and lasting solutions will require a consultative approach to deciding the nation's priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.     

The Bibbulung Gnarneep Project: practical implementation of guidelines on ethics in indigenous health research.

Human rights and ethical principles justify Indigenous control of health research conducted in Indigenous communities, but also emphasise the need for scientific rigour, knowledge and expertise, much of which currently resides with the non-Indigenous community. In 1994, we began development of the Bibbulung Gnarneep Project on Aboriginal maternal and child health in Perth, Western Australia. We describe the process of developing a protocol to ensure ethical conduct of this research through consultation and negotiation between Aboriginal and non-Aboriginal people involved in the project.     

The future of health IT innovation and informatics: a report from AMIA's 2010 policy meeting

While much attention has been paid to the short-term impact that widespread adoption of health information technology (health IT) will have on the healthcare system, there is a corresponding need to look at the long-term effects that extant policies may have on health IT system resilience, innovation, and related ethical, social/legal issues. The American Medical Informatics Association's 2010 Health Policy Conference was convened to further the national discourse on the issues surrounding these longer-term considerations. Conference participants self-selected into three broad categories: resilience in healthcare and health IT; ethical, legal, and social challenges; and innovation, adoption, and sustainability. The discussions about problem areas lead to findings focusing on the lack of encouragement for long-term IT innovation that may result from current health IT policies; the potential impact of uneven adoption of health IT based on the exclusions of the current financial incentives; the weaknesses of contingency and risk mitigation planning that threaten system resilience; and evolving standards developed in response to challenges relating to the security, integrity, and availability of electronic health information. This paper discusses these findings and also offers recommendations that address the interwoven topics of innovation, resilience, and adoption. The goal of this paper is to encourage public and private sector organizations that have a role in shaping health information policy to increase attention to developing a national strategy that assures that health IT innovation and resilience are not impeded by shorter-term efforts to implement current approaches emphasizing adoption and meaningful use of electronic health records.     

适用于我国社区卫生中心小儿上感诊疗流程的探讨

目的 通过前期的调研及文献检索发现,西安市社区医生乃至全国专科医生对小儿上呼吸道感染(简称"上感")的诊疗存在认识不足,导致治疗上的盲目性,存在重复用药、不恰当联合用药和过多使用抗病毒、抗生素等诸多问题,使得部分社区医院未能完全承担起小儿上感的首诊之责。现有的小儿上感诊疗流程都是针对儿科专科医生,缺乏完全适宜全科医生使用的规范流程。为了提升全科医生的能力,迫切需要适宜于全科医生使用的小儿上感诊疗流程。本研究目的是总结出适合社区全科医生使用的小儿上感诊疗及管理流程,引导社区全科医生规范诊疗小儿上感。 方法 经检索多个数据库及相关文献,共收集、筛选出最新国内外小儿上感诊疗指南、规范或专家共识7个,从全科医生岗位实际出发,就小儿上感诊断标准、鉴别诊断、治疗原则、合理用药4个维度进行逐个对比、分析和归纳。 结果 总结出适宜社区全科医生使用的小儿上感诊断和治疗、管理流程各1个。 结论 按照该流程社区全科医生应对首诊上感患儿进行全面评估,根据上感不同类型及病情给予适当治疗。如在急性期以病情观察和对症治疗为主,仅在有指征时才能使用抗生素,流感患儿应尽早用抗病毒药物。      

儿童保健团队在社区卫生服务中的作用分析

目的：为提高社区健康服务中心的管理内涵,以试点方式探讨儿童保健团队建设在社区健康服务中的作用。方法：以深圳市宝安区西乡人民医院颐康园社区健康服务中心为试点现场,通过儿童保健团队的建设、工作任务和流程的制订,研究现场的试点,并对试点前抽样调查430名儿童和试点1年后抽样调查436名儿童的相关情况进行调查、统计和分析。结果：试点前后常住、暂住和流动儿童计划免疫规范接种率分别为32.55%、28.02%、9.49%和53.33%、45.41%、30.47%,较规范种率分别为23.26%、36.71%、32.12%和45.56%、50.46%、61.72%,前后比较差异均有高度统计学意义（P〈0.01）;试点前后常住、暂住和流动儿童体检达标率分别为30.23%、26.09%、4.38%和48.89%、42.66%、29.69%,基本达标率分别为32.56%、27.05%、27.74%和46.67%、54.13%、64.06%,前后比较差异具有高度统计学意义（P〈0.01）;试点前后儿童保健系统管理率分别为48.37%和95.64%,儿童保健覆盖率分别为74.19%和99.08%。结论：儿童保健团队式服务模式,有利于推进社区基本医疗和公共卫生服务的进一步落实,使社区儿童在成长过程中能够享受到可及性、连续性和综合性的社区卫生服务,具有一定的推广价值。     

EBM and the health of Indigenous Australians

Implementing evidence-based medicine (EBM) in primary healthcare for Indigenous people will usually involve increasing services, particularly those for chronic conditions. As shown by the example of diabetes care, there are significant organisational, educational, economic, cultural and structural barriers to implementing EBM in many Indigenous communities. Many of these barriers could be reduced by better-organised service delivery systems at the community level, greater numbers of Indigenous health professionals and greater advocacy for healthy public policy by health services. There is evidence that delivering evidence-based primary healthcare, particularly for chronic diseases, can improve health outcomes in Indigenous communities. There is a need for more investment in strategies to implement EBM and evidence-based public health in Indigenous settings.     

Maintaining an agenda for children: the role of data in linking policy, politics and outcomes

There is growing recognition in Australia of the importance of early childhood to later health and wellbeing, with developments such as the National Agenda for Early Childhood and the National Public Health Action Plan for Children. To sustain a policy agenda for children and improve long-term outcomes, we need timely, comprehensive and accurate indicators and data on child health, development and wellbeing. Building this evidence requires a national monitoring and surveillance system that involves more than aggregating or linking existing data. Steps to building a national system are: to agree on key indicators of child health, development and wellbeing for regular reporting, to research a comprehensive set of indicators for each domain and ascertain data gaps, and to ensure development and coordination of data relevant to policy-making.     

2012年桂林市13家妇幼保健机构现状分析

目的：为了掌握桂林市各级妇幼保健机构基本情况和发展的现状,找出存在问题,为全市妇幼保健机构今后的发展规划和卫生行政部门的科学决策提供依据。方法：根据国家与自治区机构调查要求,组织辖区13家妇幼保健院进行本机构的机构调查,并及时录入到国家妇幼中心的全国妇幼保健机构监测信息网络直报系统,经各级数据审核通过后导出数据,对辖区妇幼保健机构的基本情况、人力资源、设备配置、服务运营情况等数据进行分析。结果：桂林市辖区13家妇幼保健院存在人员缺编1100人,人员素质偏低,群体保健人员严重不足,服务提供能力有限,县级妇幼保健院设备不足,妇幼保健机构工作经费紧张。结论：有关部门应根据市、县两级妇幼保健机构的功能定位,重新修订人员编制、加强妇幼保健人才队伍建设,建立稳定的妇幼保健机构补偿机制,落实妇幼保健机构人员经费、公共卫生服务经费,逐年增加投入,改善设备条件,保证妇幼保健机构可持续发展。     

Tensions in setting health care priorities for South Africa's children.

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities.     

某省初中教师心理健康状况研究

[目的]了解初中教师的心理健康状况,为加强学校的心理健康工作,促进学生的心理健康提供参考.[方法]使用症状自评量表对183名初中教师进行调查,使用SPSS13.0对数据进行统计分析.[结果]心理健康较差的教师占调查教师总体的比例为21.86％,比较突出的心理健康问题主要有强迫、敌对、睡眠及饮食问题、人际关系敏感;省内初中教师心理健康状况比全国正常人的水平低,因子分有显著差异;初中教师的心理健康总体状况及各因子状况无性别、年龄的差异.[结论]省内初中教师的心理健康状况存在一定问题,有待改善.     

The upsurge of interest in Indigenous health in the 1950s and 1960s

During the 1950s and 1960s, there was a dramatic explosion in the number of letters to the editor about Indigenous health published in the MJA, reflecting increased reader interest. The letters from Barry Christophers were part of the Federal Council for Aboriginal Advancement's largely successful campaign for equal civil rights for Aboriginal and Torres Strait Islander people. His letters not only drew attention to discriminatory legislation and policies, but also emphasised the structural (especially economic) determinants of Indigenous ill-health, and the negative impact on Indigenous people of racist medical representations.     

Reform in Australian medical schools: a collaborative approach to realising Indigenous health potential

The Australian medical education system is at a critical juncture in relation to what and how it delivers for Aboriginal and Torres Strait Islander health. Since 2004, three key organisations concerned with medical education have worked to provide a toolkit for implementation of sustainable reform within medical schools. The aim is a medical workforce trained in Indigenous health, and more Aboriginal and Torres Strait Islander doctors, leading to better health for Australia's Indigenous peoples.     

3～6岁儿童家长的儿童忽视相关知识、态度、行为现况调查

目的了解3～6岁儿童家长的儿童忽视相关知识、态度、行为现况,为进行防治儿童忽视干预提供科学依据。方法采用自行设计的调查问卷,对广东省东莞、惠州、中山、佛山四市3～6岁的儿童家长621人进行儿童忽视相关知识、态度、行为现况调查。结果仅5.4%听说过儿童忽视也知道内容;55.9%以前从来没有获得过防治"儿童忽视"的知识;90.7%～97.4%的家长愿意接受、需要和认为应该进行防治儿童忽视知识的教育和宣传;91.0%愿意为防治儿童忽视做力所能及的事情;家长对孩子经常有的行为依次是:温情、理解(72.4%)、严厉(48.6%)、责骂(43.3%)、过度保护(19.6%)、拒绝(18.2%);对孩子从来没有的行为依次是:恐吓(65.2%)、过分干涉(50.5%)、惩罚(38.7%)、过度保护(37.4%)、否认(29.7%)。他们认为儿童忽视主要发生在以下地方:家庭(78.3%)、幼儿园(61.0%)、公共场合(40.3%);认为保护3～6岁儿童的责任应在于家长(95.3%)、幼儿园老师(76.7%)、相关机构(39.4%)、政府(29.9%);认为目前防治儿童忽视的教育未普及的可能原因是政府、社会不重视(59.9%)、没有成立相应的专业机构(57.8%)、家长或老师本身缺乏相应知识(57.4%)、社会、医疗和教育机构宣传不力(47.4%)、宣传形式和内容不佳(40.7%)、没有相应的立法(37.3%)等;同时95.4%的家长呼吁应该成立相应的防治儿童忽视的机构、法律援助机构或立法保护儿童。结论 3～6岁儿童家长儿童忽视相关知识严重匮乏,相应的健康教育远远不足,而家长态度是肯定的、对其需求迫切,但现实与需求相差甚远。应加强健康教育,注意家庭、幼儿园是健康教育的重点,同时呼吁政府、社会、家长、老师应关注防治儿童忽视。     

Disparities in children's oral health and access to dental care

Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.