延边地区空巢老年人主观幸福感与社会支持相关分析

摘要:目的　了解延边地区空巢老年人的主观幸福感和社会支持情况,为社区空巢老年人的健康服务提供科学依据。方法　对延边地区518名空巢老年人进行主观幸福感和社会支持的调查。结果　空巢老年人主观幸福感得分为（31.26±10.25）分,不同人口学特征人群得分差异具有统计学意义;社会支持得分为（35.43±7.57）分;主观幸福感与社会支持正相关（r＝0.386,P＜0.01）。结论　延边地区空巢老年人主观幸福感水平和全国其他地区相比偏低,社会支持处于中等水平。在社区医疗护理服务中注重空巢老年人的健康管理,除了传统的健康管理外应加大心理支持,提高空巢老年人的生活质量。     

A life-span perspective on women's careers, health, and well-being

The purpose of this study was to investigate if and how health and well-being in mid-life are influenced by the ways in which individuals have combined educational, occupational, and family involvement throughout their adult lives. Life-career patterns (LC) and occupational career patterns (OC) were retrieved from a longitudinal cohort of Swedish women born in the 1950s. Retrospective occupational biographies retrieved at age 43 generated nine LC and 10 OC patterns which served as the basis for the present study. LC patterns combined timing, ordering, duration, and content of activities (e.g., education, work, and parenthood), while OC patterns considered occupational level and its stability over time. Data on life and job satisfaction, psychological well-being, work-family conflict, optimism, and mental distress were collected at age 49. For a sub-sample of the women who took part in a medical examination, seven biomarkers were combined into a measure of allostatic load (AL). The results showed that LC pattern-groups differed significantly but modestly in four aspects of health and well-being whereas OC pattern-groups displayed significant between-group differences in all outcome variables except life satisfaction. The results are interpreted in terms of a social-health gradient effect and a supportive societal context of the Swedish welfare state, which offered a considerable amount of free choice to the women in the cohort.     

"The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups

OBJECTIVE:

to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups.

METHOD:

ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique.

RESULTS:

four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study.

CONCLUSION:

the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.     

Coastal proximity,health and well-being: Results from a longitudinal panel survey

Analysis of English census data revealed a positive association between self-reported health and living near the coast. However that analysis was based on cross-sectional data and was unable to control for potential selection effects (e.g. generally healthier, personality types moving to coastal locations). In the current study we have used English panel data to explore the relationship between the proximity to the coast and indicators of generic and mental health for the same individuals over time. This allowed us to control for both time-invariant factors such as personality and compare the strength of any relationship to that of other relationships (e.g. employment vs. unemployment). In support of cross-sectional analysis, individuals reported significantly better general health and mental health when living nearer the coast, controlling for both individual (e.g. employment status) and area (e.g. green space) level factors. No coastal effect on life satisfaction was found. Although individual level coastal proximity effects for general health and mental health were small, their cumulative impact at the community level may be meaningful for policy makers.     

军队离退休老干部主观幸福感与社会支持、生活事件和健康状况的相关研究

目的探讨生活事件、社会支持及健康状况等因素对军队离退休老干部主观幸福感的影响。方法研究对象为北京市186例军队离退休老干部。调查采用问卷方式,影响因素涵盖年龄、性别、受教育程度、家庭结构、收入情况、家庭氛围、自评健康状况、体检健康状况和领悟社会支持及生活事件等。数据采用SPSS13．0软件进行统计分析。结果社会支持、生活事件、健康状况、年龄及家庭气氛与军队离退休老干部的主观幸福感有显著相关。社会支持、生活事件及他评健康状况可用来预测军队离退休干部的主观幸福感（标准化回归系数分别为-0．293、0．292和0．165）,可解释总变异的36．3％。结论社会支持、生活事件及健康状况对军队离退休老干部的主观幸福感能产生直接影响,可作为评价军队离退休老干部主观幸福感的预测指标。     

Developing health services management in South Africa: The question of transformation

The end of the Apartheid system in South Africa will have a major impact on its public sector, and the health service in particular. The key player in the process of transformation, the African National Congress, has put forward proposals for a National Health Service. The need for a management cadre to bring about and maintain these major changes is slowly being recognized. This article considers the impact of the proposed changes for health service management, and argues that management education has to produce people who possess both strategic and operational competencies to effect the transformation of an unequal and divisive health service into one that offers an equitable and high quality service to all South Africans.     

健康教育对糖尿病住院患者营养知信行的影响

目的评估健康教育对糖尿病住院患者营养知识-态度-行为(KAP)水平的影响,为今后在临床更好开展糖尿病健康教育提供依据。方法将新入院的糖尿病患者分为两组:青壮年组(年龄小于60岁)和老年组(年龄大于60岁),应用自制问卷进行调查,比较两组糖尿病患者接受健康教育前后的营养KAP水平。结果无论青壮年组还是老年组,初入院糖尿病住院患者营养KAP水平低,接受健康教育后两组患者的营养KAP水平均显著提高,前后对比差异有统计学意义;尤其对"糖尿病患者控制总能量的摄入"、"控制食盐摄入量"、"少食多餐"以及"食物交换份"等几项营养知识知晓率提高明显,两组糖尿病患者治疗饮食执行率也分别由72.2%、67.6%提高到94.4%、81.1%。结论健康教育是改善糖尿病住院患者营养KAP的有效方法,对老年糖尿病患者同样适用,建议将健康教育作为糖尿病住院患者临床治疗中的一项常规措施。     

Physical and emotional well-being and the balance of needed and received emotional support: Age differences in a daily diary study

Whether received social support matches the actual needs of the recipient is a largely overlooked aspect in research on associations of support and well-being. In particular, studies that investigate the match of needed and received support from a within-person perspective are rare. Therefore, we investigated the daily within-person relationship of well-being and the balance of needed and received social support in a German Sample of 79 younger (23–34 years) and 88 older adults (68–83 years). Health complaints and negative affect were predicted with linear effects of received and needed emotional support and quadratic effects of the balance (i.e., difference) of these two aspects using multilevel modeling of self-reports over 20 days. The predicted beneficial association between a match of needed and received support (i.e., a support balance) and well-being was observed among younger adults. Needed support was associated with more health complaints and negative affect on the same day. The match of needed and received support is important for well-being, particularly in younger adults. Future research should account for support needed in research on received support and shed more light into the processes underlying these short-term within-person relationships of social support and well-being.     

Health ratings in relation to illnesses,physical functioning,general mental health and well-being: Self-reports of college alumnae,ages <40–80 and older

Objectives: This paper examines health perception as an outcome in relation to physician-diagnosed illnesses, vitality, mental health and well-being, physical activities, and social and behavioral factors among women, ages late 30's to 80 and older, whose responses were obtained in non-medical settings. Subjects and methods: 3940 college alumnae responded to a self-administered mailed questionnaire, which covered personal and behavioral factors; physical activity; diet; medical history; mental health; physical limitations, and health perception. Results: The prevalence of medical diagnoses, physical limitations, and health rating (good, fair, poor vs. excellent, very good) increased by age. Measures of low vitality and psychological distress varied by age, but not linearly. Stress declined dramatically by age. Irrespective of age, vitality and psychological distress were important predictors of health rating. The multivariate odds ratios (ORs) were, respectively, OR: 3.3, 95% CI (2.6, 4.1), and OR: 1.6, 95% CI (1.3, 2.0). Other predictors of health rating included physical limitations and medical diagnoses of breast and reproductive cancers, respiratory conditions, and chronic back problems. Conclusion: For women across the age span, who rated their health and health-related quality of life in a non-medical setting, having low vitality was a major factor in predicting their perceived health, even when adjusting for medical conditions and physical limitations.     

2014年四川省社区高血压和糖尿病患者健康管理服务现状调查

目的：探讨四川省基本公共卫生服务项目中高血压和糖尿病患者健康管理服务的数量、质量及其效果。方法2014年3月,采取多阶段分层随机抽样方法,在四川省21个市(州)中抽取11个市的22个县（区）的44个乡镇卫生院(社区卫生服务中心),获取高血压和糖尿病患者健康管理率,并在每个乡镇卫生院（社区卫生服务中心）等距抽取高血压和糖尿病档案各10份,开展电话调查,核查档案表单、个人信息、体检记录、随访信息等,根据国家基本公共卫生服务规范设定条件,判断档案信息准确性和服务规范性。比较档案信息准确和不准确、服务规范和不规范的受访对象满意率和控制率。结果高血压和糖尿病患者健康管理率分别为33.8%（69680/206154）和24.0%（25562/106508）。慢性病患者档案信息准确率为81.16%（702/865）,服务规范率为74.36%（522/702）,血压控制率为86.92%（299/344）,血糖控制率为85.46%（288/337）,患者满意率为94.58%（698/738）。档案信息准确和不准确的对象满意率分别为98.69%(677/686)和40.38%(21/52)（χ2=320.52,P<0.001）;服务规范和不规范的对象满意率分别为99.22%(508/512)和97.13%(169/174)（χ2=2.92,P=0.087）。结论四川省高血压和糖尿病患者健康管理服务质量较好,需进一步提高管理率、档案信息准确率和服务规范率。     

饮食习惯和体力活动对妊娠期糖尿病的影响

目的 探讨饮食习惯和体力活动对妊娠期糖尿病发病的影响。方法 选择产科门诊确诊妊娠期糖尿病孕妇942列（GDM组）及其配对对照组作为调查对象,以问卷方式,对膳食史、饮食习惯和体力活动等情况进行回顾性调查。结果 GDM组每日膳食总热能、脂肪供热比、动物比脂肪百分比均显高于对照组（P＜0．05）;GDM组长期饱餐和喜甜食的比例显高于对照组（P＜0．05）;而GDM组平均体力活动量低于对照组（P＜0．05）。结论 孕期高热能、高脂肪的膳食,喜饱餐和喜甜食和较少的体力活动是诱使发生妊娠期糖尿病的重要影响因素。     

Awareness, treatment and control of hyperlipidaemia, hypertension and diabetes mellitus in a selected population of southern Italy

The purpose of the present study was to assess the degree of awareness, treatment and control of hyperlipidaemia compared with hypertension and diabetes mellitus in a selected population of southern Italy. All participants to a cardiovascular disease prevention campaign examined between April 1994 and July 1995 were screened for hyperlipidaemia, hypertension and diabetes mellitus. Subjects received also ECG, echo-Doppler of carotid arteries and filled in a questionnaire concerning personal and familial cardiovascular diseases, smoking habit and drug consumption. Of the 742 participants, 327 were found to have hypertension, 73 to have diabetes mellitus, 287 to have mild hyperlipidaemia and 322 to have moderate-severe hyperlipidaemia. Among hypertensive subjects, 60.2% were aware of their condition, 53.5% were treated and 15.6% had their blood pressure controlled at the recommended level (> 140/90 mmHg). Among diabetic subjects, 76.7% were aware, 64.4% treated and 19.2% reached fasting blood glucose level of less than 7.77 mmol/l (140 mg/dl). Only 24.0% of subjects with mild hyperlipidaemia were aware of their condition. Of the subjects found to have moderate-severe hyperlipidaemia, 64.9% were aware, 32.3% were treated and 9.0% had plasma cholesterol and triglycerides concentration of less than 6.45 and 5.65 mmol/l (250 and 500 mg/dl), respectively (cutoffs chosen to separate mild from moderate-severe hyperlipidaemia). These results show that mild hyperlipidaemia is almost neglected whereas awareness of moderate-severe hyperlipidaemia is quite widespread and comparable to that of hypertension and diabetes mellitus. Prevalence of treatment and control of moderate-severe hyperlipidaemia is, however, much lower than that of hypertension and diabetes.     

糖尿病社区健康教育方式与内容的研究进展

随着人们生活水平不断提高以及医疗保障制度越来越完善,社区医疗场所成为了许多慢性病、多发病以及常见病等的就医场所。糖尿病是常见的慢性病之一,患者需进行长期综合性治疗,社区门诊因医疗费用低且就诊方便,成为了糖尿病患者首选的就医场所。但是目前许多糖尿病患者对糖尿病的认知程度不高,再加上不良生活习惯以及缺乏运动锻炼,导致血糖控制情况不佳。因此,在社区开展糖尿病健康教育是十分必要的。健康教育对于糖尿病患者来说也是一种治疗,健康指导效果直接影响患者的生存质量和健康。本文通过对糖尿病社区健康教育方式与内容的研究进展进行相关阐述,使糖尿病患者掌握正确的相关知识,从而改善血糖控制效果和生命质量。     

妊娠期糖尿病管理与妊娠糖尿病母儿结局的临床分析

目的:探讨妊娠期糖尿病筛查与管理,调查其患病率及妊娠糖尿病血糖控制对妊娠结局的影响。方法:选择已确诊的妊娠期糖尿病患者51例,按孕期未进行系统管理(孕期血糖控制不良)21例为病例组A,已系统管理(孕期血糖控制良好)30例为病例组B,两组进行比较。结果:妊娠糖尿病患病率为20.98%,A组的妊高征、早产儿、先兆子痫、胎死宫内等的发病率较B组明显增高,有显著差异。A组的新生儿畸形、低体重儿均较B组明显增高,有显著差异。结论:加强妊娠期糖尿病系统管理,有效地控制糖尿病孕妇孕期血糖,可减少孕产妇合并症。     

卫生监督管理框架的构建与思考

基于卫生监督工作的现状，提出了卫生监督管理框架，具体包括目标管理、法规标准、监管实施、评估预警、信息、应急防范等六大系统，政府、行业中介、单位三个层面。     

农村高血压和糖尿病患者对健康管理服务的认知与评价研究:以扬州市江都区为例

目的:分析农村高血压和糖尿病患者对健康管理服务的认知与评价,发现问题并提出对策。方法:采用分层随机抽样方法调查农村高血压和糖尿病患者570人,应用描述性统计和logistic回归分析患者对健康管理服务的认知与评价。结果:绝大部分农村慢性病患者知晓健康管理服务,对疾病控制效果的满意率达82.28%,其中年龄低于60岁患者的满意率偏低(P0.05),为77.24%,患者认为健康管理服务内容提供不足的方面主要有上门随访、健康体检和并发症防治(选择比例分别为11.90%、10.41%和9.29%);农村健康管理服务的问题主要有随访次数少、医疗设备不全和服务项目开展不足(选择比例分别为16.36%、9.29%和8.92%)。结论:构建乡村两级医疗卫生机构的协作机制,加大农村公共卫生的投入,加强农村卫生人员培训,合理安排上门随访、健康讲座等,提高高血压和糖尿病等慢性病的管理质量与效果。     

合肥市某社区2型糖尿病患者生活质量与社会支持的相关性研究

目的 了解合肥市某社区2型糖尿病患者生活质量与社会支持的现状,并探讨其相关性.方法 以合肥市某社区433例2型糖尿病患者为研究对象,分别采用健康调查简表(the MOS item short from health survey, SF-36)和社会支持评定量表(social support rate scale,SSRS)对患者进行问卷调查.结果 2型糖尿病患者生活质量总分为(69.68±17.32)分,社会支持总分为(37.04±7.11)分,其中客观支持得分为(8.75±2.75)分,主观支持得分为(20.70 ±4.03)分,对支持的利用度为(7.60±1.99)分.相关性分析显示2型糖尿病患者生活质量和社会支持呈明显的相关性.多重线性回归分析显示,影响糖尿病患者生活质量的因素有:年龄、并发症和社会支持.结论 2型糖尿病患者的生活质量不容乐观,今后应积极采取措施,特别是改善社会支持来提高患者的生活质量.     

Action on the social determinants of health: A historical perspective

Abstract

A renewed concern with social factors has emerged in global public health, spearheaded by the World Health Organization's Commission on Social Determinants of Health. The coming decade may see significant health gains for disadvantaged populations if policies tackle the social roots of health inequities. To improve chances of success, global action on social determinants must draw lessons from history. This article reviews milestones in public health action on social determinants over the past 50 years. The goal is to bring into sharper focus the persistent challenges faced by social determinants agendas, along with distinctive opportunities now emerging. The historical record highlights the vulnerability of health policy approaches incorporating social determinants to resistance from entrenched interests. The Commission on Social Determinants of Health can consolidate political support by building collaborative relationships with policymakers in partner countries. However, this strategy must be complemented by engaging civil society constituencies. Historically, successful action on social determinants has been spurred by organized civil society demand.     

医疗保险资金管理模式研究:以A市为例

在全国几乎统一的管理模式下,A市经过多年探索和实践,建立了一套与全国其他地区不同的城镇医保资金管理模式。本文从A市医保资金管理模式形成、目前管理模式实施情况和各方对管理模式运行的评价与意见几方面对管理模式进行具体介绍。本文运用定性访谈方法重点对管理模式为什么形成,为什么能顺利运行,管理模式的优势和劣势进行了分析和讨论。本文认为应当挖掘A市的医疗保险资金管理模式的"精髓",切实建立一个多部门协调的平台。     

2003年和2010年上海市某疗养院体检者糖尿病和空腹血糖受损检出率

目的 对2003年和2010年上海市体检者糖尿病(DM)和空腹血糖受损( IFG)检出率进行分析并探讨其变化情况.方法 将2003年和2010年某疗养院人群按性别和年龄分组,每5年为一小组,共分成10个小组.分别统计各组IFG和DM检出率,根据《中国人口统计年鉴2006》公布的全国人口年龄和性别组成标化DM和IFG检出率.结果 在同年度,相同性别DM和IFG检出率随年龄增加而增大,60～69岁组基本达到最高峰,至≥70岁组发病率有下降趋势,但仍处于高位.2003年体检人群DM检出率男性和女性分别为3.99％ (986/24 699)和1.61％ (176/10 948),2010年分别达7.85％ (3366/42 899)和2.55％ (531/20 820);2003年体检人群IFG检出率男性和女性分别为9.97％ (2462/24 699)和5.88％ (644/10 948),2010年分别达30.96％( 13 283/42 899)和17.16％(3573/20 820).2003和2010年年龄标化DM检出率,男性分别为3.89％和6.90％(x2=371.89,P＜0.01),女性分别为2.12％和3.23％(x2=29.32,P＜0.01);2003和2010年年龄标化IFG检出率,男性分别为9.51％和28.55％(x2=3865.56,P＜0.01),女性分别为6.97％和17.88％(x2=790.81,P＜0.001).按人口年龄和性别组成标化DM和IFG检出率,2003和2010年DM检出率分别为3.00％和5.05％(x2=385.39,P＜0.01),IFG检出率分别为8.23％和23.17％(x2=4480.21,P＜0.01).结论 从2003年到2010年,体检人群DM和IFG检出率有了明显提高,DM的一级预防应从青年开始,预防重点应放在IFG人群尤其是男性.