医学思想卫生服务临床教育

医学模式的转变，使医学思想也发生了相应的变化，为实现２０００年人人享有卫生保健的战略目标，卫生服务的目的、范畴、模式、观念、内容、体系和需求都将发生一系列变化；而医学思想和卫生服务的转变，要求临床教育从教育观念、教育目标、课程改革和教学方法等方面加以改革，以适应知识经济时代的需要。     

欧洲卫生保健改革的公正性与公平分配问题

公正是大多数欧洲国家卫生保健体系追求的核心目标。但近年来它们进行的卫生保健改革都没有把公正，特别是公平分配作为改革的重点。美国埃莫里大学公共卫生学院卫生政策与管理系的理查德·Ｂ·萨尔特曼在１９９７年第２７卷第３期ＩｎｔｅｒｎａｔｉｏｎａｌＪｏｕｒｎａｌｏｆＨｅａｌｔｈＳｅｒｖｉｃｅｓ上撰文，从三个方面探讨了近年来欧洲国家卫生保健改革的公正性问题。文章概括了公正在卫生领域的含义；简要回顾了当前条件下的公正性状况；并就目前欧洲国家的卫生保健改革对公正性问题所产生的影响进行了讨论。     

欧洲重建初级卫生保健服务体系的理念与措施

越来越多的欧洲国家政府开始呼吁重建初级卫生保健服务体系,很多国家已经采取了一系列的改革措施来强化初级卫生保健服务体系。由于在社会经济背景、改革理论依据和价值取向等方面的差异,各国逐步形成了各具特色的初级卫生保健服务模式。这些模式的特点包括集治疗、康复和预防,以及健康促进等工作为一体,基于初级卫生保健服务来改善卫生服务的供给,突出以人为本的卫生保健服务特色,强调卫生服务的协调性与整体性,提供综合、连续、可获得的卫生保健服务等。这也为我国完善初级卫生保健服务体系提供了许多经验。     

发展医疗卫生事业的一种中间模式：荷兰卫生事业评价

荷兰的卫生保健在世界上有其特色，是一种将政府的计划调控与市场机制相结合的中间模式。在这一模式中，病人、医疗卫生机构和健康保险公司三方互相依存和制约，加上政府的宏观调控，形成了一个立体三角结构的卫生保健体制。荷兰的医疗卫生服务为居民提供基础卫生保健、初级卫生保健和医院服务，其中以家庭医生、家庭护理、护理院和老年院等具有特色。推动荷兰卫生事业发展的重要原因是不断的改革解决面临的问题。现在荷兰政府提出的“在卫生保健中做出选择”的改革口号，很值得人们思考。     

中国医药卫生体制改革与中国卫生政策研究类型

中国医药卫生体制改革处于总体制度框架设计与改革发展模式选择的关键时刻，改革发展实践迫切需要卫生政策研究。卫生政策研究质量决定卫生改革的成败。卫生政策研究在医药卫生制度框架设计、发展模式选择、体制改革实践、卫生保健体系创新、医院质量管理和构建和谐医患关系等工作中扮演基础性和核心角色，发挥举足轻重的作用。本文简要论述医药卫生体制改革与卫生政策研究关系，介绍中国卫生政策研究的基本类型。     

应用FDSL模式评价初级卫生保健实力的研究

本文引进 FDSL模式,从支持系统、投入规模和产出功能三大方面建立了初级卫生保健评价体系,提出了初级卫生保健实力的概念。     

发展社区卫生服务理论与政策的聚焦

上海市城市初级卫生保健始于50年代初，根据当时历史背景创立和发展的城市初级卫生保健体系，在保障广大居民基本医疗服务需求和促进居民健康方面卓有成效。虽然在不同历史时期几经变革和发展，既有成功的经验也有发展错位的教训，但是，上海城市初级卫生保健始终走在全国的前列，成为中国特定历史阶段具有代表性的发展模式。     

工业化国家卫生保健筹资模式及其经验教训

本文综述了哈佛大学公共卫生学院肖庆伦教授及其领导的研究小组对工业化国家卫生保健筹资模式的系统研究成果及其他学者的研究成果，分析了各种卫生保健筹资模式的优、缺点和经验教训，以供我国城镇医疗保障制度改革借鉴     

卫生检疫口岸卫生保健服务中心的工资制度及其实施意见

目前国家正在按照十四届三中全会精神进行劳动工资改革。在工资改革中，国家对事业单位提出了实行不同工资制度的要求．卫生检疫机关正根据国家改革开放的要求和法律赋予的职责和义务．也正由以前的口岸执法和医疗卫生服务一体的模式向口岸执法、面向全社会的卫生保健服务、第三产业的三大工作任务和三种机构模式并存的方向转化。口岸执法参照国际惯例将并入国家公务员序例，执行公务员工资制度；第三产业实行企业工资制度；而卫生保健服务部分将成为非盈利性的公益事业单位或称自收自支的事业单位，对这部分单位从国家的文件上看，国家对其规定了比较宽松的工资政策．笔者根据几年来从事劳动工资工作的体会和对有关文件研究的心得，就下述三个方面：一、工资改革的指导思想；二、改革的具体措施；三、改革中应注意的问题，提出了本人对工资改革，主要是口岸卫生保健服务中心的工资改革措施。     

不同卫生保健制度对产妇保健的影响

本文描述了国外不同卫生保健制度对产妇保健的影响。产妇卫生保健有赖于整个卫生保健制度，研究卫生保健制度有助于理解产妇保健服务。对孟加拉国，俄罗斯，南非与鸟干达这四国的产妇保健与卫生保健制度进行了比较分析，发现很多对产妇保健有影响的卫生保健制度的特点。作为产妇保健基础的最重要的一个方面，是人力资源结构，公立与私营混合的服务提供方式，及与保健领域改革相关联的变化。特定国家的环境可以进一步确定很多影响产妇保健结果与服务效果的因素。     

企业职工高尿酸血症与血压、血脂、血糖的相关性研究

目的探讨企业职工高尿酸血症（HUA）与血压、血脂、血糖的相关性,为企业进行健康管理提供依据。方法以中国石油长庆油田公司各下属企业为抽样单位,整群随机抽取2个单位,每个单位中所有的HUA者作为HUA组,共720人;同时在尿酸水平正常者中随机选取620人为正常组。通过Logistic回归分析HUA与年龄、性别、血压、血脂、血糖的关系。结果HUA合并高血压、高血脂、空腹m糖受损任意一项、两项、三项的比例均远高于正常组（OR值分别为：4．036,2．562,4．174）。多因素Logistic回归发现：男性、收缩压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇是HUA的危险因素（OR值分别为7．736,2．309,1．721,2．761,1．411）;高密度脂蛋白胆固醇为HUA的保护因素（OR值为0．211）。结论HUA存在性别差异,且与血压、血脂密切相关。企业对职工的健康管理应充分考虑多危险因素的综合作用,全面的进行健康教育及干预。     

癌缺氧病因及预防和治疗

目的 探讨癌及安阳林州市食管癌高发原因及癌病因预防和治疗措施.方法 对林州市食管癌等疾病现场进行调查,在进行10余年统计分析基础上,综合分析了全国156篇文献成果.结果 提出癌缺氧病因学说,使用制氧机、按摩器、饮用纯净水治疗恶性肿瘤,取得良好效果,改水能够大幅降低林州市居民食管癌发病率、死亡率.结论 癌可能是由于机体长...     

Recruitment and retention challenges and successes

Objective: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention.

Design: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women?≥?15 years old) were recruited through a regional hospital.

Results: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study.

Discussion: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.     

初产妇与经产妇焦虑抑郁状态分析及干预

目的：分析初产妇、经产妇心理状态特点,以便采取更有效的干预措施。方法筛选2014年6月至2015年1月在咸阳市旬邑县妇幼保健院产科门诊产前检查的健康初产和经产妇各60名,孕周为28~40周。入组时用焦虑自评量表( SAS)、抑郁自评量表(SDS)对两组孕妇进行心理评定,并给1次支持性心理干预(40~60分钟),1周后再次用SAS、SDS对两组孕妇进行评定分析。结果经产妇干预前SAS(50.73±3.45)、SDS(49.13±3.86)评分明显高于初产妇SAS(42.45±2.08)、SDS(41.77±2.21),差异均有统计学意义(t值分别为-15.921、-12.817,均P<0.01);干预后两组SAS、SDS评分均比干预前明显降低,差异均有统计学意义(t值分别为14.999、15.413;15.724、15.832,均P<0.01);干预后经产妇 SAS(38.61±5.02)、SDS(39.10±3.03)评分明显高于初产妇SAS(34.88±3.31)、SDS(32.01±4.27),差异均有统计学意义(t值分别为-4.805、-10.489,均P<0.01)。结论初产妇和经产妇均伴有焦虑、抑郁情绪,干预前后经产妇抑郁、焦虑情绪均较初产妇明显,支持性心理干预能有效改善孕妇的不良情绪。     

Continuity and change in neighborhood disadvantage and adolescent depression and anxiety

We used data from the Fragile Families and Child Wellbeing Study which includes a sample of adolescents of age 15 at the most recent wave (between 2014 and 2017) from mainly low-income urban families in the United States, to examine the association between neighborhood poverty entries and exits and adolescent depression and anxiety. In addition, we examined whether these associations differed by gender. Adolescents who consistently lived in disadvantaged neighborhoods had the highest level of depression and anxiety. Those who entered poor neighborhoods were more depressed than those who never lived in poor neighborhoods. Those who exited poor neighborhoods showed no significant difference in depression and anxiety compared to those never lived in poor neighborhoods. Furthermore, these associations applied to adolescent girls only and were not statistically significant for boys. The results suggest that neighborhood poverty has cumulative negative impacts on adolescent mental health and disproportionally affects adolescent girls. Reducing neighborhood poverty would substantially improve the health of adolescents, especially girls, which would reduce health disparities.     

Enabling positive change: Progress and setbacks in HIV and sexual and reproductive health and rights

At a point in history when the future of sexual and reproductive health including HIV looks particularly uncertain, it is helpful to recognise that many of the challenges currently faced are neither new nor insurmountable. Reflecting on past achievements and lessons learned helps us to have confidence that positive change is feasible. This paper reflects on some of the changes observed in countries like India and Mozambique and identifies a range of factors which need to coalesce to enable these developments, along with specific contextual factors. It is the combination of these influences rather than any one of them alone that brought about the change in the three instances described – fostering a positive political response to HIV in its early years in India; bringing about policy reform on abortion in Mozambique; and increasing contraceptive prevalence and age at marriage in some districts in Bihar, India. Change is always fragile and susceptible to setbacks, but change-seekers can learn in the process and gain renewed hope that progress can and often does take place if they persevere.     

儿童青少年超重肥胖评价方法及SPSS和SAS实现

超重肥胖已成为世界各国儿童青少年面临的重大公共卫生问题之一。现行的儿童青少年超重肥胖筛查标准不统一,逐条评价或自行编写程序容易出错且效率较低。本研究以中国学龄儿童青少年超重与肥胖筛查标准为例,详细介绍了国际和中国共四种评价儿童青少年超重肥胖的方法和步骤,结合具体案例详细介绍其应用方法,同时编制SPSS和SAS程序包和解...     

Car ownership and the association between fruit and vegetable availability and diet

Objective

Nearly all research on the food environment and diet has not accounted for car ownership — a potential key modifying factor. This study examined the modifying effect of car ownership on the relationship between neighborhood fruit and vegetable availability and intake.

Methods

Data on respondents' (n = 760) fruit and vegetable intake, car ownership, and demographics came from the 2008 New Orleans Behavioral Risk Factor Surveillance System. Shelf space data on fresh, frozen, and canned fruits and vegetables were collected in 2008 from a random sample of New Orleans stores (n = 114). Availability measures were constructed by summing the amount of fruit and vegetable shelf space in all stores within defined distances from respondent households. Regression analyses controlled for demographics and were run separately for respondents with and without a car.

Results

Fruit and vegetable availability was positively associated with intake among non-car owners. An additional 100 m of shelf space within 2 km of a residence was predictive of a half-serving/day increase in fruit and vegetable intake. Availability was not associated with intake among car owners.

Conclusions

Future research and interventions to increase neighborhood healthy food options should consider car ownership rates in their target areas as an important modifying factor.