重视全科医师风湿病的病史采集和体检方法

目的 推进全科医师风湿病和关节炎的普及教育.方法 当接诊风湿病和关节炎患者时,应首先了解患者发病前的健康状况,发病年龄、性别、诱因,发病方式,前驱表现,首发部位,演变过程,病变范围,伴随现象,加重或缓解的因素,接受过的检查和治疗以及对治疗的反应等.注意关节受累的特点,将患侧与健侧对比或与检查者的健康关节对比检查.结果 完整的病史和体格检查资料是关节炎和风湿病临床诊断和治疗最基本和重要的方法.结论 加强风湿病基本技能的教育,对普及风湿病的医疗服务,提高风湿病的诊治水平具有重要意义.     

Exploring the relation between class, gender, and self rated general health using the new socioeconomic classification. A study using data from the 2001 census

OBJECTIVE: To examine the relation between class, gender, and self rated health in adults in Great Britain. DESIGN: Cross sectional study using data from the 2001 national census. SETTING: Great Britain. PARTICIPANTS: Adults aged between 25 and 64 in Great Britain, enumerated in the 2001 census (n = 30.3 million). MAIN OUTCOME MEASURES: Age standardised rates of self rated general health for men and women in different socioeconomic groupings as defined by the National Statistics classification (NS-SeC), rate ratios and the (modified) relative index of inequality. RESULTS: There was a pronounced gradient in rates of "not good" health among people in different social positions. The rate for people in class 7 (routine occupations) was more than double that for people in class 1 (higher managerial and professional occupations): 95 per 1000 and 37 per 1000 respectively. Health inequalities were larger for men than for women-the rate ratio of class 7 to class 1 was 2.7 for men and 2.2 for women. The nature and size of the gender differences varied by socioeconomic class, with the greatest gap among people in class 1 (higher managerial and professional occupations), where the rate for women was 25% higher than for men. CONCLUSIONS: The NS-SeC shows a pronounced gradient in self rated general health across the population of working age in Great Britain in 2001. It was found that the NS-SeC was a useful measure for women, although it may be better at classifying men. The size of the gender gap in "not good" health varied by NS-SeC class.     

The general practitioner in Lebanon: is he a potential family physician?

A cross-sectional exploratory study was conducted on a group of general practitioners in Beirut, Lebanon to assess the level of family medicine practice among them. Data were collected on the age, sex, number of children, marital status, load of patients per day, field of specialization, if any, and place of study of medicine of 43 general practitioners. The level of family medicine practice was assessed through a self-administered questionnaire containing questions related to the various criteria of family medicine practice. Only 2.3% of the general practitioners had an adequate level of family medicine practice, defined as the top 15th percentile of a maximal score. Doctors were most likely to adhere to the 'informality' criterion and less likely to adhere to the 'family approach', 'ensuring maximal compliance' and 'comprehensiveness of care' criteria. They performed poorly on 'the continuity of care' and on 'the art of medical care' criteria. Overall, family medicine was found not to be adequately practised by the general practitioner and is deemed necessary as a specialty in Lebanon. Suggestions and future recommendations are further presented.     

Knowledge of sexually transmitted diseases and attitudes towards them in populations at risk in Djibouti

Sexually transmitted diseases (STDs) are an increasing public health problem in Djibouti. The authors have attempted to obtain basic information on the level of knowledge concerning STDs and on the sexual behaviour of highly sexually promiscuous individuals for use in the organization of future STD control programmes; the information was obtained from a population of 213 bar hostesses, 66 unlicensed prostitutes, and 115 male sufferers from STDs. The level of knowledge of these diseases was very high among the prostitutes and the bar hostesses, except that little was known about syphilis by the bar hostesses; the male sufferers were relatively ignorant concerning both syphilis and AIDS. Medical and paramedical personnel do not figure among the sources given for knowledge of STDs. On the other hand, friends play an important role in this knowledge, especially among unlicensed prostitutes. The second most frequently instanced source was radio and TV. The bar hostesses and the unlicensed prostitutes often exhibited distinct social characteristics. Neither education nor marriage appeared to prevent men from contracting STDs. The use of condoms is extremely rare among STD patients and not very common among unlicensed prostitutes. Half the bar hostesses report their frequent use.     

2008-2009年榆林市2466名进城务工妇女妇女病普查结果分析

[目的]了解榆林市进城务工妇女的健康状况,掌握发病规律,探讨发病因素,制定下一步的防治措施。[方法]对2008年6月-2009年6月到榆林市妇幼保健院接受妇女病普查的2466名进城务工妇女资料进行分析。[结果]检查2466人,检出患有妇女病者1184人,占48．01％。全部检查对象中,检出患有2种及2种以上妇女病的678人,占27．49％。疾病检出率,阴道炎为39．94％,慢性宫颈炎为34．71％,乳腺囊性增生为6．33％,子宫肌瘤为3．77％,附件炎为2．31％,盆腔炎为1．01％,外阴炎为0．85％,乳腺良性肿瘤为0．20％。卵巢良性肿瘤为0．12％,尖锐湿疣为0．12％。阴道炎、宫颈炎检出率均为31～40岁最高,乳腺疾病检出率31～50岁最高,子宫肌瘤检出率50-58岁最高,4种妇女病不同年龄的差异均有统计学意义（P〈0．01或〈0．05）。[结论]进城务工妇女妇女病患病率较高,所患妇女病主要是阴道炎、慢性宫颈炎、乳腺囊性增生。     

Pathways between socioeconomic determinants of health

STUDY OBJECTIVE: Many previous studies on socioeconomic inequalities in health have neglected the causal interdependencies between different socioeconomic indicators. This study examines the pathways between three socioeconomic determinants of ill health. DESIGN, SETTING, AND PARTICIPANTS: Cross sectional survey data from the Helsinki health study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55, and 60 years received a mailed questionnaire. Altogether 6243 employees responded (80% women, response rate 68%). Socioeconomic indicators were education, occupational class, and household income. Health indicators were limiting longstanding illness and self rated health. Inequality indices were calculated based on logistic regression analysis. MAIN RESULTS: Each socioeconomic indicator showed a clear gradient with health. Among women half of inequalities in limiting longstanding illness by education were mediated through occupational class and household income. Inequalities by occupational class were largely explained by education. A small part of inequalities for income were explained by education and occupational class. For self rated health the pathways were broadly similar. Among men most of the inequalities in limiting longstanding illness by education were mediated through occupational class and income. Part of occupational class inequalities were explained by education. Two thirds of inequalities by income were explained by education and occupational class. CONCLUSIONS: Parts of the effects of each socioeconomic indicator on health are either explained by or mediated through other socioeconomic indicators. Analyses of the predictive power of socioeconomic indicators on health run the risk of being fruitless, if interrelations between various indicators are neglected.     

Socioeconomic factors associated with the onset of disability in older age: a longitudinal study of people aged 75 years and over

Although the association between socioeconomic status and mortality is well documented, there is less work focusing on the association with morbidity in older people. This is partly due to the difficulties of measuring socioeconomic status at older ages. The work that does exist tends to use cross-sectional data and objective measures of socioeconomic status such as education, social class or income. However, these standard measures may be less relevant for older people. In this study, we explore the association between socioeconomic status and disability in older people using a range of individual, household and area level indicators of socioeconomic status, including a subjective measure of adequacy of income. We use cross-sectional data of 1470 participants aged 75 years or over on 31/12/1987 and registered with a UK primary care practice. Of these 719 participants with no disability at baseline were followed up until 2003 with measurements at up to seven time points to determine onset of disability. Disability was defined as difficulty with any one of five activities of daily living. In cross-sectional multivariate analysis, age, housing tenure, living status and a subjective measure of income adequacy were associated with prevalence of disability. In longitudinal analyses, self-perceived adequacy of income showed the strongest association with onset of disability; with those reporting difficulties managing having a median age of onset 80.5 years, 7 years younger than those who felt their income was adequate (median age 87.8 years). The prospective association between self-perceived adequacy of income and onset of disability decreased with age. This subjective measure of income adequacy may signify difficulties in budgeting, but could also capture differences in objective indicators of status not recorded in this study, such as wealth. Further work is needed to explore what causes older people to experience difficulty in managing their money and to understand the mechanisms behind its impact on their physical health.     

Area deprivation, social class, and quality of life among people aged 75 years and over in Britain

BACKGROUND: There is a shortage of research studies that assess how selected characteristics of neighbourhood and personal social circumstances contribute towards health-related quality of life (QoL) among older people. METHODS: Analysis of baseline data for 5581 people aged > or =75 years and over from the Trial of Assessment and Management of Older People in the Community. The scores for four dimensions from the UK version of the Sickness Impact Profile and for the Philadelphia Geriatric Morale Scale were analysed in relation to individual social class and the Carstairs score of socioeconomic deprivation for the enumeration district of residence. RESULTS: In age and sex adjusted analyses, the proportion of participants of social class IV/V living in the most deprived areas who were in the quintile with worst QoL scores was more than double that among those from social class I/II living in the least deprived areas. Individual social class and area deprivation score contributed roughly equally to this doubling for home management, self-care and social interaction, whereas social class appeared a stronger determinant for mobility. Adjustment for living circumstances, health symptoms, and health behaviours substantially reduced the excess risk associated with social class and area deprivation. Being in a rural area was associated with lower risk of poor morale. CONCLUSION: Poor socioeconomic characteristics of both the area and the individual are associated with worse functioning (QoL) of older people in the community. This is not fully explained by health status. Policy should consider community-level interventions as well as those directed at individuals.     

Patient perceptions of continuity of care: is there a socioeconomic factor?

This study aimed to assess perceptions of continuity of care by patients from different socioeconomic areas using focus group interviews augmented by postal replies. Patients were randomly selected from two contrasting primary medical care locations: a middle class suburb and a less affluent suburb in Adelaide, South Australia. The Ethnograph was used to analyse the content of the interviews and postal responses. Analysis used the framework described by Curtis and Rogers in the USA and Freeman in the UK. The response rate was much lower from the lower socioeconomic group (5% focus group; 20% when postal replies included). They emphasized access factors and importance of records, and alleged situations where they were taken too casually and their problems were not dealt with. Those from the middle class area (response rate 25%) emphasized interpersonal ('art of care') factors and were more likely to use their presenting problem as a criterion to decide whether they needed to postpone the problem to a time when they could see their personal doctor. Focus groups can be useful evaluation tools in general practice, but oversampling of lower socioeconomic groups is needed. Continuity of care should be considered as an aid to consistent quality of care, rather than its essence. Well controlled intervention-outcome studies in different types of practice organization in differing socioeconomic situations will increase our understanding of continuity of care.     

Individual social class,area-based deprivation,cardiovascular disease risk factors,and mortality: the Renfrew and Paisley Study

OBJECTIVE: To investigate the associations of individual and area-based socioeconomic indicators with cardiovascular disease risk factors and mortality. DESIGN: Prospective study. SETTING: The towns of Renfrew and Paisley in the west of Scotland. PARTICIPANTS: 6961 men and 7991 women included in a population-based cardiovascular disease screening study between 1972 and 1976. MAIN OUTCOME MEASURES: Cardiovascular disease risk factors and cardiorespiratory morbidity at the time of screening: 15 year mortality from all causes and cardiovascular disease. RESULTS: Both the area-based deprivation indicator and individual social class were associated with generally less favourable profiles of cardiovascular disease risk factors at the time of the baseline screening examinations. The exception was plasma cholesterol concentration, which was lower for men and women in manual social class groups. Independent contributions of area-based deprivation and individual social class were generally seen with respect to risk factors and morbidity. All cause and cardiovascular disease mortality rates were both inversely associated with socioeconomic position whether indexed by area-based deprivation or social class. The area- based and individual socioeconomic indicators made independent contributions to mortality risk. CONCLUSIONS: Individually assigned and area-based socioeconomic indicators make independent contributions to several important health outcomes. The degree of inequalities in health that exist will not be demonstrated in studies using only one category of indicator. Similarly, adjustment for confounding by socioeconomic position in aetiological epidemiological studies will be inadequate if only one level of indicator is used. Policies aimed at reducing socioeconomic differentials in health should pay attention to the characteristics of the areas in which people live as well as the characteristics of the people who live in these areas.       

Personal goals and factors related to QoL in Dutch homeless people: what is the role of goal‐related self‐efficacy?

Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal‐related self‐efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal‐related self‐efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal‐related self‐efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = ?0.45, P < 0.001), income (β = 0.14, P = 0.002) and being institutionalised (β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal‐related self‐efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal‐related self‐efficacy by strength‐based interventions.     

Socioeconomic, psychosocial, behavioural, and psychological determinants of BMI among young women: differing patterns for underweight and overweight/obesity

OBJECTIVES: Underweight, overweight, and obese women aged 18-34 years were compared with normal weight women of the corresponding age according to socioeconomic, psychosocial, health behaviour, self reported global and psychological health, and locus of control characteristics. METHODS: The 2000 public health survey in Scania is a cross-sectional study. A total 13,715 persons aged 18-80 years, of which 1967 were females of 18-34 years of age, were included in this study. They answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model adjusted for age was used to investigate the association between socioeconomic, psychosocial, health behaviour, self reported global and psychological health, locus of control, and the BMI categories. RESULTS: A 17.5% proportion of the women, aged 18-34 years, were underweight (BMI < 20.0), 18.4% were overweight, and 7.0% obese. The prevalence of underweight according to the BMI < 18.5 definition was 5.8% among women aged 18-34 years. Women who were underweight had significantly higher odds ratios for overtime work, being students, low emotional support, and poor self reported global as well as poor psychological health than normal weight women. Women who were overweight/obese were unemployed, had low education, low social participation, low emotional and instrumental support, were daily smokers, had a sedentary lifestyle, had poor self reported global health, and had lack of internal locus of control compared with normal weight women. CONCLUSIONS: Underweight women are more likely to have poorer psychological health than normal weight women. In contrast, overweight and obese women are more likely to have poor health related behaviours and lack of internal locus of control compared with normal weight women. These differing patterns suggest both different etiology and different preventive strategies to deal with the health risks of people who are underweight as opposed to those who are overweight/obese.     

Neighbourhoods and self rated health: a comparison of public sector employees in London and Helsinki

STUDY OBJECTIVE: Mortality and morbidity vary across neighbourhoods and larger residential areas. Effects of area deprivation on health may vary across countries, because of greater spatial separation of people occupying high and low socioeconomic positions and differences in the provision of local services and facilities. Neighbourhood variations in health and the contribution of residents' characteristics and neighbourhood indicators were compared in London and Helsinki, two settings where inequality and welfare policies differ. DESIGN: Data from two cohorts were used to investigate associations between self rated health and neighbourhood indicators using a multilevel approach. SETTING: London and Helsinki. PARTICIPANTS: From the Whitehall II study (London, aged 39-63) and the Helsinki health study (aged 40-60). MAIN RESULTS: Socioeconomic segregation was higher in London than in Helsinki. Age and sex adjusted differences in self rated health between neighbourhoods were also greater in London. Independent of individual socioeconomic position, neighbourhood unemployment, proportion of residents in manual occupations, and proportion of single households were associated with health. In pooled data, residence in a neighbourhood with highest unemployment was associated with an odds ratio of less than good self rated health of 1.51 (95% CI 1.30 to 1.75). High rates of single parenthood were associated with health in London but not in Helsinki. CONCLUSIONS: Neighbourhood socioeconomic context was associated with health in both countries, with some evidence of greater neighbourhood effects in London. Greater socioeconomic segregation in London may have emergent effects at the neighbourhood level. Local and national social policies may reduce, or restrict, inequality and segregation between areas.     

Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.     

The meaning of complementary and alternative medicine practices among people with HIV in the United States: strategies for managing everyday life

The meanings of complementary and alternative medicine (CAM) practices in the everyday lives of people with HIV in the United States were investigated. Interviews of people with HIV revealed that two out of three interviewees (N = 62) used some form of CAM over the course of their ongoing HIV infection. Management of their everyday lives as ill persons was improved to the extent that CAM meanings addressed self-regulation of treatment practices and strategies to cope with uncertainty. Four main strategies are dealt with: managing symptoms, medications and emotions; self experimenting to evaluate disease progression; gaining freedom from medical regimens; and managing AIDS stigma. It was shown that CAM practices are one way people with HIV can increase control over their illness and attempt to normalise health status. CAM practices were discussed in the context of self-regulation in relation to other illnesses.     

A comparative study of knowledge and attitude of urban and rural dwellers towards vagrant sufferers of schizophrenia in Delta State of Nigeria

This study aimed at assessing comparatively knowledge of schizophrenia and attitudes towards vagrant sufferers in urban and rural areas of the state. The sample of 583 and 120 respondents from urban and rural areas were drawn using the multi-stage sampling technique. The administered structured questionnaire consisted of respondents' socio-demographies, knowledge of schizophrenia, and attitude towards vagrant sufferers of Schizophrenia. Data generated were statistically analyzed using the SPSS version 11 of Fishers test (ANOVA). The significant finding among others shows that knowledge is most potent factor to determine attitude towards vagrant sufferers of schizophrenia. Conclusively, it was recommended that government legislate against mass media organizations negative depictions of sufferers of mental illness. Also, mass media organizations engage ill compulsory informative, educative and enlightenment campaigns to positively change attitudes of people towards people living with schizophrenia.     

The socioeconomic status of older adults: How should we measure it in studies of health inequalities?

STUDY OBJECTIVE: To identify which of seven indicators of socioeconomic status used singly or combined with one other would be most useful in studies of health inequalities in the older population. DESIGN: Secondary analysis of socioeconomic and health data in a two wave survey. SETTING: Great Britain. Participants were interviewed at home by a trained interviewer. PARTICIPANTS: Nationally representative sample of 3543 adults aged 55-69 interviewed in 1988/9, 2243 of whom were interviewed again in 1994. METHODS: Desirable features of socioeconomic measurement systems for identifying health inequalities in older populations were identified with reference to the literature. Logistic regression was used to examine variations in self reported health by seven indicators of socioeconomic status. The pair of indicators with the greatest explanatory power was identified. MAIN RESULTS: All indicators were significantly associated with differences in self reported health. The best pair of variables, according to criteria used, was educational qualification or social class paired with a deprivation indicator. DISCUSSION: For a range of reasons the measurement of socioeconomic status is particularly challenging in older age groups. Extending our knowledge of which indicators work well in analyses and are relatively easy to collect should help both further study of health inequalities in the older population and appropriate planning.     

Identification of factors contributing to successful self‐directed weight loss: a qualitative study

Background

Despite the number of weight management programmes and their wide promotion, most overweight and obese individuals tend to lose weight on their own. The present study aimed to understand the characteristics and strategies of those who successfully engage in self‐directed weight loss, which could empower other overweight and obese individuals with information and strategies to manage their weight on their own.

Methods

Men and women who had lost at least 5% of their body weight without direct interaction with professionals or weight management programmes were recruited. Demographic data were collected by questionnaire and participants' weight‐loss experiences were explored using semi‐ structured interviews to elicit in‐depth individual experiences and perspectives. Iterative thematic method data analysis was used to generate themes describing contributing factors to the success of self‐directed weight loss identified by participants.

Results

Most characteristics of those who successfully self‐managed their weight loss were in line with those reported by successful weight losers participating in professional‐led projects. However, strategies such as early embedding of new lifestyle behaviours into daily routine, the ability to learn from previous weight‐loss experiences, and not requiring social support were identified as distinctive factors that contributed to the success of self‐directed weight loss by participants of the present study.

Conclusions

Overweight or obese individuals with strong internal motivation, problem‐solving skills and self‐reliance are more likely to be successful at achieving self‐directed weight loss. The patients identified with these characteristics could be encouraged to self‐manage their weight‐loss process, leaving the places available in more resource‐intensive professional‐led programmes to those individuals unlikely to succeed on their own.

     

Who has Pap smears in New South Wales? Patterns of screening across sociodemographic groups

Abstract: The aim of this study was to determine whether Pap smear screening at adequate intervals is associated with area of residence, frequency of consultations with a general practitioner, socioeconomic status and non-English-speaking background. A representative 10 per cent sample of women from New South Wales and the Australian Capital Territory, aged 25 to 69 years and registered with the Health Insurance Commission (Medicare) (N = 155 281) was used to obtain age, postcode, frequency of Pap smears and frequency of consultations with general practitioners in the three-year period from February 1985 to January 1988. Census data for each postcode area were used as an indicator of other sociodemographic characteristics. Age-specific screening rates did not vary between Sydney, Newcastle/Wollongong, Canberra, and nonmetropolitan areas. In all age groups, having had a smear was most strongly associated with the frequency with which a woman consulted a general practitioner. Women who visited a general practitioner at least four times a year on average were about twice as likely to have had a recent Pap smear as those who averaged less than one visit per year. Screening rates were lowest among women living in areas with the most non-English-speakers and the lowest socioeconomic status. Sociodemographic factors and health service usage patterns influence the proportion of women who are currently being screened. Evaluation of interventions to improve Pap smear screening rates should consider whether the percentage of women screened increases overall, and also whether the imbalances in screening rates between different groups are diminishing.