区域卫生信息化建设相关方的人才需求及对策

实施区域卫生信息化建设对卫生信息管理人才的需求数量巨大,建设过程涉及的相关各方对人才需求的特点各异。深入分析相关方对信息人才的共性需求和特性需求,可指导高校结合区域卫生信息化建设相关方的需求特点,明确卫生信息管理专业培养目标定位,建立以需求为导向的科学合理的培养利用机制,优化课程体系,强化实践教育,增加就业指导,为医药卫生行业培养急需紧缺的专门人才。     

疾病预防控制机构卫生应急专业人员培训需求调查

目的：了解疾病预防控制机构卫生应急专业人员的培训需求,为制订培训工作规划提供依据。方法采用问卷调查的形式,于2014年7月对参加2014年河南省疾病预防控制系统卫生应急培训班的66名专业人员进行调查,调查内容包括培训内容、形式、时间、师资、考核形式和结业方式6个方面。结果41名（62．12％）选择的培训内容为“各类突发事件的卫生应急处置”,培训形式为“案例分析”。不同性别、文化程度、职称、人员类别和供职机构人员选择不同“培训内容”和“培训形式”的构成比例,差异均无统计学意义（ P＞0．05）。52名（78．79％）认为每年培训1～2次比较合适,53名（80．30％）认为每次培训2～3 d比较合适。选择“国内专家”担任培训老师的比例最高（56．06％）,其次为“卫生应急管理干部”（34．85％）和“国外专家”（6．06％）;选择“高校教授”的比例最低（3．03％）。71．21％（47名）选择“模拟处理实际问题”作为考核形式,71．21％（47名）选择“授予学分”作为结业方式。“性别”和“供职机构”为选择不同结业方式的重要影响因素（P＜0．05）。结论卫生应急培训应以需求为导向,选择适当的培训内容和形式,以提高培训质量和效果,提升专业人员的业务能力。     

Community health service utilisation and needs in an elderly population

This study was carried out to determine community health service utilisation and needs of an elderly population living in a geographically defined area of Dublin. A random sample of 208 persons was taken from the 11,852 elderly persons living in the area. Activities of daily living and cognitive function were assessed in the person’s own home. Whilst the community health services provided were less than comprehensive, they were targeted to those most in need; the very elderly, those living alone, and persons with a mental or physical disability. Objectively assessed need for further services far outweighed the demand for such services. Studies such as this are essential if the elderly are to receive their fair share of services in a demand based health service.     

Where they gonna live? Affordability and availability of housing for consumers of community based mental health services after reform

To successfully meet the needs of persons disabled by mental illness, developmental disabilities or substance abuse in a re-organized, de-centralized, community-based setting, existing resources dedicated to affordable housing will need to be re-targeted and new resources from within the mental health funding stream will need to be re-directed to increasing both availability and affordability. The gap between the cost of basic housing and what is affordable to persons whose resources are limited by their disability is not currently being met. Mental health reorganization must address the affordability and availability of housing for persons that the system is intending to serve if the entire effort aimed at more effective, efficient and economic delivery of mental health services is to be successful.     

Justice and the NHS: a comment on Culyer

The nature and significance of equity and equality in relation to health and healthcare policy is discussed in the light of a recent article by Culyer. Culyer makes the following claims: (a) the importance of equity in relation to the provision of health care derives from the human need for health in order to flourish; and (b) for the sake of equity, equality of health among the members of particular political jurisdictions should be the aim of health policy. Both these claims are challenged in this paper.The argument put forward is that it is only when needs arise and are met in particular contexts that need and equity are fused. The state and its agents and agencies should distribute what it distributes impartially, whatever it distributes. Whether or not equity applies to the distribution of healthcare services depends on how they are provided and not on their nature as "primary goods". Contrary to what Culyer suggests, a policy of trying to produce the outcome of health equality would be inequitable. It would not be impartial and it would fail to treat persons as persons ought to be treated.     

天宁寺社区高龄老人卫生服务需求调查分析

目的了解广外天宁寺社区高龄老人的健康状况和卫生服务需求,为有针对性地开展社区卫生服务提供依据。方法采取整群抽样调查方法,随机抽取天宁寺社区80岁以上高龄老人130人进行调查。调查内容涉及高龄老人的健康状况、卫生服务需求、护理照料需求、医疗保健需求及相关背景资料等内容。结果慢性病是高龄老人的主要卫生问题,医疗护理照料需求量增大。结论高龄老人是身体衰老、高概率带病生存的健康弱势群体,社区卫生服务要加强服务功能和形式的转变,为高龄老人提供医疗和护理照料为主的卫生服务,以提高老年人生活质量,保障社会家庭稳定。     

加强社区卫生服务,提高人民健康水平

为深化医疗卫生体制改革, 加快社区卫生服务的开展, 于１９９８ 年１０ ～１１ 月对昆明市五华、盘龙两城区２０３ 户６２１ 名居民进行了家庭卫生服务入户调查． 结果发现： 昆明市城区老龄化进程迅速, 医疗卫生服务需要量大, 需求高, 卫生资源充足, 但医疗服务利用率低． 主要影响因素为： 人口老龄化趋势加剧, 医疗费用过高, 接受教育程度等． 调查人口中有７４１％ 的人希望开展社区卫生服务, 不愿者仅有７１ ％ ． 作者对如何加强社区卫生服务提出了建议．     

Options to control the rising health care costs of older Americans

The author rejects suggestions that age limits be set for the allocation of government-supported health benefits in order to reduce the projected growth of health care costs for older Americans. He proposes increased investment in research targeted toward preventing and treating those diseases that produce the greatest need for long-term care in our aging population. Increased attention to preventing disorders such as Alzheimer's disease and Parkinson's disease would not produce new and more costly burdens on the health care system and could lead to the compression of the needs for long-term care into a few short months or years, thereby decreasing the substantial cost of services for victims of the diseases which afflict older persons.     

江苏省社区卫生服务卫生人力资源评价

为了对江苏省社区卫生服务中心(站)卫生人力开发进行评价，我们选择了社区卫生服务搞得较好的、初见成效、有代表性的3个城市(南京市、无锡市和徐州市)，从每个城市中抽取部分区，调查区所属社区卫生服务中心(站)卫生人力资源情况。结果显示本省社区卫生服务人力相对不足，按人口服务比例尚缺素质高、服务能力强的全科医生、护士等，目前应加强现有卫生人员的必备技能和知识的培训，在现有基础上逐步配备好各类社区卫生人员，逐步从以医疗为切入点过渡到六位一体的服务。     

Use of unqualified practitioners by disabled people in rural Bangladesh

This community-based study examines health care seeking strategies with respect to types of practitioners consulted by disabled persons in rural Bangladesh. A primary health care specialist collected the data through household surveys. The study found that 81% of the disabled people had sought some forms of care from various health practitioners. Unqualified practitioners were found to be strongly involved (96%) in providing health care in this area. Persons with learning difficulties, speech difficulties, fits and strange behavior were more likely to seek treatment from unqualified practitioners. Mean delay and cost of treatment were significantly higher among the qualified practitioners than the unqualified practitioners. Visits to universally free public or government health care facilities were characterized as frustrating, inconvenient, time-consuming and less rewarding for disabilities by 34% of the disabled people. Further examination of the plurality of providers and practitioners in rural Bangladesh is warranted to see how best they can be used or re-trained to respond to the health care needs of disabled persons.     

The health of the very aged.

Little information is available on the health status of persons 85 years or over. Recent United States data indicate that 20% of individuals 85 years of age or over reside in nursing and personal care homes and that among these institutional residents 31% are bedfast, 11% are chairfast and 71% manifest evidence of senility. An investigation into the health of persons 85 years of age or over in two Ontario counties revealed that 39% resided in long-stay institutions, and that one of the main differences between old people living independently in the community and those in institutions was the higher proportion of the latter needing help with the activities of daily living and showing mental disorientation. Of those individuals 85 years of age or over in institutions for 1 year, 26% acknowledged often feeling depressed and 18% acknowledged often wishing they were dead, but these tendencies were not more frequent in those 85 years of age or over than in those 65 to 84 years of age. These findings have implications for service and research needs and attitudes towards death.     

镇安县医务人员艾滋病知识、信念、行为调查分析

目的了解镇安县医务人员对艾滋病知识的知晓情况及其对艾滋病健康教育的需求,为在医务人员中进一步开展健康教育提供依据。方法2007年6月,对镇安县627名医务人员进行问卷调查。内容包括:医务人员的一般情况;艾滋病基本知识和职业知识;对艾滋病防治有关问题的态度及行为;艾滋病知识来源。结果医务人员对艾滋病基本知识总体掌握较好,但缺乏职业知识。医务人员对艾滋病患者和感染者的态度比较消极,部分存在恐惧和歧视心理。医务人员的艾滋病相关知识多来自于大众媒体,对专业防治教育有较强需求。结论应有所侧重地加强艾滋病知识的宣传教育,努力消除对艾滋病患者的歧视和恐惧,通过加强多种形式的艾滋病知识培训,进一步做好职业知识教育。     

The uninsured and the debate over the repeal of the Massachusetts universal health care law.

OBJECTIVES--The debate in Massachusetts over the repeal of the first state-based "pay or play" universal health plan is discussed using data from a survey of 1066 Massachusetts households. The survey attempted to measure the problems of the uninsured, to estimate the likelihood that they would buy insurance if offered, and to calculate the proportion of the uninsured who would be covered under an employer mandate. DESIGN--A survey conducted in person and by telephone in 1066 households, with an oversample of uninsured households, using stratification, clustering, disproportionate sampling, and poststatistical weighting. PARTICIPANTS--Adults aged 18 years and older who were knowledgeable about the insurance status of persons in their household. MAIN OUTCOME MEASURES--Insurance status, employment status, access to and use of health services, and willingness to purchase health insurance. RESULTS--First, the present system of hospital-based uncompensated care in Massachusetts is inadequate by itself to meet the needs of uninsured residents. Uninsured persons are less likely than insured ones to seek medical care for chronic health problems and serious symptoms requiring evaluation. Second, 83% of uninsured families and 24% of uninsured individual respondents would purchase one of several insurance options with 30% of the cost subsidized. Last, the employer mandate provisions of the legislation would cover 43% of the uninsured in Massachusetts. CONCLUSION--In the current economic climate, the political viability of the universal health care plan and similar national initiatives is uncertain given the intractable conflict between perceptions of the financial stability of small businesses that do not offer insurance and the health care needs of uninsured individuals.     

Perspective: Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here.     

130例慢性阻塞性肺疾病就业者的疾病负担现况 及影响因素分析

目的 探讨慢性阻塞性肺疾病（chronic obstructive pulmonary diseases，COPD）就业者的疾病负担现况及影响因素。方法 选取2021年8月1日至9月30日就诊于温州医科大学附属第二医院呼吸内科门诊的130例COPD就业者的临床资料，统计COPD就业者的疾病负担现况，设计一般资料调查问卷，纳入可能的影响因素，应用单因素及多元线性回归分析COPD就业者疾病负担的影响因素。结果 入选的130 例COPD就业者的疾病负担现况得分为（11.01±6.50）分。多元线性回归分析结果显示，不同的每周平均工作天数、呼吸道症状的影响、前1年与COPD相关的住院次数、健康状况是COPD就业者疾病负担的影响因素（P<0.05）。结论 COPD就业者的疾病负担仍需不断改善，不同的每周平均工作天数、呼吸道症状的影响、前1年与COPD相关的住院次数、健康状况是COPD就业者疾病负担的影响因素。     

楚雄州农村居民卫生资源可及性与家庭医疗费用支出的关系

目的 调查农村居民的家庭医疗费用支出情况及卫生资源可及性, 探讨导致家庭医疗费用支出过多的主要影响因素.方法 采用分层整群随机抽样法对楚雄州3 659户15 309名的农村居民进行入户调查.结果楚雄州农村居民家庭年医疗费用支出均值为1 987.5元.65.1%的住户离最近的医疗机构在1 km之内, 高于全国调查水平;70.6%的住户在10 min之内能到达最近的医疗机构, 低于全国调查水平.多重线性回归分析显示家庭医疗费用支出过高的影响因素为到最近医院所需时间、到最近医院距离、2周就诊人次、2周患病未就诊人次、年住院人次.结论 农村居民的卫生服务供给已基本满足需要, 但利用率不高;“看病难”现象已得到较大改善, 但“看病贵”问题仍是影响利用率的主要制约因素;需继续加强对农村居民的健康教育, 提高卫生服务可及性, 缩小不同区域间居民健康水平差异.     

The Community Psychogeriatric Programme: a pilot project in the eastern sector of Singapore

As the population in Singapore ages rapidly, there is a race against time to prepare for the growing psychiatric needs of this population. The Community Psychogeriatric Programme was set up in Changi General Hospital to provide community mental health services for early detection and treatment of psychogeriatric disorders in the eastern sector of Singapore. The model of care involves working closely with community partners to provide training on mental healthcare in the older person, case discussion and consultation as well as clinical home visits. Efforts to raise awareness of mental health issues faced by our greying population have been encouraging but challenging. We hope that by reducing stigma and raising awareness, early access to treatment in the community will help to keep our older persons in the community for as long as possible.     

残疾人对健康体检需求的调查分析

目的了解残疾人对健康体检的服务需求,提出相应的援助措施。方法采用自行设计的问卷调查表对350名残疾体检者进行体检服务需求调查,内容包括体检中心无障碍设施的需求、相关辅助器具的配备、专职导医导检的设置、体检信息无障碍的获取等。结果影响残疾人体检的因素主要是身体不便和无障碍设施不完善,残疾人对体检中心的需求包括升降电梯、无障碍卫生间、辅助器具的配备、提供有声读物和视频节目配字幕等信息资料,以及节省等候时间和得到优质的服务等。结论健康体检中心应加强残疾人无障碍设施的设计、提供专门的服务措施,满足更多的残疾人健康体检的需求。     

Health-seeking behaviour of the elderly living alone in an urbanised low-income community in Singapore

INTRODUCTION:Elderly persons who live alone are more likely to be socially isolated and at increased risk of adverse health outcomes, unnecessary hospital re-admissions and premature mortality. We aimed to understand the health-seeking behaviour of elderly persons living alone in public rental housing in Singapore.METHODS:In-depth interviews were conducted using a semi-structured question guide. Participants were selected using a purposive sampling approach. Interviews were conducted until theme saturation was reached. Qualitative data collected was analysed using manual thematic coding methods.RESULTS:Data analysis revealed five major themes: accessibility of healthcare services and financial assistance schemes; perceived high cost of care; self-management; self-reliance; and mismatch between perceived needs and services.CONCLUSION:Elderly persons living in one-room rental flats are a resilient and resourceful group that values self-reliance and independence. Most of the elderly who live alone develop self-coping mechanisms to meet their healthcare needs rather than seek formal medical consultation. The insightful findings from this study should be taken into consideration when models of healthcare delivery are being reviewed and designed so as to support the disadvantaged elderly living alone.     

Health care technology and the inevitability of resource allocation and rationing decisions. Part I

Increasingly, it is recognized that resources available to meet health care needs are limited. Recently, this has been evidenced by reductions in federally funded health care programs and the leveling off of research funds made available to the National Institutes of Health. The problem of severely constrained resources is likely to become more acute, given new medical technology and the high cost of medical care. It is now apparent that both resource allocation and resource-rationing decisions will become inevitable, since not all persons with catastrophic or complicated medical conditions will be able to benefit from medical technology. While the careful assessment of health care technology can conceivably increase the efficiency of the health care delivery system, the methods by which allocation and rationing decisions are made must be improved. In doing so, it will ultimately be essential for this society to come to grips with life and death issues in a manner to which it is not accustomed.