A public hospital closes. Impact on patients' access to care and health status

We studied the impact of the closing of a public hospital on patients' access to care and health status. We surveyed individuals who had been medical inpatients at Shasta General Hospital, Redding, Calif, in the year prior to its closing and compared them with those in a second county, San Luis Obispo, whose public hospital did not close. Surveys were administered after the closing of Shasta General Hospital and 1 year later. We assessed outcomes using the Medical Outcomes Study Short Form and a series of transition questions that asked about changes in health over time. Data were available for 88% of patients at 1 year: 219 from Shasta County and 195 from San Luis Obispo County. At follow-up, the percentage of patients from Shasta County who reported no regular provider increased from 14.0 to 27.7 and the percentage who reported they were denied care rose from 10.8 to 16.9. Meanwhile, patients in San Luis Obispo County reported improved access to a regular provider and the level of denied care was unchanged. Patients in Shasta County had significant declines on the Medical Outcomes Study Short Form in health perception, social and role function, and increases in pain as compared with those patients in San Luis Obispo County. The closing of a public hospital had a significant effect on access to health care and was associated with a decline in health status.     

2010-2020年社会经济地位对心理健康影响的知识图谱演化

目的基于科学计量学分析2010-2020年社会经济地位对心理健康影响知识图谱的演化历程。方法检索CNKI数据库中以社会经济地位与心理健康为主题词文献,检索时段限定为2010年1月至2020年5月,基于Citespace5.6.R5系统对上述文献进行科学计量学分析。结果入选文献585篇,发文量呈逐年上升态势。其中,社会经济地位、家庭社会经济地位、大学生、心理健康和社会分层为高关注度主题。研究基于社会分层理论逐渐拓展到社会经济地位、社会资本、世界信念与控制感、亲社会行为、自我教育期望等领域。研究热点主题由社会经济地位逐步演化至情绪智力等。结论本领域研究关注度逐渐提升。今后应采取多元实验手段、路径与工具,继续加强与深化该领域研究。     

血液透析病人电子健康素养现状及其影响因素分析

目的：对维持性血液透析病人电子健康素养现状进行调查,并分析其影响因素。方法：2019年3-10月采用便利抽样抽取安徽省20家三甲医院符合纳入标准的维持性血液透析病人399例,采用一般资料问卷、电子健康素养量表、慢性病自我效能量表、血液透析病人自我管理行为量表对病人进行调查。采用单因素分析、Pearson相关分析及多元线性回归分析维持性血液透析病人电子健康素养的影响因素。结果：399例维持性血液透析病人中,电子健康素养得分为(22.05±7.24)分,67例病人得分>32分,合格率16.8%。性别、是否患有高血压、透析时是否上网查阅血液透析相关知识、透析时间4个因素对维持性血液透析病人电子健康素养的影响具有统计学意义(P<0.05～P<0.01);Pearson相关分析表明,维持性血液透析病人电子健康素养得分与自我管理行为、慢性疾病自我效能得分之间呈正相关关系(r=0.452、0.146,P<0.01);多元线性回归分析结果表明,透析时上网查阅血液透析相关知识和男性电子健康素养评分较高(P<0.01),透析时间与维持性血液透析中病人电子健康素养评分呈正相关(...     

痴呆照料者心理健康与应对策略的跨人种研究

目的探讨不同人种痴呆照料者心理健康与其照料过程中的应对策略之间的关系。方法121名痴呆照料者,包括29名美籍华人（CN）、29名美籍非洲人（BK）、32名高加索人（可汀）和31名拉丁族裔（LT）,所有被试者接受“老年人照料者的预后”问卷调查,内容包括受照料者的认知状况问卷、受照料者的简短生活能力量表和工具性生活能力量表、照料者抑郁量表、照料者健康状况问卷,及照料应对方式问卷。结果BK、可汀和LT组照料者以女儿居多;CN组配偶、子女所承担的角色较均衡。照料者抑郁量表评分和健康状况评分组间差异不具显著性。不同种族照料者采取的应对方式不同;接纳现状条目和寻找积极因素条目评分均为BK〉WT〉LT〉CN（P〈0．05）,增加疾病知识条目评分组间差异无显著性。多元逐步回归分析发现,照料者抑郁体验与照料者和受照料者的基本背景及照料应对方式有关（P〈0．01）,不同种族照料者抑郁体验相关的应对方式不同。结论不同种族痴呆照料者心理状况与其应对策略有关,抑郁体验相关应对方式具有跨人种差异。有必要探讨适合于不同文化背景的照料者应对策略培训和保健模式,以提高痴呆照料质量和生活质量。     

Correlations of work, leisure, and sports physical activities and health status with socioeconomic factors: a national study in Israel

Objective: To evaluate levels of physical activities at work, leisure, and sports and to correlate them with socioeconomic and health factors. Methods: Validated questionnaire administered to a random sample of 406 adults. Items covered demographic data, health status, smoking, and duration, frequency, intensity of physical activities. Indices of physical activity at work, leisure, and sports were analysed. Results: Adults (both sexes) with poor self perceived health status and less than 13 years of education, regardless of their body mass index, perform no or few physical activities during their leisure time. Conclusions: The correlations of physical activity with socioeconomic and health factors differ significantly for work, leisure, and sports. Physicians should differentiate physical activities by type and intensity during anamneses.     

An evolving model for training and education in resource-poor settings: teaching health workers to fish

Training and education of health workers remains an indispensable part of good health development in resource-poor settings. Many past training programs have failed to achieve significant gains in health outcomes because of poor selection of participants, inadequate methodology, and/or the influence of external factors in the health system or social environment. The solutions lie in better planning of "who" and "what" should be trained; effective methods based on adult learning principles; alternative methods that maximise learner input and locate training as close as possible to the workplace and its problems; appropriate inclusion of the community; and coordination with other health system interventions.     

Approaches to screening for intimate partner violence in health care settings: a randomized trial

Context  Screening for intimate partner violence (IPV) in health care settings has been recommended by some professional organizations, although there is limited information regarding the accuracy, acceptability, and completeness of different screening methods and instruments. Objective  To determine the optimal method for IPV screening in health care settings. Design and Setting  Cluster randomized trial conducted from May 2004 to January 2005 at 2 each of emergency departments, family practices, and women's health clinics in Ontario, Canada. Participants  English-speaking women aged 18 to 64 years who were well enough to participate and could be seen individually were eligible. Of 2602 eligible women, 141 (5%) refused participation. Intervention  Participants were randomized by clinic day or shift to 1 of 3 screening approaches: a face-to-face interview with a health care provider (physician or nurse), written self-completed questionnaire, and computer-based self-completed questionnaire. Two screening instruments—the Partner Violence Screen (PVS) and the Woman Abuse Screening Tool (WAST)—were administered and compared with the Composite Abuse Scale (CAS) as the criterion standard. Main Outcome Measures  The approaches were evaluated on prevalence, extent of missing data, and participant preference. Agreement between the screening instruments and the CAS was examined. Results  The 12-month prevalence of IPV ranged from 4.1% to 17.7%, depending on screening method, instrument, and health care setting. Although no statistically significant main effects on prevalence were found for method or screening instrument, a significant interaction between method and instrument was found: prevalence was lower on the written WAST vs other combinations. The face-to-face approach was least preferred by participants. The WAST and the written format yielded significantly less missing data than the PVS and other methods. The PVS and WAST had similar sensitivities (49.2% and 47.0%, respectively) and specificities (93.7% and 95.6%, respectively). Conclusions  In screening for IPV, women preferred self-completed approaches over face-to-face questioning; computer-based screening did not increase prevalence; and written screens had fewest missing data. These are important considerations for both clinical and research efforts in IPV screening. Trial Registration  clinicaltrials.gov Identifier: NCT00336297      

Knowledge of cardiovascular disease risk factors among the Canadian population: relationships with indicators of socioeconomic status

BACKGROUND: We examined the ability of adult Canadians to recall cardiovascular disease risk factors to determine the associations between their ability to recall risk factors for cardiovascular disease and their socioeconomic status. METHODS: This study used the database assembled by the Canadian Heart Health Surveys Research Group between 1986 and 1992--a stratified representative sample comprising 23,129 Canadian residents aged 18 to 74. Nurses administered a standard questionnaire asking respondents to list the major risk factors for cardiovascular disease: fat in food, smoking, lack of exercise, excess weight, elevated blood cholesterol and high blood pressure. Six logistic regressions examined the multivariate associations between ability to recall each risk factor with education, income adequacy, occupation, sex, age, marital status and province of residence. RESULTS: More people knew about the behaviour-related risk factors for cardiovascular disease than about the physiologic risk factors: 60% recalled fat in food, 52% smoking and 41% lack of exercise, but only 32% identified weight, 27% cholesterol and 22% high blood pressure. Education was the socioeconomic status indicator most strongly and consistently associated with the ability to recall risk factors for cardiovascular disease. The odds ratios of reporting an association of the risks between people with elementary education and those with university degrees varied between 0.16 (95% confidence interval 0.12 to 0.22) for lack of exercise to 0.55 (95% confidence interval 0.39 to 0.77) for smoking. INTERPRETATION: People in categories at greater risk of cardiovascular disease, such as those aged 65 or more or those with only elementary education, are less able to recall important cardiovascular disease risk factors.     

Making a difference to socioeconomic determinants of health in Australia: a research and development strategy

Disparities in health across the socioeconomic spectrum are now recognised worldwide and demand policy action. Pathways from social disadvantage to health outcomes are poorly understood, and reducing social disadvantage poses crosscutting political, moral and methodological issues. The Health Inequalities Research Collaboration, an initiative of the Commonwealth Department of Health and Aged Care, is establishing a research and development process to support departmental efforts to reduce health inequalities. The collaboration is building research networks in child development, community resources and primary healthcare. Policy action needs to extend beyond the health portfolio and the role of government. Broad strategies are required, as is research to fearlessly evaluate the health effects of government policy, economic activity and cultural change. The Canadian Institute for Advanced Research is a model for national research of the kind needed in Australia.     

农村育龄妇女阴道炎滴虫、假丝酵母菌感染状况及求医状况分析

目的探讨农村育龄妇女阴道滴虫、假丝酵母菌反复感染者的病因及加强防治措施.方法2003年我院妇产科对124例阴道炎患者进行问卷调查、体格检查和实验室检查,了解她们滴虫性和假丝酵母菌性外阴阴道炎患病情况及求医状况和就医环境.结果两种疾病的检出率分别为16.13%和24.19%,其中假丝酵母菌性外阴阴道炎非白化严重(非白色假丝酵母菌占86.67%),对常见抗真菌药敏感性降低;病人就诊率较高,但复诊率较低,病人的就医环境较差.结论加强基层卫生工作者的培训、加强对农村妇女的宣传教育势在必行.     

Drinking, smoking and drug-taking patterns in a predominantly lower socioeconomic status sample: comparison with Medicheck sample

The drinking, smoking, and drug-taking patterns of 9829 adult members of the Australian Workers Union in Sydney are compared with data collected through the Medicheck Referral Centre. Overall, the two sets of data are very similar, but the results of this survey point to the high prevalence of heavy alcohol consumption, and of regular drug-taking in young people.     

Family planning -- a priority social and health action programme for Africa and the role of the physician

The issues of contraception and family planning have been particularly sensitive and complex in sub-Saharan Africa. Family planning programs which promote the use of safe and effective modern methods of contraception have generally not been well received on the continent. The reality, however, is that sub-Saharan Africa has a rapidly growing population in the context of the world's least developed region. 25 of the world's 35 least developed countries are in sub-Saharan Africa. It is difficult enough to maintain existing services for populations in the region let alone expand them to meet the needs of even more people. Family planning should be seen as one of several strategies or interventions in an overall and integrated socioeconomic development plan. Unless population growth slows sharply and rapidly, living standards will continue to fall, unemployment and poverty will increase, and famine and hunger will lead to accelerated rural-urban migration, threatening national security and peace. The provision of family planning and high-quality reproductive health care can also help reduce the currently high levels of maternal mortality and morbidity. Physicians need to become more actively involved in advocating and providing family planning services.     

An international data analysis on the level of maternal and child health in relation to socioeconomic factors

International data on health and socioeconomic factors were analyzed to understand the trends and the determinants of maternal and infant mortality in the late years. Multivariate analyses were carried out to summarize the structure of the data. Multiple regression analyses were also carried out with these two mortality rates as dependent variables. The range of independent variables included health resource availability, immunization, GNP, illiteracy rates, distribution in working area, the indicators of living standards such as percentage of telephone lines and television sets per capita and the percentages of working children, population with access to safe water and sanitation, people living in urban areas, among others. In the preliminary analysis the indicators of living standards appeared highly correlated to maternal and infant mortality. Working area (industrial or agricultural) showed also an important correlation. In factor analysis indirect variables (economic and living condition) were summarized into two factors. Two regression analyses were executed. In the first the variables were used directly, while factors obtained by the factor analysis were used in the second. The second analysis confirmed the previous analysis: fertility rate, immunization and urbanization appeared as determinants of maternal mortality. Birth rate, percentage of females working in agriculture and total illiteracy appeared as determinants of infant mortality. The factors extracted in the factor analysis made a significant contribution to the second regression analysis. We concluded: 1) The factors extracted by factor analyses from indirect variables had high explanatory ability on infant mortality rates, 2) The presence of immunization together with birth rate and fertility rate in the regression models pointed out the importance of investing in birth rate reduction and disease prevention methods.