短期、中期、长期健康状况代际传递及其城乡异质性研究

目的  探究中国居民健康状况的代际传递,并分析其城乡异质性。方法  基于中国健康与营养调查(China Health and Nutrition Survey, CHNS)数据,通过二分类Logistic回归分析模型、多元线性回归分析模型及交互作用模型,分析短期、中期、长期健康状况的代际传递及城乡调节作用。结果  母亲、父亲的短期、中期、长期健康状况对子代相应的健康状况有重要影响(母亲-子代：OR_短期=5.649, β_中期=0.305, OR_长期=3.719;父亲-子代：OR_短期=3.436, β_中期=0.388, OR_长期=3.483);城乡调节了母亲-子代健康状况的代际传递(P_短期=0.023, P_中期=0.038, P_长期=0.072),居住于城市地区能弱化母亲-子代间的健康传递。结论  亲代短期、中期及长期健康对子代相应健康状况影响密切,建议以家庭为单位开展健康促进工作,遏制不良健康状况代际传递。     

Developing the Intergenerational Community Survey for older adults: Assessing neighborhood environments,social and physical activities,and health

Many survey instruments have been developed to assess neighborhood environments for their impacts on people's health and daily activities. However, no instruments are available for capturing social interactions with different age groups among older populations. This study introduces a four-phase process of developing a comprehensive Intergenerational Community Survey (ICS) covering six domains: (1) physical activities, walking, and sedentary activities; (2) mental health and quality of life; (3) social activities (e.g. intergenerational and peer interactions) in and outside the neighborhood; (4) neighborhood environments (e.g. safety, streets and sidewalks); (5) supportive services or programs (e.g. intergenerational programs, transportation services); and (6) personal characteristics. Test-retest reliability assessments among 38 community-dwelling older adults (aged 65+) showed fair to good reliability results. ICS can serve as a useful tool to facilitate future research on intergenerational communities and interactions for older adults.     

家庭健康循环视角下的健康代际传递研究——基于CHNS 2015的实证分析

目的:基于家庭健康循环视角与家庭生态系统理论,探究健康状况、健康行为及健康认知的代际传递,为制定精准健康促进政策提供依据。方法:基于2015年CHNS数据,采用多分类Logistic、有序Logistic以及OLS模型探讨母亲主客观健康状况,健康行为及认知对子代主客观健康状况,健康行为及认知的影响。结果:母亲BMI显著影响子代BMI,母亲超重或肥胖,则子代超重、肥胖的相对风险高;母亲自评健康显著影响子代自评健康;母亲饮食得分与锻炼得分显著影响子代饮食得分与锻炼得分;母亲健康认知显著影响子代的健康认知。结论:健康状况、行为及认知均显著代际传递,建议开展亲子健康促进行动,并建设健康家庭环境。     

Intergenerational interaction, social capital and health: results from a randomised controlled trial in Brazil

Recent years have seen a burgeoning of intergenerational programmes aiming to improve the well being of participants. However, very few programmes have been formally evaluated. In this paper we report results from a randomised controlled trial of a school-based intergenerational intervention undertaken in Brazil. Randomly selected samples of 253 adolescents and 266 elders aged 60 and over resident in the school's catchment area were administered a questionnaire including questions on cognitive components of social capital, family relationships, and self-rated health. Participants were then randomly allocated to control and intervention groups. The intervention comprised participation in a 4 month programme of intergenerational activities in which the elders shared their memories with the students. At the end of the intervention the questionnaire was re-administered to the samples. High proportions (85-95%) of both samples completed the questionnaires but compliance with the intervention was low in the elderly group. In the analysis of results from the elderly sample, we therefore compared the control group with the group assigned to the intervention (intention to treat analysis). Results showed that adolescents in the intervention group were nearly three times more likely to rate their health as good than those in the control group, but also more likely to judge that most people were selfish. In the elderly sample, those from the intervention group were over twice as likely as those from the control group to report positively on the helpfulness of neighbours; judge most people to be honest or consider their family relationships as good. There were no significant differences between groups on other outcome measures. These results suggest that structured intergenerational activities may have positive effects on some aspects of social capital for both adolescents and elderly people, although further research is needed to elucidate the processes involved and the extent to which the findings are context specific. This study is the first to use a controlled trial design to evaluate this type of intervention and is valuable in showing that this design can be used in interventions of this kind, and also the difficulties involved.     

Unfortunate Moms and Unfortunate Children: Impact of the Nepali Civil War on Women's Stature and Intergenerational Health

I analyze the long-term health impacts of Nepal's 1996-2006 civil conflict. I use information on monthly conflict incidents at the village level, which allows me to identify the effects of exposure to conflict more accurately than prior studies. I exploit the heterogeneity in conflict intensity across villages and birth cohorts to document the impacts on adult stature and intergenerational health. I find that childhood exposure to conflict and, in particular, exposure starting in infancy, negatively impacts attained adult height. Each additional month of exposure decreases a women's adult height by 1.36 millimeters. The impacts are not limited to first-generation - I find that a mother's exposure to conflict in her childhood is also detrimental to her child's health. Mothers exposed to conflict during their childhood have more children and live in less wealthy households, likely reducing their ability to invest during their children's critical period of physical development.     

职业地位及其代际变化对健康的影响

目的分析儿童期家庭的职业地位及其代际变化对子女成年后心理健康的效应,为进一步提高居民心理健康的公平性提供依据。方法应用中国综合社会调查2005年的数据,通过多元方差分析,测量不同职业地位及其代际变化分组对一系列心理健康指标的综合影响。结果儿童时期父亲为较低层次职业者的比例约为59．0％,母亲为较低层次职业者的比例占62．9％,子女成年后从事低层次职业者的比例降至49．8％。儿童期家庭的职业地位的不同,会导致成年后的心理健康水平不同（F=1．449,P=0．015）;职业地位的代际流动的方向对心理健康亦有重要影响（F=3．050,P=0．048）。结论儿童期家庭职业地位与职业地位的代际变化,同时影响着子女成年后的心理健康,是改善健康公平应予以关注的重要方面。     

Health insurance,endogenous medical progress,health expenditure growth,and welfare

We study the impact of health insurance expansion on medical spending, longevity and welfare in an OLG economy in which individuals purchase health care to lower mortality and medical progress is profit-driven. Three sectors are considered: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the subsidization of health care through health insurance creates excessive health care spending, the gains in life expectancy brought about by induced medical progress more than compensate for this.     

Paradigm shifters, professionals, and community sentinels: immigrant community institutions' roles in shaping places and implications for stigmatized public health initiatives

Immigrant community institutions are strategically positioned to facilitate or impede public health efforts in their neighborhoods and communities because of their influence over discourse regarding values and tradition. Their authority may be particularly relevant when stigmatized or sensitive issues, such as HIV or reproductive health, are addressed. Using qualitative and quantitative methods to analyze data collected from 22 Chinese and South Asian immigrant institutions in New York City, we examine attitudes about HIV, social change and tradition to delineate the different structural roles that Asian immigrant community institutions play in relation to the preservation of traditional values and culture in their neighborhoods and communities. Implications are explored for working with immigrant community institutions to conduct HIV-related work and other stigmatized public health initiatives in immigrant neighborhoods.     

深化卫生改革促进卫生事业与社会经济协调发展

该文首先回顾了改革开放以来上海卫生经济领域发生的历史性巨变,接着分析了卫生经济领域目前面临的一系列问题与挑战。文章最后提出要采取宏观调控卫生资源甚量,完善医院补偿机制,推进医院综合改革,转变医疗消费观念,开展多层次服务等措施迎接挑战,深化卫生经济改革,促进卫生事业与社会经济协调发展。     

Intergenerational financial transfers and health in a national sample from France

Financial transfers from parents to their adult children are a growing trend in contemporary societies, and this study investigates the relation of those transfers to their beneficiaries' health in France. In the 2005 nationally representative Gender and Generation Survey, nearly 6% of the subjects aged 25-49 years reported having received financial transfers during the last 12 months. Subjects who had achieved intergenerational upward mobility as well as those who had remained in the upper class were more likely to receive transfers, suggesting that parents rewarded those of their children who achieved most social success. After adjusting for a wide range of socio-demographic factors, subjects who had been given large transfers were much more likely to report very good health than subjects who had not been given anything. Findings were interpreted within the framework of sociological research on intergenerational transfers and that of lifecourse epidemiology.     

Meeting health need, accessing health care: the role of neighbourhood

Much of what we know about the determinants of access to health care comes from studies undertaken at a large scale, such as between cities, regions/counties/provinces/states and countries. This paper examines local level variations in access to and utilization of health care services across four distinct neighbourhoods in Hamilton, Ontario, Canada. Survey data (n = 1500) were analysed using logistic regression to explore the potential relationships between neighbourhood and health care utilization and unmet health care need. Results show some relationships between neighbourhood of residence and levels of reported utilization as well as unmet need, even when controlling for predisposing, enabling, and need factors (i.e. Age, gender, household composition, income, education, perceived gp visit time) as well as health status. Findings from this empirical study suggest a finer lens is required to examine the mechanisms through which place impacts access to and utilization of care, one that recognizes the roles of compositional, contextual and collective aspects of neighbourhood.     

从国际经验看卫生筹资和社会健康保障

卫生筹资涉及卫生资源的生产、分配和利用,在卫生系统中占有举足轻重的地位,越来越成为世界各国政府和人民关注的中心问题,也是全球卫生研究的热点领域之一。本文从卫生筹资的目的和功能、社会健康保障的含义及实现途径、全球卫生筹资及社会健康保障的现状和面临的挑战、以及应对挑战的策略等角度综述了卫生筹资和社会健康保障方面的国际经验。     

健康危险因素与个体健康间的结构方程模型

目的探索健康危险因素与个体健康间的潜在关系,以及各潜变量对测量指标的影响。方法利用健康风险评估调查问卷调查西安市某三级甲等医院健康体检人群。构建健康危险因素与个体健康间的结构方程模型,解释不同因子间的相互作用及其对总体健康的效应权重。结果健康行为与健康意识之间呈显著正相关。健康行为对躯体健康的直接效用为0.85,健康意识不仅直接作用躯体健康,而且通过对心理健康的影响对躯体健康产生间接效应,总效应达0.78。结论健康行为、健康意识均是可控的健康危险因素,对躯体健康、心理健康产生一定影响。通过改变这些可控因素可以提高人们整体健康水平。     

社区居民高血压认知行为调查

目的研究社区居民对高血压的知识、态度、行为，为高血压的社区健康促进和卫生服务政策的制订提供参考。方法对长新居委会264名42岁以上的居民进行血压测量和问卷调查。调查的内容主要包括：人口学特征、高血压相关的行为危险因素、有关健康知识和对健康促进的态度和需求。结果接受调查的高血压患者264例。单因素分析结果：高血压的患病率与文化程度、体重指数、饮食习惯、饮酒、精神紧张等有关。结论高血压行为危险因素在社区居民中较普遍，应该采取讲座、发放宣传品等他们喜欢的方式对社区居民开展高血压预防的健康教育和健康促进。     

Places and health: a qualitative study to explore how older women living alone perceive the social and physical dimensions of their neighbourhoods

There is growing interest in the impact that neighbourhood environment might have on the health of older people. Although the number of older Australian women, particularly those living alone, is projected to increase in coming decades, their experiences of neighbourhood have not been exclusively examined. The aims of this paper are: (1) to explore, from the perspective of these women, the social and physical dimensions of neighbourhoods and (2) to investigate variation in these accounts according to whether women lived in areas of higher or lower socioeconomic status. Twenty women aged between 75 and 93 years, residing in metropolitan Adelaide, South Australia (SA), participated in a series of two in-depth interviews. Women's perceptions of their neighbourhood, and accounts of every-day activities in the community were analysed to determine how both social and physical aspects of neighbourhood might relate to health and wellbeing. Findings suggest that a reciprocal and trusting relationship with neighbours underpinned older women's sense of satisfaction with, and feeling of security within, the neighbourhood. Other factors such as living in close proximity to services and existing social networks were also seen as important. Women's stories demonstrated that they were able to draw on both existing social networks and neighbours to sustain their independence and social connection within the community. Women living in more disadvantaged areas were more conscious of social disconnection in their neighbourhoods, and to the way that traffic noise and pollution detracted from their neighbourhood environment. These findings indicate that, for older women living alone, trusting and reciprocal relationships with neighbours are likely to form an important part of their broader social support network and should be recognised in relation to the process of maintaining the health of older women living in the community.     

略论灾害卫生救援个人着装和装备的基本要求

通过2008年四川汶川地震灾害卫生救援工作实践,总结救援队伍的着装以及携带的工作、生活装备的具体经验,为进一步提高卫生应急装备提供现场经验.笔者认为卫生救援队伍所携带的工作、生活装备需要适用于灾害地区的环境,气候条件,并要求质量精良,卫生救援队同时还需要配备良好的通讯、信息保障和后勤保障,只有这样才能保证卫生救援工作的顺利进行.     

健康教育对社区老年糖尿病患者的作用

目的评价健康教育对社区老年糖尿病（DM）患者防治和预防并发症的作用。方法对本社区240例DM患者进行健康教育，通过认知水平和血糖控制水平2项监测指标观察健康教育效果。结果健康教育使社区老年DM患者的认知度有明显提高，患者血糖控制在理想水平。结论社区老年DM患者实施健康教育。有利于控制患者血糖，减少和预防DM并发症，提高生存质量。     

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities

BackgroundThe aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood.MethodsWe performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI).ResultsThe percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25–0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74–1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA.ConclusionsOur study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.     

上海市徐汇区社区卫生服务中心医务人员吸烟相关情况调查

[目的] 了解社区卫生服务中心医务人员烟草使用情况及相关态度。 [方法]对徐汇区社区卫生服务中心的医务人员进行吸烟相关情况的问卷调查。 [结果] 吸烟率为14．0％;多数调查对象对无烟医院持赞同态度;经常劝导病人戒烟的医务人员占58．3％,其中能做到根据病人实际吸烟情况进行针对性劝导的仅25．1％;对吸烟和被动吸烟重度有害健康的认识分别为71．2％和74．3％。 [结论] 徐汇区社区卫生服务中心医务人员的吸烟率较低,但对烟草相关知识及劝导病人戒烟的意识仍需加强。