社区人群健康干预与管理探讨

健康管理是一种对个人及人群的健康危险因素进行全面管理的过程,提供科学的健康指导、健康生活方式的干预、调动其自觉性和主动性,有效地利用有限的资源来达到最大的健康改善效果,保护和促进人类的健康,真正达到预防疾病的发生,提高生命质量,降低医疗费用的目的.健康管理包括:健康体检、健康评估、健康促进和健康服务4个部分.     

健康干预在社区糖尿病患者管理中的应用

目的:探讨健康干预在社区糖尿病患者管理中的应用效果.方法:将146例Ⅱ型糖尿病患者,按照患者就诊顺序将146例患者分为观察组和对照组各73例,对照组单纯应用降糖治疗,观察组在对照组基础上给予心理安抚、饮食指导、调节生活方式、合理运动、科学指导服用降糖药物等健康干预.观察随访18个月后,比较两组患者治疗依从性、实验室监测指标、患者对健康干预的满意度.结果:健康干预18个月后,观察组治疗依从性,实验室监测指标和患者对健康干预满意度均优于对照组,差异有统计学意义,P＜0.05.结论:健康干预能使社区糖尿病患者血糖水平稳定,提高患者健康干预的满意度.     

健康管理对社区血脂异常人群的干预效果

目的探讨健康管理对社区血脂异常人群的干预效果。方法对照组60例受试者不受用任何管理方法,研究组60例受试者均采用健康管理干预。结果两组受试者管理前体重指数和血压差异无统计学意义(P>0.05),管理后研究组体重指数、血压均有明显改善,对照组血压有明显改善,研究组受试者的改善幅度明显优于对照组(P<0.05)。两组受试者管理前TC、TG、LDL-C和HDL-C差异无统计学意义(P>0.05),管理后,研究组各血脂指标均明显改善,对照组TC和LDL-C有明显改善,研究组受试者管理后各指标改善程度明显优于对照组(P<0.05)。结论健康管理对于社区血脂异常人群具有较好的干预效果,适合于临床推广。     

护理干预在社区老年慢性病健康管理中的作用

目的分析在为社区老年慢性病患者实施健康管理的过程中护理干预的作用与价值。方法本次研究将2018年2月-2019年2月期间天津市新港辖区内社区老年慢性病患者198例作为研究对象,根据随机双盲法将患者分为研究组和对照组各99例,研究组患者的健康管理方法为护理干预,对照组患者的健康管理方法为常规护理。结果研究组在积极参加锻炼、低盐低脂饮食、戒烟限酒、心态平和、不适即就医等生活行为优于对照组,差异均有统计学意义(P<0.05)。研究组疾病知识掌握率、治疗依从性、以及护理满意率分别高于对照组,一年内再住院率低于对照组,差异均有统计学意义(P<0.05)。结论在为社区老年慢性病患者实施健康管理的过程中护理干预具有积极的作用,值得进行的临床运用。     

基于社区"知己健康管理"的孕产妇干预效果研究

目的为提高孕产妇及家属对孕产期健康行为的依从性,及时纠正孕产期的误区,最终实现心理健康、营养均衡、合理运动的健康生活方式。方法对初次建卡的孕产妇至产后42天的产妇,主要从营养、运动、环境、心理等方面实施全程的＂知己健康管理＂干预。结果通过健康管理,干预组孕产妇在整个孕期的体质量增幅异常率、妊娠贫血、妊娠糖尿病的发生率均明显低于对照组;同时孕产妇对高危妊娠的认识有了显著提高;在分娩期,干预组新生巨大儿发生率明显低于对照组,且产后抑郁的发生率亦明显降低。结论对孕产妇实施全程健康管理,可以避免各种危险因素的升级,促进母婴健康,减少并发证;降低母婴死亡率。     

健康教育与健康促进在社区高血压病健康管理和干预效果

目的评价冷水滩区运用健康教育与健康促进在社区进行高血压健康管理和干预的效果。方法采用随机抽样方法,抽取肖家园社区居民中健康人群和高血压患者各200名,参照《中国高血压防治指南》[1]对干预前后进行评价。结果经过3年的综合干预,健康人群和高血压患者对高血压病的相关知识知晓率显著提高,分别为65.4%、51.3%;行为改变率为50.3%、40.8%,坚持规律服药率达33.5%,血压控制率25.5%。结论健康教育与健康促进干预模式在社区高血压病管理与干预中,提高了社区居民的知晓率、行为改变率和控制率,为控制和减少高血压并发症,提高患者人群的生活质量等起到了应有的作用。     

学校健康促进对上海外来务工人员随迁子女健康知识和行为的影响

目的:评价学校健康促进对上海市外来务工人员子女的健康知识和健康行为的干预效果。方法:选取上海市闵行区、松江区3所外来务工人员子女学校为干预学校,2所公办学校为对照学校,对干预学校的全校学生进行2年的干预,对照学校不进行任何干预。在干预前后,按照分层整群随机抽样的原则,抽取一定比例的4～6年级的学生进行问卷调查。结果:干预学校学生经过干预后,健康知识得分显著提高(P<0.05),且健康行为和生活方式、疾病预防知识的得分与公办学校学生得分的差距有所缩小。干预对学生健康行为的作用不明显,仅体育锻炼的得分显著性提高(P<0.05)。结论:短期学校健康促进对提高外来务工人员子女的健康知识水平效果明显,对改善健康行为效果不明显。建议出台全市统一的政策,使外来务工人员子女学校的健康促进政策具有可持续性。     

社区儿童健康需求及干预措施

为适应现代医学模式的转变,进一步做好儿童保健社区卫生服务工作,我院在原地段保健科基础上,组建了社区卫生服务科,在对本社区内儿童进行健康需求情况调查的基础上,采取了6项干预措施,包括走访儿童家庭、拓宽儿童系统化管理健康查体内容、承担社区儿童的医疗就诊、出诊及转诊任务、建立儿童保健医疗优惠卡、健康教育宣传深入社区及保存儿童健康档案。为社区儿童提供了优质、高效、便捷的医疗保健服务,有效地提高了儿童全身心的健康水平。     

社区高血压患者健康干预分析

目的探讨健康干预对社区高血压患者疗效分析。方法对我社区高血压患者登记并建立高血压病档案,对高血压患者进行面对面咨询(包括心理咨询)和宣教是高血压防治的重要环节,通过测量血压、发放宣传品等提高他们的健康知识、自信心和配合治疗的依从性。结果通过健康干预,患者的不良生活方式改变显著,服药依从率显著提高,血压得到有效控制,对治疗充满信心,学会了疾病的预防、自我保健等知识,使医患关系得到发展和升华。结论通过健康干预帮助患者树立健康的信念,养成健康的行为,建立了有规律的生活方式,给患者以安慰战胜疾病的信心。     

社区健康教育盲区现象及干预对策

外来务工经商人员由于疾病预防和卫生保健方面的管理和宣传空白,形成了社区健康教育盲区,进而使这部分人群的卫生防病意识淡薄和保健观念滞后,并造成相应后果。如何填补管理宣传空白和采取相应干预对策,应引起政府职能部门的重视和关注。     

Sex preference and the value of sons and daughters in Nepal

Sex preference and the specific value of sons and daughters to parents in Nepal are examined using rural and urban survey data from 1979. Ideal family size among all respondents was, on average, three children, with two sons and one daughter the preferred sex composition for about 90 percent of all respondents. Among those who reported current contraceptive use, the mean number of living sons was higher than the mean number of living daughters for all respondents. Most couples have at least one son before they adopt contraception; respondents had, on average, three to four births before adopting contraception. Sons are preferred to daughters by Nepalese parents mainly for socioeconomic and religious reasons, as opposed to the economic reasons reported elsewhere in many developing societies. The findings indicate that the economic motive for having both sons and daughters may be weakening in Nepal, but that a preference for sons does exist.     

Do daughters of female alcoholics have more problems during childhood and adolescence than sons?

171 female alcoholic inpatients living in Stockholm were examined and found to fulfil the alcoholism criteria of DSM-III-R. They comprised 171 women consecutively admitted to the Karolinska Alcohol Clinic and staying at least one week for treatment. The examination included a general medical examination, a psychiatric and social history, blood tests and ECG. The subjects' and their families' possibilities of creating a good upbringing environment for their children and their own childhood were studied.

The alcoholics and their offspring were followed from the registers of the child welfare committees, temperance boards, social service departments, the Social Insurance Office and the Medical Information System of the Medical Services Board of Stockholm County Council.

The children of the female alcoholics had, during their childhood, often had contact with an educational welfare officer, a psychologist or a physician for various problems and were also registered in the children's welfare committee registers. 29% of the female alcoholics themselves had been fostered by their biological mother alone or by grandparents until 16 years of age. 51% of the women had an alcohol-abusing mother and father during childhood. Signs of social maladjustment and having been under the care of a child welfare committee were recorded in 20% and 12% of the women.

Among the children, we found that the boys were more vulnerable during their adolescence than the girls and that there were also major similarities in the social situation for these children of alcoholic women. The indications were that there is also a vulnerable group among girls who develop high consumption of alcohol and simultaneous drug abuse during their teens. Forty five per cent of the girls and 60% of the boys among the female alcoholics' children had school problems and were also in contact with an educational welfare officer, psychologist or physician for various problems. Scrutiny of the Children's Welfare Committee Register showed 60% of the sons and 40% of the daughters were registered. Forty five per cent of the boys and 30% of the girls were registered by the Temperance Board. Forty per cent of the boys and 25% of the girls were registered in the Criminal Offenders Register. Forty five per cent of the boys and 30% of the girls had had hospital treatment on at least one occasion for underlying physical illness or injury. The most common reason for establishing contact with children's psychiatric outpatient clinics or counselling clinics was recommendation and investigation necessitated by supportive measures and school adjustment problems.

It is concluded that female alcoholics resemble male alcoholics and that these females have a disturbed childhood and often have an alcohol and drug-abusing parent, nervous problems in the parents, attempted suicide by a parent and serious schisms in the family and that especially the boys from these female alcoholics' families are extremely vulnerable and they have a more traumatic childhood than the girls, but both of them fare ill.     

浅议基层卫生监督工作的质量管理

卫生监督管理从一定意义上来说,既是卫生监督机构的重要职责,也是该机构为公众提供的一种服务。其服务质量的好坏,直接关系到人民群众的生命安全、身体健康和社会的和谐稳定,同时,对卫生监督执法队伍的自身形象也关系重大。因此,如何对目前基层卫生监督机构内部普遍存在的问题予以高度重视,建立和健全必要的质量监督、管理和控制体系,以确保全体卫生监督执法人员准确高效地履行职责,为公众提供优质便捷的服务,应是基层机构当前的重要任务之一。对此,该文就目前我国基层卫生监督机构质量管理中存在的问题进行初步探讨,并针对其问题提出几点建议。     

The "inverse housing law" and respiratory health

STUDY OBJECTIVE: To investigate whether there is a mismatch within Britain between climate severity and housing quality ("inverse housing law") and whether this mismatch is associated with respiratory health. DESIGN, SETTING AND PARTICIPANTS: Cross sectional observational study. Britain (Scotland, Wales and England). The 3023 male and 3694 female Health and Lifestyle Survey participants with valid data available on all relevant items. MAIN RESULTS: Geographical mapping shows a mismatch between climate severity and housing quality. Individual level analysis shows that lung function is associated with climate and housing, and their interaction, independently of cigarette smoking status. The physical quality of the housing seems to be most important to respiratory health in areas with harsh climate. CONCLUSIONS: Interpretation must be cautious because cross sectional data have been used to investigate processes that are longitudinal and, possibly, selective. Nevertheless, there does seem to be an "inverse housing law", such that some of the worst quality housing is found in areas with severe climate; and, on the balance of probabilities, this inverse housing law affects respiratory health.     

Perceptions of parental communication orientation, perfectionism, and disordered eating behaviors of sons and daughters

This study investigated the influence of perceived parental communication orientation and individual perfectionism on late adolescent offspring's maladaptive eating behaviors using a nonclinical sample ( N=424). College students' perceptions of their communication patterns with parents, self- and parentally prescribed perfectionism, and perceptions of personal control were measured to explore possible associations among these variables and whether they, in combination, predicted maladaptive eating. Results revealed that 23% of the sample participated in maladaptive eating behaviors; in addition, a father-child conformity communication pattern and paternally prescribed perfectionism predicted maladaptive eating within this sample when controlling for individual factors such as offspring's perfectionism and perceived loss of personal control. These findings suggest that father-child communicative interaction that emphasizes conformity to high paternal standards may increase offspring's risk of developing maladaptive eating behaviors.     

卫生行政执法文书档案管理存在的问题及对策探讨

随着卫生监督体制改革的不断深入发展 ,卫生行政执法文书档案的管理在卫生监督工作中的地位也越来越重要。人们对卫生行政执法文书档案管理工作的重要性的认识也有了根本的变化。但是在对基层卫生监督工作进行检查时还是发现 ,很多基层卫生监督机构的卫生行政执法文书制作、整理、归档工作还很不规范 ,存在着许多问题。为了促进卫生监督监测基础档案的建设 ,现就基层卫生监督机构在卫生行政执法文书制作、整理、归档中存在的主要问题作一探讨。1　存在的主要问题1 1　卫生行政执法文书制作问题　　卫生行政执法文书形成较粗制滥造 ,达不到档…     

Response to alcohol in daughters of alcoholics: a pilot study and a comparison with sons of alcoholics

Drinking, but not alcohol-dependent, 18-29-year-old daughters of alcoholics (n = 38) from the Collaborative Study on the Genetics of Alcoholism were compared to 75 family-history-positive (FHP) men from the same families, and 68 family-history-negative (FHN) male controls. Subjects received 0.75 ml/kg of ethanol (for women), 0.9 ml/kg of ethanol (for men), and placebo, each of which was consumed over 8 min on different occasions. The breath-alcohol concentrations (BrAC) and reactions to alcohol [using the Subjective High Assessment Scale (SHAS) and body sway measures] were evaluated over 210 min. The results indicate that, despite slightly higher BrAC values for the FHP men, on the SHAS the FHP women and the FHP men demonstrated significantly lower scores than the FHN male controls, although the values for FHP men and women did not differ. On body sway, the FHP men showed evidence of less alcohol-related increases than FHN men, and there was a trend in the same direction for FHP women, but only early in the session (e.g. at 60 min). Pilot data for 11 FHN women revealed higher scores for both SHAS and body sway at 60 min, compared to FHP women, but, perhaps reflecting the small number of subjects, the family history differences were not significant. Overall, the results in FHP women resemble those for FHP men, and suggest that a low level of response to alcohol might also be a characteristic of daughters of alcoholics.