Addressing the Nursing Shortage: A Critical Health Care Issue

This article explores factors that influence a nurse's choice between working in a rural and an urban area. Understanding how nurses make the choice of which type of environment is critical to addressing this shortage, especially in these hardest hit rural areas. A comprehensive literature review suggested a number of factors worthy of investigation. These factors were assessed through six focus groups and a survey. Results suggest that native geographic preferences dominate, but that value congruence, economics, work facilities and stress all play a significant role in the decision when choosing between an urban and rural work environment.     

Health Care Worker Contact with MERS Patient,Saudi Arabia

To investigate potential transmission of Middle East respiratory syndrome coronavirus (MERS-CoV) to health care workers in a hospital, we serologically tested hospital contacts of the index case-patient in Saudi Arabia, 4 months after his death. None of the 48 contacts showed evidence of MERS-CoV infection.     

Health Care Expenditure and Income: A Global Perspective

This paper investigates the long‐run economic relationship between healthcare expenditure and income in the world using data on 167 countries over the period 1995–2012, collected from the World Bank data set. The analysis is carried using panel data methods that allow one to account for unobserved heterogeneity, temporal persistence, and cross‐section dependence in the form of either a common factor model or a spatial process. We estimate a global measure of income elasticity using all countries in the sample, and for sub‐groups of countries, depending on their geo‐political area and income. Our findings suggest that at the global level, health care is a necessity rather than a luxury. However, results vary greatly depending on the sub‐sample analysed. Our findings seem to suggest that size of income elasticity depends on the position of different countries in the global income distribution, with poorer countries showing higher elasticity. Copyright © 2016 John Wiley & Sons, Ltd.     

不同病区医护手监测调查与分析

目的 了解医院手术室、重点感染病区、普通病区医务人员洗手效果，根据不同病区、不同特点，进一步加强和有针对性的对医务人员手的监督与监测。方法 回顾性分析我院手术室、妇产科、儿科、外科、门诊医护手监测资料。结果 医护手监测总合格率为89．7％，手术室护士手监测合格率96．8％；重点感染病区(妇产科、儿科)医护手监测合格率89．2％；普通病区(外科、门诊)医护手监测合格率88．4％。结论 医务人员对手的清洁与消毒，仍缺乏足够的认识，加强重点感染病区医务人员手的消毒管理、提高全院医务人员对手清洁与消毒意识，是预防医院感染的关键。     

Effectiveness of a Community Health Worker Cardiovascular Risk Reduction Program in Public Health and Health Care Settings

Objectives. We evaluated whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings.Methods. The CHWs provided point-of-service screening, education, and care coordination to residents in 34 primarily rural Colorado counties. The CHWs utilized motivational interviewing and navigated those at risk for CHD into medical care and lifestyle resources. A software application generated a real-time 10-year Framingham Risk Score (FRS) and guideline-based health recommendations while supporting longitudinal caseload tracking. We used multiple linear regression analysis to determine factors associated with changes in FRS.Results. From 2010 to 2011, among 4743 participants at risk for CHD, 53.5% received medical or lifestyle referrals and 698 were retested 3 or more months after screening. We observed statistically significant improvements in diet, weight, blood pressure, lipids, and FRS with the greatest effects among those with uncontrolled risk factors. Successful phone interaction by the CHW led to lower FRS at retests (P = .04).Conclusions. A CHW-based program within public health and health care settings improved CHD risk. Further exploration of factors related to improved outcomes is needed.The US Affordable Care Act specifies implementation of a national partnership for disease prevention and health promotion, with a focus on reducing health disparities.1 Although the Affordable Care Act includes community outreach as a key component, it provides little detail on optimal methods for integrating community and health care silos. One potential linkage is the community health worker (CHW) who is a lay person trained to carry out specific health interventions. There is considerable evidence supporting the positive impact of CHWs on the health of diverse populations with hypertension and other chronic conditions.2–6 However, systematic reviews of CHW effectiveness suggest important gaps in the evidence base,7,8 and studies of coronary heart disease (CHD) risk factor interventions, in particular, were isolated within health care delivery settings. In addition, no studies to date have demonstrated a reduction in global CHD risk, the strongest predictor of long-term fatal and nonfatal cardiovascular events.9Although the burden of CHD continues to decline,10 it remains the leading cause of morbidity and mortality in the United States11 where substantial health disparities persist among underserved populations, particularly geographically isolated residents.12–14 In addition to limited access to primary care, rural medical centers have significantly fewer clinical capabilities, worse measured processes of care, and higher mortality rates among patients presenting with acute cardiovascular conditions.15From 2006 to 2009, a previous statewide CHW-based network provided CHD screening to medically underserved populations including urban, rural, and frontier regions of Colorado.16 The CHWs were deployed to provide point-of-service health screenings and education. In this population of 17 995 individuals, 82% were unaware of their risk for CHD, which suggested an important unmet public health need. This previous program was not designed to track health outcomes and focused primarily on the first step in the health improvement continuum by raising awareness among vulnerable individuals. Given this background, we enhanced the framework of the previous program by integrating best practices from multiple public health and health care models. This included:

1. creating a decision-support algorithm that would generate tailored health messages based upon national treatment guidelines,
2. assessing participant readiness to change,
3. utilizing motivational interviewing techniques to promote healthy behavior change,
4. incorporating longitudinal follow-up for at-risk participants,
5. improving navigation into medical care and community resources, and
6. integrating health care provider educational detailing.

These enhancements were incorporated into an electronic data collection system designed to assist the CHWs’ workflow within the overall program framework. The program was adapted to the culture of the community to effectively link community outreach with local medical clinics. We sought to demonstrate whether a CHW-based program that integrated both public health and health care models would reduce CHD risk. We assessed outcomes from 2010 to 2011, and investigated factors associated with changes in Framingham Risk Score (FRS).     

产科保健新模式——阶段性责任制健康教育的可行性

目的探讨实施阶段性责任制健康教育对提高产科质量的促进作用。方法针对孕产妇的心理需求,制定产妇住院期间不同阶段的健康教育内容以及产科健康教育实施表,再造宣教流程,选择2009年2—6月的住院产妇1500例为观察组。选择2008年6月—2009年1月住院的产妇1500名为对照组,按照常规进行产科健康教育,对其住院资料进行分析。观察组在住院的全过程责任到人,落实和接受情况由宣教者及受教育者双方签名,并采用自行设计的产妇住院全程意见征询表进行调查,对阶段性责任健康教育的各项内容掌握程度进行评估,比较2组产妇相关知识及技能掌握情况,护患纠纷发生率、护理投诉及护理满意度。结果观察组产妇健康教育知识中的合理饮食、自我监护、分娩时配合母乳喂养技巧、伤口护理、婴儿护理、异常识别掌握情况明显优于对照组,差异均有统计学意义（χ2=58.01、94.28、94.73、37.50、58.36、41.04、91.34,均P〈0.01）。观察组无护理投诉、纠纷发生,满意度达（98.66%）,与对照组比具差异有统计学意义（P〈0.01）。结论围生期应用阶段性责任制健康教育可显著提高教育质量和效果,提升母婴生活质量,在临床实践中切实可行,值得推广。     

The Unique Role of the Child Life Worker in Children's Health Care Settings

The author expresses his concern that many child life workers are not aware of the uniqueness of their role in child health care settings He comments on four ways in which he perceives the child life workers role to be unique He concludes that the child life worker is irreplaceable in the child health care environment.     

The Unique Role of the Child Life Worker in Children's Health Care Settings

The author expresses his concern that many child life workers are not aware of the uniqueness of their role in child health care settings He comments on four ways in which he perceives the child life workers role to be unique He concludes that the child life worker is irreplaceable in the child health care environment.     

Spiritual Care,Pastoral Care,and Chaplains: Trends in the Health Care Literature

This study analyzes trends in the health care literature based on electronic searches of MEDLINE between the years 1980 and 2006. The search terms used were “spiritual care,” “pastoral care,” and “chaplain.?” The results document an expected surge in the rate of English-language journal articles about spiritual care beginning in the mid 1990s. Although the rate of articles about pastoral care was several times higher than that for spiritual care over much of the study period, there was a steady decline in articles about pastoral care during the past 10 years. These two trends produced a convergence in the rates, so by 2006 the rate of published articles on pastoral care (21.1 per 100,000) was less than twice as high as that on spiritual care (13.3 per 100,000). The rate of articles about chaplains rose moderately but significantly from 9.6 per 100,000 in the years 1980–1982 to 12.2 per 100,000 in the years 2004–2006. Increasing interest in spiritual care was evident in nursing, mental health, and general health care journals, being most pronounced in nursing. Declining interest in pastoral care was also most pronounced in nursing. This article discusses some implications of and responses to these trends.     

贯彻"一法两纲"推进母婴保健

孕产妇死亡率、围产儿死亡率及人均期望寿命是反映一个国家和地区卫生工作质量的三大重要指标 ,也是我国母婴保健法、儿童发展纲要及妇女发展纲要 (简称“一法两纲”)的核心指标 ,而母婴保健工作的质量与这三大指标均密切相关。上海市的母婴保健工作以“母亲安全、儿童优先、提     

Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access,Health Care Utilization,and Health Status

To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0–11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent’s language, parental education, ethnicity, and children’s insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.     

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools—accountability measures and payment designs—to improve access to and quality of care for patients with behavioral health needs.     

初级卫生保健全球发展策略与评价进展

29年前，世界卫生组织提出了人人健康（HFA）目标和初级卫生保健（PHC）的全球战略。HFA和PHC一直引导世界各国卫生系统的发展方向。文章通过综述，探讨PHC在各国卫生系统中的战略地位、发展方向和内涵变化，并介绍了PHC评价的全球进展。