The school health nurse's assessment of a successful health dialogue

The purpose of this paper is to achieve a deeper understanding of the learning processes that occur within a regular health dialogue between pupils and school health nurse from the school health nurse's perspective. The study used a grounded theory approach for the data collection and analysis. Eight experienced school health nurses were interviewed using a semistructured 'interview guide'. The interviews were audio recorded and transcribed verbatim. A detailed analysis presented the processes involved and the core category emerged as creating a communicative room to learn about health. The core category contained factors related to competencies, authenticity, reflective openness and environmental support, which was the basis for learning processes and a successful health dialogue. This paper adds to our understanding of the processes in school health nursing and the learning about health which takes place within a health dialogue.     

Women's health, men's health, and gender and health: implications of intersectionality

Although intersectionality is now recognized in the context of women's health, men's health, and gender and health, its full implications for research, policy, and practice have not yet been interrogated. This paper investigates, from an intersectionality perspective, the common struggles within each field to confront the complex interplay of factors that shape health inequities. Drawing on developments within intersectionality scholarship and various sources of research and policy evidence (including examples from the field of HIV/AIDS), the paper demonstrates the methodological feasibility of intersectionality and in particular, the wide-ranging benefits of de-centering gender through intersectional analyses.     

Schools, health literacy and public health: possibilities and challenges

Health literacy is a concept that can be widely embraced by schools. Schools throughout the world contribute to the achievement of public health goals in conjunction with their educational commitments. In this paper, the interface between a school's core business of education and public health goals is identified, and examples provided in the area of nutrition demonstrating how these links can operate at school level. The structure and function of the health promoting school is described and the author proposes that there is a very close connection between the health promoting school and the enabling factors necessary in achieving health literacy. Major findings in the literature that provide evidence of good practices in school health education and promotion initiatives are described. Also, those factors that make schools effective and which facilitate learning for students are identified. There is a substantial overlap between the successful components of a health promoting school and effective schools. This enables schools to potentially achieve all three levels of health literacy, including level 3-critical health literacy. However, there are three challenges that must be addressed to enable schools to achieve this level: the traditional structure and function of schools, teachers practices and skills, and time and resources. Strategies are proposed to address all three areas and to reduce the impediments to achieving the goals of health literacy and public health using the school as a setting.     

社会医疗保险共付制度对居民健康影响

目的 探讨社会医疗保险共付制度对医疗费用的影响和对患者健康状况的影响,为城镇居民基本医疗保险提供政策性建议.方法 利用我国6个省份、13个城市的城镇居民家庭调查数据,采用SPSS13.0软件进行T检验和Logistic回归分析.结果 自付医疗与公费医疗相比,健康人群医疗费下降了60.6%,非健康人群下降了61.4%.不同共付制度下人均医疗费用差异有统计学意义 (P<0.05),不同的共付比例对健康状况影响差异有统计学意义 (P<0.05).此外,年龄、性别、教育程度、收入对健康状况影响差异均有统计学意义 (P<0.05).结论 共付制度能够有效节约医疗费用,但对居民的健康状况也有明显的负向影响.     

依法婚前保健 促进生殖健康

《中华人民共和国母婴保健法》、《中华人民共和国母婴保健法实施办法》是婚前保健步入依法服务轨道 的法律保障。明确了婚前保健服务方针,界定了婚前保健服务机构、服务人员、服务对象及相关部门的法律责任;规定了 婚前保健服务范围;严格了监督机制,标志着婚前保健工作进入了一个崭新的阶段。     

Institutional one health and animal-human health connections in Nthongoni,Eastern Kenya

In recent years, there has been increased global advocacy for the use of a collaborative, multisectoral, and transdisciplinary approach: a One Health approach, with the goal to achieve optimal health outcomes for people, animals and their shared environment. This study explored One Health implementation and practice in Kenya. Further, I used a case study of Nthongoni, a remote rural area in Eastern Kenya, to help us to understand and think about implementation of One Health in an area where mainstream biomedical system runs parallel to or is in conflict with, a deeply entrenched indigenous health system. I used a qualitative research approach including participant observation, and key informant and general respondents' in-depth interviews. Data was transcribed verbatim, translated, checked for consistency and coded for content and thematic analysis. The findings indicate that although Kenya's One Health approach was hailed as a key strategy and a model for other countries in the region, the approach faced significant challenges including insufficient funding, competing priorities and concerns over its sustainability. But while the formal One Health is embroiled in structural and politico-economic influences that curtail its operationalization and success, this study illuminates a lay one health that is part of lived realities in Nthongoni, inviting us to reflect on the place for and status of traditional healers, and meaning of health for people and animals. The study further provokes our thoughts over whether One Health should integrate or do away with traditional health systems, or be abandoned altogether. I argue that incorporating traditional health knowledge and practitioners in One Health might help to make health care more robust and culturally responsive. The work contributes to debates on anthropology of health in general and to anthropological understanding of both the lay one health and the institutional One Health agenda.     

Variation in the infant health effects of the women,infants, and children program by predicted risk using novel machine learning methods

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has an extensive literature documenting positive effects on infant health outcomes, specifically preterm birth, low birthweight, small size for gestational age, and infant mortality. However, existing studies focus on average effects for these relatively infrequent outcomes, thus providing no evidence for how WIC affects those at greatest risk of negative infant health outcomes. Our study focuses on documenting how WIC's infant health effects vary by level of risk. In doing so, we leverage a uniquely rich database describing maternal and infant outcomes and risk factors. Additionally, we use high dimensional data to generate predictions of risk and combine these predictions with the novel double machine learning method to stratify the effects of WIC by predicted risk. Our estimates of WIC's average treatment effects align with those in the existing literature. More importantly, we document significant variation in the effects of WIC on infant health by predicted risk level. Our results show that WIC is most beneficial among those at greatest risk of poor outcomes.     

Education for health: case studies of two multidisciplinary MPH/MSc public health programmes in the UK

Amidst the winds of change that are blowing across the UK public health (PH) landscape in relation to the essential abilities and national standards that are required for the 'art and science' of PH, the preparation for a new cadre of 'PH professionals' is already underway. Several postgraduate masters programmes in public health (MPH) have taken on board the challenge of addressing the requisite sets of skills and expertise as a guide to their content and delivery. Although there are recommendations regarding teaching PH to undergraduate medical students, little consensus seems to exist on teaching postgraduate PH to non-medically qualified professionals, health managers and administrators. Employing a case study approach, this article analyses the methods used, philosophies and processes, structure and organization, outcomes to date, and lessons learnt from MPH programmes implemented at two institutions in the UK. The programmes have been initiated recently, and have had the opportunity to take on board the recent national guidelines about training standards. The findings indicate that preparatory work of the programmes, and the challenges and strengths in meeting the recent policy developments in PH training are pertinent points. The MPH programmes highlight key issues in interprofessional education and its purpose, its process and its outcomes in relation to multidisciplinary specialist practice. These programmes provide a variety of models for others wishing to develop or restructure their postgraduate PH teaching programmes. The finalization of the national standards for specialist practice in PH in the UK is encouraged, along with clearer working definitions of the domains of expertise required. Collectively, attention to these measures can ensure that the processes which teaching programmes embrace to refine their content and delivery will equip tomorrow's professionals with PH knowledge and skills.     

A self-directed fieldwork program to provide alternative occupational health placements for undergraduate occupational therapy students

Second-year students of undergraduate occupational therapy at the University of Newcastle, NSW, undertake a fieldwork placement in occupational health. However, sufficient placements are not always available. A new fieldwork program attempts to meet this need. Three groups of students conducted risk assessments throughout the academic year, with generally positive results. Students enjoyed the self-directed nature of the placement and the opportunity to learn generic and occupational health related skills. Although there were some limitations to the program, we believe that fieldwork placements met the learning needs of second-year students and offered them an excellent opportunity to gain practical experience related to occupational health practice in prevention.     

Physical health,mental health,and behaviour problems among early adolescents in foster care

Background Adolescents with chronic illness in the general population are at increased risk of mental health and behaviour problems. Depression is also associated with delinquency. Adolescents in foster care are more at risk for chronic illness and mental health issues. We investigated whether adolescents in long‐term foster care with chronic illness have associated higher rates of internalizing and externalizing problems and delinquency. We also investigated if depression mediates the relationship between physical health and externalizing behaviours. Methods Data are from the National Survey of Child and Adolescent Well‐Being; adolescents age 11 and older residing in long‐term foster care (n= 188). Children whose caregivers reported on the occurrence of a chronic illness were compared using anova on internalizing and externalizing subscale scores and total scores of the Youth Self Report (YSR) and Child Behavior Checklist (CBCL), and modified Self‐Report of Delinquency (MSRD) scores of delinquency and total number of delinquent acts. Bootstrapping analyses were used to test our hypothesis that depressive symptoms (Children's Depression Inventory) function as a mediator. Results Adolescents with a chronic illness reported greater internalizing (YSR: F= 7.069, P= 0.009; CBCL: F= 4.660, P= 0.032) and externalizing (YSR: F= 5.878, P= 0.016; CBCL: F= 3.546, P= 0.061) problems, a greater number of delinquent acts (6.66, F= 5.049, P= 0.026) and heightened overall delinquency (F= 5.049, P= 0.026). Depression significantly mediated the effects of overall health on delinquency (95% CI, 0.03–1.76). Conclusions It is important to consider the complex interrelationships between physical health, mental health, and behaviour for adolescents in foster care. These findings support the need for comprehensive services for these youths, including specialized assessments and collaboration between protective services and healthcare systems.     

Association between health behaviour and self-reported health in Estonia, Finland, Latvia and Lithuania

BACKGROUND: The aim of the present study is to examine the associations of the selected health behaviours (daily smoking, frequent strong alcohol use, consumption of fresh vegetables less than 3 days a week and leisure time physical activity less than two/three times a week) to the self-assessed health after adjustment to the age and education in Estonia, Finland, Latvia and Lithuania. METHODS: Data from cross-sectional surveys carried out in all the above-mentioned countries were used. The methodology and questionnaires of the surveys were standardized between the participating countries within the Finbalt Health Monitor System. Logistic regression was used to assess the effect of self-perceived health status on prevalence of health behaviours. RESULTS: In Finland both women and men rated their health better than both genders in all the Baltic countries. In Finland self-assessment of health is significantly associated with most health behaviours, but in the Baltic counties the associations are weak or unstable. CONCLUSION: The results suggest that in Finland as in many other stable countries self-assessed health status was related to health behaviours and can be used as an indicator of health behaviours. In the Baltic countries, factors other than health behaviours may be more relevant to the self assessment of health status.     

参与型口腔健康教育对口腔卫生知信行的影响

目的评价参与型口腔健康教育对牙周健康状况及相关知识、行为改善的影响。方法将北京市两个城区中8个社区或单位的300名15～64岁的志愿参加者分为实验组（参与组）和对照组（常规教育组）。参加者在基线、6个月和12个月时，接受牙周健康状况的检查和问卷调查。基线检查后，对所有参加者进行龈上洁治术。随后对实验组在专题小组访谈的基础上，进行小组讨论形式的参与型口腔健康教育，在6个月当中，提供在家使用的保健牙刷、牙间隙刷、牙膏和菌斑染色片。同时，提供专为口腔健康教育设计的阅读材料。对照组发给同样内容的健康教育阅读材料。最后比较两组间在牙周健康状况、口腔卫生知识和行为方面的改善情况。结果12个月后实验组牙石指数的均值明显低于对照组（P〈0．05），并有显著性差异。在口腔卫生知识和行为方面，实验组也在刷牙方法、选择保健牙刷、更换牙刷频率和使用牙间隙刷上比对照组提高了8．7％～31．3％。结论参与型口腔健康教育方法能明显改善牙周健康状况，能提高参与者的口腔卫生知识和行为。     

货币时间当量、潜在卫生资金与卫生事业大发展

我国由政府组织筹集的潜在卫生资金数量巨大,潜在卫生资金具有随时失去、不可存储,指向未来、可以计划,外部转化、等同货币等特点。将潜在卫生资金转化为卫生资金,可解决卫生事业大发展问题,对此,需要坚持政府主导、市场运作、银行参与、保医密接、供需同补等原则。     

Socioeconomic status, psychosocial health and health behaviours among Hungarian adolescents

BACKGROUND: While socioeconomic differences in health, morbidity, and disability are highest among middle-aged persons, there is a certain level of 'equalization' during adolescence and young adulthood. Despite this equalization, however, there still are differences in psychosocial variables or health-related behaviours, often very subtle and sometimes difficult to measure. METHODS: Using data (n = 1114) on high school students (aged between 14 and 21 years) from the Southern Plain Region, Hungary, the present study looks at the role of multiple SES indicators (objective and subjective; occupation and education; family structure) in adolescents' psychosocial health (self-perceived health, psychosomatic, and depressive symptomatology) and health behaviour (substance use and sports activity). RESULTS: Based on the results of multivariate logistic regression analyses, findings suggest the following: (i) SES self-assessment proved to be a significant predictor of adolescents' psychosocial health and health behaviours; (ii) family structure (that is, living in a non-intact family) also significantly influenced adolescents' psychosocial health and health behaviours; (iii) parents' employment status and schooling had a limited influence on their children's health outcomes; (iv) in a word, SES gradients in adolescents' psychosocial health and health behaviour were inconsistent and sometimes irregular (that is, inverse). The subjective SES measurement plays an important role (positive association), whereas certain types of parents' inactive status (in terms of labour market, that is, unemployment or retirement) seem to act in a predictable way (negative association). CONCLUSIONS: Our results indicate that despite certain level of equalization during adolescence, some important relationships between SES variables and health outcomes may occur.     

Iron, meat and health

This article is a summary of the publication "Iron and Health" by the Scientific Advisory Committee on Nutrition (SACN) to the U.K. Government (2010), which reviews the dietary intake of iron and the impact of different dietary patterns on the nutritional and health status of the U.K. population. It concludes that several uncertainties make it difficult to determine dose-response relationships or to confidently characterize the risks associated with iron deficiency or excess. The publication makes several recommendations concerning iron intakes from food, including meat, and from supplements, as well as recommendations for further research.     

开展区域卫生规划进行卫生资源调整积极探索社区卫生服务发展新思路

全面实施区域卫生规划，加强卫生资源的宏观管理，能够充分地合理配置和有效利用卫生资源。文章介绍了天津市在充分做好调查研究的基础上，以区域卫生规划为指导，开展全市卫生资源调整，积极推进社区卫生服务发展的思路和具体做法，以期引起讨论。     

Modifiable health risk factors,related counselling,and treatment among patients in health centres

Chronic disease burden and its related health risk factors are especially concentrated among the poor. Community health centres reach the nation's most vulnerable population. This study explored the prevalence, racial/ethnic, and gender disparities of five modifiable health risk factors and the receipt of related counselling and treatment among patients in U.S. federally qualified health centres. The 2014 Health Center Patient Survey was used for this study. We performed a cross‐sectional study. Measures included tobacco use, excessive alcohol consumption, obese/overweight, high blood pressure, high blood cholesterol, and five related counselling/treatment measures. Logistic regression models were conducted to examine the multivariable‐adjusted putative associations of several sociodemographic and health‐related factors with modifiable health risk and counselling/treatment measures. Preliminary findings revealed differences in modifiable health risk factors across different racial/ethnic groups, while few racial/ethnic differences existed in related counselling/treatment measures. In the multivariable‐adjusted logistic regression models, these differences in health risk factors were still apparent, while associations between race/ethnicity status and counselling/treatment measures were not detected. Gender was also a predictor for four types of health risk measures and two types of counselling/treatment measures. Health centre patients had high rates of modifiable health risk factors. The rates were different across race/ethnicity groups, and the differences found did not always favour non‐Hispanic Whites. However, the findings reveal equitable access to related counselling/treatment service among patients across race/ethnicity groups.