Adverse health behaviors and chronic conditions in working-age women with disabilities

This retrospective, cross-sectional, multiple cohort study of women with disabilities addresses two health-related areas in a nationally representative sample of women living in the community. Using data from the 1997-1998 National Health Interview Survey (NHIS), health risk behaviors and chronic conditions were examined for women with mild, moderate, and severe functional limitations, and their responses were compared to those of women who reported no limitations. Women with severe limitations evidenced the highest risk for heavy cigarette smoking. They were also more likely to meet the Body Mass Index criterion for obesity. Adverse health behaviors were strongly associated with the five potentially disabling chronic conditions that were studied.     

绵阳市5岁儿童口腔健康相关行为抽样调查

目的:了解绵阳市5岁儿童口腔健康行为现状和口腔卫生服务利用情况,为口腔卫生保健工作规划和口腔卫生服务项目效果评估提供信息支持。方法:采用分层、多阶段、不等比、随机抽样的方法,抽取绵阳市5岁常住人口734名,采用第三次全国口腔健康流行病学问卷调查方案设计的问卷进行调查。了解5岁儿童的饮食行为、口腔卫生行为以及利用口腔医疗服务行为。结果:每天进食至少1次的食品主要是新鲜水果、甜点心和糖果/巧克力,72.5%的儿童有睡前吃甜点或喝甜饮料的行为,近80%每天刷牙1～2次,含氟牙膏使用率仅为15.9%。42.5%的儿童近2年未接受口腔检查。城乡5岁儿童相比,睡前吃甜点、开始刷牙年龄、刷牙频率、家长帮助刷牙和家长检查刷牙均具有统计学差异。结论:绵阳市儿童口腔健康行为有待改善,有必要加强对家长的口腔健康教育,促使儿童树立正确的口腔健康行为。     

中国卫生总费用研究30年：历程与特点

中国医药卫生体制改革30年来,卫生总费用研究从无到有,由易到难,由边缘到主流,成为医药卫生体制改革、宏观卫生政策研究和卫生财政学的核心议题。笔者分四个阶段全面系统回顾了卫生总费用研究的发展历史与基本特征,客观描述了卫生总费用的研究现状、研究范围与主要成果,明确提出了卫生总费用研究的战略议题和优先领域,以期为医药卫生体制改革总体方案设计、公共财政体制与卫生财政体制建设,构建公共服务型政府提供超前理论指导和理论基础。     

Gaps in health coverage among working-age Americans and the consequences

This paper examines health coverage and access to care among working-age adults using the Kaiser/Commonwealth 1997 National Survey of Health Insurance. One in three (52 million) working-age adults were either uninsured at the time of the survey or had a recent gap in their health coverage in the past two years. Having even a temporary gap in health coverage made a significant difference in access to care. Compared to the elderly, who are continuously covered by Medicare, working-age adults have greater problems paying their medical bills and gaining access to care and are less satisfied with their health insurance coverage.     

The role of health-related behaviors in the socioeconomic disparities in oral health

This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988–1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.     

改革开放30年来我国政府卫生投入及政策回顾

改革开放以来，政府卫生投入年均增幅高于财政支出年均增幅，但政府卫生投入占卫生总费用的比重逐年下降。政府公共卫生投入经历了从改革开放前的全额预算管理，到改革开放后预算内拨款比重下降、预算外资金逐步增加，直至2003年以后加大投入的过程；而政府基本医疗投入则经历了从计划经济时期“供需兼补、补供为主”到市场经济体制下“需方为主、购买服务”的转变，并向城乡基层卫生机构倾斜。     

Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage

South Korea introduced mandatory social health insurance forindustrial workers in large corporations in 1977, and extendedit incrementally to the self-employed until it covered the entirepopulation in 1989. Thirty years of national health insurancein Korea can provide valuable lessons on key issues in healthcare financing policy which now face many low- and middle-incomecountries aiming to achieve universal health care coverage,such as: tax versus social health insurance; population andbenefit coverage; single scheme versus multiple schemes; purchasingand provider payment method; and the role of politics and politicalcommitment. National health insurance in Korea has been successfulin mobilizing resources for health care, rapidly extending populationcoverage, effectively pooling public and private resources topurchase health care for the entire population, and containinghealth care expenditure. However, there are also challengesposed by the dominance of private providers paid by fee-for-service,the rapid aging of the population, and the public-private mixrelated to private health insurance.     

中国成年及老年人预防性口腔卫生行为状况

目的 了解中国35~44岁成年人和65~74岁老年人看牙、洗牙、刷牙、使用含氟牙膏4种预防性口腔行为水平及达到《中国居民口腔健康指南》推荐标准情况。方法 采用多阶段分层随机整群抽样方法,对全国23 271名35~44岁成年人和8 902名65~74岁老年人就上述4种口腔卫生行为进行问卷调查,采用描述性统计分析方法对调查结果进行分析。结果 中国35~44岁居民达到《指南》推荐的“每年进行1次口腔检查”、“每年洗牙1次”、“早晚刷牙”、“使用含氟牙膏刷牙” 4种口腔卫生行为的人数比例分别为8.4%、2.3%、36.3%和42.3%,65~74岁居民达到标准的人数比例分别为12.1%、1.5%、22.1%和32.5%;城市居民4种口腔行为达到推荐标准的人数比例均高于农村居民(P<0.05);每年口腔检查、早晚刷牙、使用含氟牙膏行为达标比例均为东部地区>中部地区>西部地区(P<0.05);女性口腔检查和早晚刷牙情况好于男性(P<0.05);不同地区、性别居民洗牙情况差异无统计学意义(P>0.05)。结论 当前中国成年人和老年人的4种口腔卫生行为达到《指南》推荐标准的人群比例均较低,并以农村地区、西部地区、男性最为突出,应采取及时有效的干预措施。     

Understanding parents' oral health behaviors for their young children

Young children with extensive dental decay often require a general anesthetic (GA) to enable dental treatment. The purpose of this study was to develop a grounded theory to help our understanding of the processes that influence parental adoption of dentally healthy behaviors following the experience of their child's "dental general anesthetic." Twenty six interviews were conducted. Data were analyzed and a conceptual model was generated. Overall, the dental GA experience had an immediate, but short-lived, impact on parental behavior change. Parents had difficulty over time maintaining these behaviors. Social influences, family context, and parenting strategies were the key categories that influenced parental behavior change; however, parenting strategies occupied the central position in the model. Cultural beliefs, actions of dental professionals, and media/advertising were some of the identified barriers to behavior change. Those parents who were more confident in their ability to successfully carry out dentally healthy practices were more likely to maintain them over time.     

Arc welders' respiratory health evolution over five years

Summary The respiratory health of 138 arc welders and 106 control subjects in the same company was studied in 1981 and in 1986. Most of the subjects welded mild steel using the Metal Inert Gas (MIG) process. The controls were workers in the same company, not exposed to any known pulmonary risk. The welders and controls in the analysis had not changed their professional activity nor their smoking habits during these five years. The examinations consisted of a questionnaire on respiratory symptoms, a thoracic auscultation, a chest X-ray and lung function tests: flow-volume curve and steady state CO transfer test. The examinations in 1986 confirmed the risk of non specific radiological impairment (pulmonary reticulo-micronodulation) and of obstruction in the small bronchi, which had already been observed in 1981 in the arc welders in this company. These impairments did not seem to have evolved more than in the controls, but do however justify regular surveillance of the respiratory health of arc welders.     

Thirty years of fluoridation: a review

Fluoride contributes to stability of both teeth and bones and to reduction of caries, especially if ingested before eruption of teeth. Reduction of caries continues at about 60% in persons drinking fluoridated water only as long as fluoride washes over teeth. One-half the population of the US does not have access to water with an optimal fluoride concentration of about 1 mg/L. Misinformation about fluoridation contributes to reluctance of communities to supplement the natural but inadequate fluoride of those water supplies. Fluoridation of water has no positive or negative effect on incidence or mortality rates due to cancer, heart disease, intracranial lesions, nephritis, cirrhosis, mongoloid births, or from all causes together. The collective decision to increase the natural fluoride content of water supplies is not an infringement of civil rights, nor does it establish a precedent in the binding sense of the law. Supplemental fluoride in water makes it available to all members of the community in a safe, practical, economical and reliable manner. Fluoridation saves money in dental costs and time lost from work. Fluoridation is an appropriate action of government in promoting the health and welfare of society.