生命早期的健康管理

生命早期的营养环境以及生长发育状况,对成年后期的健康有独特而重要的影响,尤其是对慢性非传染性疾病的影响.健康管理需从生命早期开始,通过减小疾病风险,预防疾病的发生、发展,实现人人享有健康.     

《世界卫生统计2020》监测与健康相关的可持续发展目标(选译)

《2020年世界卫生统计》阐明了国际在实现可持续发展目标(SDGs)方面取得的进展,以及当前新冠疫情紧急情况下对世界卫生组织的影响,强调了需要全面和持续地跟踪人口健康及其决定因素.文章概要介绍了其中涉及的监测与健康相关的SDGs.     

Comparison of Patient-Based Oral Health Outcome Measures

OBJECTIVES: This project examined psychometric characteristics of four measures of oral-specific health-related quality of life. METHODS: We selected participants from two samples of community-dwelling male veterans from Boston (USA): (1) 538 users of VA outpatient medical care from the Veterans Health Study (VHS: mean age = 62); and (2) 211 relatively healthy men from the VA Dental Longitudinal Study (DLS: mean age = 70). Patient-based measures included the Geriatric Oral Health Assessment Instrument, the Oral Health Impact Profile (OHIP), the Oral Health-related Quality of Life instrument and the single-item self-report of oral health. Clinical variables included number of teeth, coronal decayed surfaces (CDS), a modification of the Root Caries Index (RCI_D), and the Community Periodontal Index of Treatment Need (CPITN). RESULTS: Cronbach's alpha ranged from 0.73 to 0.97. Percent of participants with floor and ceiling scores varied widely by instrument and by item. Patient-based measures were associated with all clinical measures in the combined sample. Number of teeth was associated with patient-based measures (p < 0.001). However, CDS, RCI_D and CPITN scores were associated with patient-based scores in the VHS but not in the DLS. The Geriatric Oral Health Assessment Instrument, the OHIP, the Oral Health-related Quality of Life instrument were strongly linearly related to the single-item global self-report of oral health (p < 0.0001). CONCLUSION: All multi-item measures have high internal consistency and all are valid for measuring oral-specific health-related quality of life.     

Recent Trends in Maternal, Newborn, and Child Health in Brazil: Progress Toward Millennium Development Goals 4 and 5

We analyzed Brazil''s efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil''s successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries.The world is now well past the midpoint for the achievement of the Millennium Development Goals (MDGs), a set of internationally agreed upon development aspirations to be achieved by 2015. Maternal, newborn, and child health are an integral part of these goals, yet global progress toward MDG 4 (reducing child mortality) has been uneven, and MDG 5 (improving maternal health) exhibits the least progress worldwide of all health MGDs.^1–3 The global economic crisis is also negatively affecting the most vulnerable women and children and threatens to undermine efforts to reduce persisting inequities in service delivery and health care outcomes.^1,4 In this context, it is becoming increasingly urgent to document and widely disseminate country success stories in improving maternal, newborn, and child survival so that they may be replicated elsewhere.Studies examining the success of low- and middle-income countries in increasing coverage of essential maternal, newborn, and child health services and narrowing the gaps between the richest and poorest population groups have attributed these accomplishments to health care reform measures and simultaneous improvements in women''s access to education and income earning opportunities.^5–8 These studies have shown that significant reductions in maternal, newborn, and child health inequities can be achieved under diverse political and economic conditions. Key to the success of countries'' efforts to progress toward MDGs 4 and 5 have been political commitment to universal access to services across the continuum of care⁹ and the adoption of specific measures (e.g., implementation of a coherent mix of financial protection schemes) aimed at ensuring that no population groups are excluded.^10,11Brazil, the nation with the largest economy in Latin America and a country historically characterized by substantial health and wealth inequities, has made rapid strides in improving maternal, newborn, and child health. In 2005, because of its high absolute number of child deaths, Brazil was included among the 60 priority countries (i.e., countries accountable for 94% of all child mortality) in the countdown to the 2015 deadline for achieving all MDGs.¹² The latest estimates show, however, that Brazil is on track for MDG 4 and is making good progress in increasing coverage for interventions relevant to MDG 5.¹³ Also, Brazil is unique among low- and middle-income countries because of its tax-based unified health service, introduced in 1988, that offers free and comprehensive health care to all Brazilian citizens regardless of employment status or contributions to Social Security.Brazil has 1 federal district (Brasilia) and 26 states (we refer to 27 states throughout for the sake of simplicity) divided into 5 regions: North, Northeast, Southeast, South, and West–Central. The Southeast and South regions are the most developed; the North and Northeast regions are the poorest. The North region, dominated by the Amazon area, is the largest, with 45.2% of the land area, but it comprises only 8.1% of the population. The West–Central region has the second largest area, but the population corresponds to only 7.1% of the country. Most of the population is concentrated in the Southeast (42%), and an additional 14.5% of the country''s residents live in the South, which has a subtropical climate. The Northeast region has a population of nearly 54 million, corresponding to 28.2% of the country''s residents.¹⁴Our goals were to investigate trends in maternal, neonatal, infant, and child mortality in Brazil from 1990 to 2007 and interpret these trends in the light of health sector reforms, the introduction of pro-poor policies and programs, and broad socioeconomic and demographic changes. To determine whether and how inequities in these mortality indices changed, we examined trends in child and infant mortality across wealth quintiles and regions. We also documented changes in the cause distribution of infant deaths nationally and by region and examined available maternal mortality estimates from 1990 to 2006.To identify possible reasons for the downward mortality trends and improvements in mortality differentials among children younger than 5 years, we assessed broad health sector changes, the introduction of specific programs and policies targeted at women and children, and coverage trends associated with proven maternal, newborn, and child health interventions during the study period. Changes in key socioeconomic, child nutritional status, and demographic factors known to influence maternal, newborn, and child health outcomes were also reviewed.     

Toward System-Wide Implementation of Patient-Reported Outcome Measures: A Framework for Countries,States, and Regions

ObjectivesThis study aimed to develop a framework facilitating (1) the maturity assessment of healthcare systems regarding patient-reported outcome measure (PROM) implementation and (2) the comparison of different healthcare systems’ PROM implementation levels to guide discussions and derive lessons for regional, state-level, and national PROM initiatives.MethodsGuided by the grounded theory methodology, a PROM healthcare system implementation framework was developed following multiple steps. Based on interviews with 28 experts from 12 countries and a literature review, a framework was drafted and refined through 29 additional validation interviews.ResultsThe resulting framework comprises 5 implementation stages along 7 dimensions. Implementation stages range from “first experimentation” to “system-wide adoption and a vibrant ecosystem.” The dimensions are grouped into patient-reported outcome (PRO) measurement and PRO utilization, the former with the dimensions “scope and condition coverage,” “metric and process standardization,” and “tools and information technology–based solutions” and the latter with “patient empowerment and clinical decision support,” “reporting and quality improvement,” and “rewarding and contracting.” The “culture and stakeholder involvement” dimension connects both groups. Although a concerted implementation approach across dimensions can be observed in advanced countries, others show a more uneven adoption.ConclusionsThe framework and its preliminary application to different healthcare systems demonstrate (1) the importance of coherent progress across complementing dimensions and (2) the relevance of PROM integration across clinical specialties and care sectors to strengthen patient-centered care. Overall, the framework can facilitate dialogues between stakeholders to analyze the current PROM implementation status and strategies to advance it.     

发展以价值为导向的医保支付模式：健康结果测量方法、进展与启示

健康结果是健康价值单元设定与购买的重要依据,科学合理地测量健康结果是发展以价值为导向医保支付模式的重要基础.通过深入分析国际上健康结果测量的方法、体系以及健康结果测量体系构建过程,为发展我国以价值为导向的医保支付模式提供参考.     

Leukemia: Progress Toward Prophylaxis

Key findings in research supported by the Special Virus-Leukemia Program of the National Cancer Institute point to the strong possibility that viruses responsible for some leukemias and lymphomas will be found and their role as direct or indirect causative agents verified. Dr. Rauscher describes some of the gains achieved in the 170 projects now under way.     

Functional Status Outcome Measures in Home Health Care Patients with Heart Failure

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches.     

The Health Care Home Model: Primary Health Care Meeting Public Health Goals

In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.THE AMERICAN PUBLIC HEALTH Association (APHA) has 3 overarching policy priorities: rebuild the public health infrastructure, ensure access to care, and reduce health disparities.1,2 The health care home model contributes to these goals by improving health care delivery at the patient level through redesigning and expanding the scope of primary health care services and improving the interface between primary care practices and public health agencies.In November 2010, APHA endorsed the health care home model of primary care for its public health value. Health care home, a term used by the National Association of Community Health Centers, is a model also referred to as the medical home.3,4 The health care home is a vehicle by which patient- and family-level care at the point of delivery may contribute to meeting population-level goals of improving access to care, reducing health disparities, increasing preventive service delivery, and improving chronic disease management.5 Here we summarize the APHA health care home policy statement and suggest next steps for moving the model forward.