社区妇女围绝经期保健现状及需求情况分析

目的本研究旨在通过调查社区妇女围绝经期保健现状及卫生服务需求情况,为健康教育及健康促进提供依据。方法随机选自2016年5-12月自愿前来参加居民妇科普查的40～65岁妇女1 000例为研究对象,采用调查问卷方式就其保健现状和需求展开调查。结果调查发现只有37. 31%的妇女在围绝经期症状发生后主动寻求保健服务,接受激素替代疗法的占6. 88%;围绝经期保健知识知晓率为62. 48%,只有35. 29%的妇女知道有更年期保健门诊,知识来源于医疗机构的只占22. 65%;健康行为形成率最高的是定期体检,最低的是调整心态;保健需求排在前3位的有:定期健康体检、妇科疾病诊治、妇女保健健康教育;希望获得围绝经期的自我监测知识意愿最高,最愿意通过医务人员来居委会办专题讲座来获取健康相关知识。结论社区妇女健康行为形成率低,保健需求迫切,因人而异开展保健宣教,提供便捷、经济、有效和贴近生活的卫生服务从而提高我国围绝经期妇女生活质量。     

罗定市妇女围绝经期症状与保健需求调查分析

目的调查了解罗定市妇女围绝经期症状和保健需求,提出合理的围绝经期保健措施,提高妇女的健康水平和生活质量。方法采用统一调查问卷和分层整群随机抽样方法,选取罗定市560例40~65岁妇女进行问卷调查。结果在560例妇女中,出现围绝经期症状有374例,发生率为66.8%,发生的主要症状有失眠,烦躁,性欲下降,头晕,容易疲劳或乏力,肌肉、骨关节疼痛等。出现围绝经期症状而就医者仅有30.6%,在未就医者当中有1/3妇女采取了自我保健的方式;有2/3妇女认为没有必要采取治疗措施。结论罗定市妇女围绝经期症状发生率与全国平均水平(2/3)相近。因此,建议我市妇女保健工作要加强围绝经期保健知识教育,普及、加强自我保健,对严重影响妇女健康的围绝经期症状采取规范的性激素治疗,以提高围绝经期妇女的生活质量。     

汕头市妇女围绝经期健康状况及保健需求调查

目的 调查了解汕头市围绝经期妇女的健康状况和保健需求,提出合理的围绝经期保健措施. 方法 采用统一调查问卷和整群随机抽样方法,选取汕头市756例35～59岁妇女进行问卷调查. 结果 围绝经期综合征发生率为63.49%,前两位保健需求为定期体检(61.92%)和围绝经期咨询(57.67%). 结论 汕头市妇女围绝经期综合症发生率与国内其他城市水平相似,围绝经期保健需求迫切,应加强健康教育,提高保健意识和保健行为.     

丽水地区农村围绝经期妇女健康状况和保健需求研究

目的:了解丽水地区农村围绝经期妇女的健康现状和保健需求,为改善农村围绝经期妇女健康状况提供帮助,为建立农村围绝经期妇女保健服务模式提供依据。方法:采用多阶段随机组群抽样方法,选取丽水地区农村40～55岁的妇女540人为调查对象,使用统一问卷进行入户现场调查。结果:在540例接受调查的妇女中,月经正常或基本正常306例,月经紊乱119例,绝经115例,自然绝经平均年龄为(49.21±2.18)岁。围绝经期综合征发生率为78.1%,主要症状为骨关节肌肉痛380例,失眠355例,头痛316例,头晕心悸316例,烦躁不安281例,易激动292例。不同年龄组别之间的妇女生存质量状况比较差异均有统计学意义(P<0.01)。只有17.4%妇女了解围绝经期知识,围绝经期激素补充治疗(HT)率2.4%;仅有35.6%的围绝经期妇女1～2年内有过健康体检。结论:丽水地区农村妇女保健意识薄弱,围绝经期综合征发病率高。开展农村妇女围绝经期的全科医疗卫生保健服务,加强围绝经期综合征的综合防治,有利于提高农村妇女的健康水平和生存质量。     

围绝经期妇女健康状况及需求调查

目的:了解围绝经期妇女健康状况即围经期综合征的发生情况及其对生活的影响,患者的就医情况和保健意识及需求,为更好地为围绝经期妇女提供有针对性的、优质的服务提供依据,以期提高其生活质量。方法:对武钢40～60岁妇女以厂为单位按不同年龄段进行整体抽样调查,调查内容包括对象的基本情况,症状的有无,有症状者的治疗情况及其对围绝经期妇女生活的影响,对围绝经期知识了解情况、途径及需求。结果:调查对象中80.30%的妇女有自觉的围绝经期症状,其中40～50岁妇女以神经系统症状较为突出,发病率达50%以上。51～60岁妇女以骨关节疼痛和心血管系统的症状较为突出,发病率达62.80%。对围绝经期知识有所了解的围绝经期妇女仅占总人数的47.55%。希望得到围绝经期知识指导的围绝经期妇女占58.05%。结论:围绝经期综合征发病率高,接受治疗率低,知晓率低,围绝经期妇女对围绝经期知识及服务的需求高。     

上海农村围绝经期妇女健康状况及保健需求的分析

目的:了解农村社区40~55岁围绝经期妇女健康状况和保健服务需求,阐述在农村社区妇女中开展围绝经期保健的重要性和必要性,探讨在农村社区中开展围绝经期保健的适宜技术。方法:选择上海市嘉定区某社区40~55岁妇女1667人进行问卷调查,了解其健康状况、围绝经期相关保健知识知晓情况和保健服务需求。结果:48.59%的被调查者至少有一种及以上围绝经期相关症状。34.5%的被调查者对围绝经期综合征有认知。15.9%的有围绝经期症状妇女接受过医疗保健服务,其中到社区医院就诊的仅占13.4%,到妇科就诊的占70.1%,而其余的去内外科或精神科就诊。结论:①农村社区40~55岁妇女中将近半数有不同程度围绝经期综合征症状。②围绝经期妇女缺乏相关保健知识,不能及时就医及有乱投医情况。③社区围绝经期保健服务滞后。总之,在农村社区开展围绝经期妇女保健工作相当重要和必要,顺应农村妇女的需求,是妇女保健工作内涵的深入,也是社区六位一体功能的体现。     

青岛市围绝经期妇女健康状况调查

目的:了解青岛市围绝经期妇女健康状况,为制订相应的保健措施提供依据。方法:采用整群随机抽样方法,选取青岛市城郊1 600名35~59岁女性作为调查对象,进行围绝经期相关健康状况的流行病学调查。结果:妇女平均绝经年龄为(49.70±3.35)岁,84%绝经前发生月经紊乱。常见的围绝经期症状为情绪波动、潮热出汗、性生活异常、失眠、疲乏,发生率分别为36.75%、34.94%、33.19%、32.38%、31.25%,症状的发生率有年龄差异,且随年龄的增长呈增加趋势。绝经的低骨量发生率为61.70%(29/47),明显高于未绝经的9.90%(10/101)。体重指数(BMI)随年龄而增加,45~59岁BMI均数>24;慢性疾病发生率也随年龄而增加。55~59岁潮热发生率高达64.26%。年龄大、生活压力大、文化水平高、吸烟、绝经、患有慢性疾病等是影响症状的主要因素。性激素周期序贯法治疗围绝经期综合征,Kupperman评分和抑郁自评量表评分明显降低。结论:积极开展健康教育,加强自我保健,规范应用性激素,是提高围绝经期妇女生活质量的重要措施。     

妇女围绝经期症状及保健需求调查

目的:了解上海妇女围绝经期症状发生情况、对围绝经期的认识及围绝经期的保健需求,以指导干预。方法:以社区为基础进行抽样,采用入户面访的方式进行问卷调查。结果:平均绝经年龄(49.96±3.13)岁,围绝经期症状发生率为62.37%。50~和55~岁年龄组症状发生率分别为61.99%和62.85%。9.5%的人认为有必要进行定期的妇科检查,只有32.52%的人近两年做过妇科检查,对各种妇女保健知识需求选择“是”的均在70%以上,有52.13%的人希望医生来居委会提供服务。结论:妇女围绝经期症状发生比例较高,保健意识还有待提高,对社区的围绝经期卫生保健服务及有关知识需求较高。     

围绝经期妇女保健

关注围绝经期妇女对保健知识的需求,实施保健指导,改善围绝经期妇女的身心健康,提高妇女生活质量。     

围绝经期妇女抑郁症状影响因素调查

目的:探讨上海市部分城区围绝经期妇女抑郁症状发生现状、影响因素及其心理保健需求。方法:采用一般情况调查表、改良更年期Kupperman评分量表、社会支持评定量表、病人健康问卷抑郁量表、围绝经期妇女心理卫生保健态度及需求调查表,于2010年12月～2011年2月在上海某社区内对935名参加普查的45～59岁妇女进行调查。结果:①围绝经期妇女抑郁症状呈现率24.8%。上海本地户籍者抑郁症状呈现率22.7%,外地户籍者抑郁症状呈现率50.7%。②与围绝经期妇女抑郁症状发生有关的影响因素包括户籍、痛经程度、1年内子女长期离家、重病、感觉异常、关节肌肉痛、更年期综合征、主观支持评分、客观支持评分等。③围绝经期妇女的保健意识和知识:39.8%的围绝经期妇女不关心心理卫生保健,分别有69.5%和61.9%围绝经期妇女选择视听媒体和报刊杂志作为保健知识的主要获得途径。结论:上海市围绝经期妇女抑郁症状呈现率较高,与多种社会、心理、生物学影响因素有关,为围绝经期妇女提供心理保健应该纳入妇女保健工作内容。     

健康管理现状与发展思考

目的：探讨健康管理改进途径,有效利用有限资源预防疾病、维护健康,提高健康管理水平。方法通过梳理国内外健康管理发展现状,分析我国健康管理特点与问题。结果我国健康管理水平逐渐提高,有社区卫生中心、医疗机构和体检中心模式,但健康管理产业仍需改进。结论加速健康管理产业三个转变;完善学科教育体系;加快健康管理信息服务平台建设;开展健康危险度评估。     

Performance measures: are we measuring what matters?

BACKGROUND: The ultimate intent of healthcare performance measures is to improve health status by stimulating improvements to healthcare quality. This report evaluates how well current performance measurement sets address the leading causes of illness and death in the United States, using the Health Plan Employer Data and Information Set (HEDIS) as an example. METHODS: We assessed whether HEDIS measures exist for the leading causes of illness and death according to five commonly used indices: physiologic cause of death, underlying cause of death, disability-adjusted life years, healthcare expenditures, and missed work days. RESULTS: Fewer than one half of the leading causes of morbidity and mortality are addressed by current measures. CONCLUSIONS: The opportunities for using accurate and meaningful measurement for disease prevention and health promotion are substantial, yet this potential remains only partly realized and depends on further expansion of performance measurement efforts.     

How To: How to Improve Patient Education

The need to manage medical information in healthcare delivery requires that information technology be optimized in diagnosing diseases; in planning and administering treatment; and in monitoring patient outcomes, services, and costs. The goals of this article are twofold: (1) to identify healthcare-specific software that addresses specific parameters set forth by the World Health Organization (WHO) for healthcare information systems and (2) to identify issues that managers should keep in mind when choosing an integrated information systems software package. For our analysis, we gathered, through Internet research, information about more than 400 software products from more than 200 companies.     

上海市高端社会办医发展的现状及趋势

目的:了解上海市高端社会办医发展的现状及趋势。方法:应用机构数量等7个指标分析其资源配置状况,应用门急诊人次等2个指标对其服务量进行分析,应用次均门诊费用等8个指标分析其费用情况,通过不同类别机构之间的横向比较分析2013年上海市高端社会办医机构的整体情况,并对2011—2013年高端社会办医情况进行纵向比较,分析其发展趋势。结果:目前上海市高端社会办医机构资源配置水平偏低,规模化建设尚处于初期阶段,医务人员结构欠合理;高端社会办医机构服务总量虽迅速增加,但仍远低于公立医院特需服务量;高端社会办医机构医疗费用总体处于较高水平,内部结构较为合理。结论与建议:当前上海市高端社会办医尚处于发展初期,但发展前景广阔。高端社会办医应在医疗技术、服务水平、管理能力、人力队伍建设、品牌发展等方面加以强化。     

What can the Canadians and Americans learn from each other's health care systems?

Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single‐payer system to save 12–20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white‐collar jobs at hospitals, physician offices and insurance companies, a long‐term economic gain. Only a few would agree with the statement that Canada already functions with a multi‐payer reimbursement system as evidenced by (1) a federal‐provincial, tax‐supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer‐paid health insurance benefits, underwritten primarily by investor‐owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper‐income Canadians could opt out of their federal‐provincial plan and purchase private insurance coverage — being eligible for far more comprehensive “private” benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non‐emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to “private” wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two‐tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in considerable political rancor. There is greater likelihood, however, that the Canadians because their need to be more effective and efficient in their delivery of care, and their overall long‐term fiscal outlook will agree to the further privatization of their healthcare system before the Americans will mandate universal access, use the smart card to process insurance eligibility and claims or will impose price controls on high‐tech services and on pharmaceuticals. Copyright © 2016 John Wiley & Sons, Ltd.     

用“公共卫生路径”的思路控制公共卫生质量和成本

目前状况下的农村卫生工作是极具中国特色、极富挑战的研究内容，理清卫生工作理论和实践两方面的线索是当前亟需解决的重要问题。由于公共卫生成本需求不能完全与高成本需枣的医疗服务相比，因此，不能简单地以公共卫生费用占卫生事业费份额作为标准来对公共卫生投入是否适宜进行评价。公共卫生服务工作亟需健全标准化、完整的、规范化、量化的，以服务的绩效质量为标准的计划、实施、评估体系。     

病例缺陷分析与医疗质量研究

病例质量控制是医疗质量管理的核心内容,采用回顾调查方法调查了250例住院病例,从病历、诊断、治疗、抢救等方面进行分析,发现病历书军存在问题最多,并直接影响之后的诊疗过程各环节。临床医师在该质控中作用重要,加强临床医师素质培养,提高诊疗水平,主动查找病例缺陷,发现并及时纠正、减少直到避免病例缺陷是不断提高医疗质量的必要前提。     

Quotable Quotes

Patient adherence is extremely important to achieve positive outcome. While quality of healthcare service has been studied as a determinant of patient satisfaction and loyalty, its impact on patient adherence has not been examined. The authors attempt to determine dimensions of quality and their impact on patient adherence in primary healthcare in India. Exploratory factor analysis resulted into seven factors. Factor scores were used for regression to identify the influence of dimensions of service quality on patient adherence. Quality of healthcare emerged as a determinant of patient adherence.     

高端医疗服务的概念、内涵与优先发展领域——以上海为例

高端医疗服务既是社会资本办医的主要方面,也是健康服务业鼓励发展的产业之一,是我国"十三五"时期医疗卫生发展的重要内容。文献研究表明,目前国内对高端医疗服务的内涵缺乏明确的阐述,而这是开展高端医疗服务相关研究的基础和前提。本研究通过系统综述、现场调查和关键知情人访谈等方法,明确了当前我国社会经济环境下高端医疗服务的概念、内涵,结合上海市工作实践,借鉴国际先进经验,建议应优先发展健康管理、医疗养老、移动医疗等领域。     

最新国际医疗质量过程管理的精益医疗服务方式

目前美国医院管理接受最新精益医疗服务方式（Lean Production Methods）的原则是在最大程度上积极地努力提高医疗质量，同时最大程度科学地优化医疗资源而降低医疗成本。文章旨在将医院管理前沿、最先进的精益医疗服务方式的46步法则实施步骤系统地向医院管理者介绍，使之成为在医院管理工作中不断持续改进医疗质量的方法。