卫生监督机构公共信息服务的定性研究

目的探讨卫生监督机构公共信息服务的现状和问题,并提出改进建议。方法 运用定性研究的焦点组访谈方法,对新闻记者和管理对象代表进行访谈。结果受访者对卫生监督公共信息关注度高,但卫生监督机构信息服务意识不强,在内容、时效、传播渠道等环节上有待改进。媒体对市民生活有指示性和警示性意义的信息较关注;管理对象对卫生法律法规、卫生标准等信息较关注。结论卫生监督机构应提高信息服务意识,强化公共信息服务功能,满足公众和管理对象的信息服务需求。     

Methods for Leveraging a Health Information Exchange for Public Health: Lessons Learned from the NW-PHIE Experience

The intent of this article is to provide public health and health information exchanges (HIEs) insight into activities and processes for connecting public health with clinical care through HIEs. In 2007 the CDC issued a Request for Proposal (RFP) for the “Situational Awareness through Health Information Exchange” project. The project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. This article describes the approach and methodology used by the Northwest Public Health Information Exchange to achieve the project’s goals. The experience of the NWPHIE Collaboration provides an organizational and operational roadmap for implementing a successful regional HIE that ensures secure exchange and use of electronic health information between local and state public health and health care entities.     

Factors Affecting Latina Immigrants’ Perceptions of Maternal Health Care: Findings From a Qualitative Study

Due to the influx of Latino immigration in the United States, health care services are faced with the challenge of meeting the needs of this growing population. In this qualitative study, we explored Latina immigrants’ experiences with maternal health care services. We found that despite enduring language barriers and problems, Spanish-speaking women expressed satisfaction with their care. Factors influencing women's perceptions of care included sociocultural norms (respeto, personalismo, and familismo), previous experiences with care in their countries of origin, having healthy babies, and knowledge about entitlement to interpreter services. We offer recommendations for public health practice and research.     

Leveraging Health Information Exchange to Support Public Health Situational Awareness: The Indiana Experience

Public health situational awareness is contingent upon timely, comprehensive and accurate information from clinical systems. Ad-hoc models for sending non-standard clinical information directly to public health are inefficient and increasingly unsustainable. Information sharing models that leverage Health Information Exchanges (HIEs) are emerging. HIEs standardize, aggregate and streamline information sharing among data partners, including public health stakeholders, and HIE has supported public health practice in Indiana for more than 10 years. To accelerate nationwide adoption of HIE-supported situational awareness processes, the CDC awarded three HIEs across the nation, including Indiana, New York and Washington/Idaho. The Indiana partners included Indiana University School of Medicine, Regenstrief Institute, Indiana Health Information Exchange, Indiana State Department of Health, Health & Hospital Corporation of Marion County, and Children’s Hospital Boston. Activities included augmenting biosurveillance processes, enabling bi-directional communication, enhancing automated detection of notifiable conditions, and demonstrating technological advances at national forums. HIE transactions destined for public health were enhanced with standardized clinical vocabulary and more complete physician contact information. During the 2009 H1N1 flu outbreak, the HIE delivered targeted public health broadcast messages to providers in Marion County, Indiana. We will review the partnership characteristics, activities, accomplishments and future directions for our health information exchange.     

Managing Health(-Care Systems) Using Information Health Technologies

This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany’s and England’s healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective values, actors’ and institutions’ organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they tend to affect practitioners’ practices more dramatically in England. The conclusion is drawn that with the usage of IHTs, healthcare systems reproduced existing patterns of health provision while also enabling a sort of convergence. Future research should investigate whether the new concept of patienthood emerging in both welfare states actually suits patients’ and professionals’ needs and requirements.     

Scientific Rigour in Qualitative Research--Examples From a Study of Women's Health in Family Practice

The increase in qualitative research in family medicine raisesa demand for critical discussions about design, methods andconclusions. This article shows how scientific claims for truthfulfindings and neutrality can be assessed. Established conceptssuch as validity, reliability, objectivity and generalizationcannot be used in qualitative research. Alternative criteriafor scientific rigour, initially introduced by Lincoln and Guba,are presented: credibility, dependability, confirmability andtransferability. These criteria have been applied to a researchproject, a qualitative study with in-depth interviews with femalepatients suffering from chronic pain in the locomotor system.The interview data were analysed on the basis of grounded theory.The proposed indicators for scientific rigour were shown tobe useful when applied to the research project. Several examplesare given. Difficulties in the use of the alternative criteriaare also discussed.     

Current Issues in Undergraduate Psychiatry Education: The Findings of a Qualitative Study

Background  Recruitment into psychiatry is correlated with the quality of undergraduate medical school teaching programmes and with a commitment of major resources to teaching students. There is an extensive literature related to attitudes towards psychiatry but less on the learning and teaching of psychiatry. Aims  To identify the current issues in undergraduate psychiatric education in the UK for lead teachers at UK medical schools. Method  Semi-structured telephone interviews with psychiatric leads at UK medical schools. A total of 26 participants were interviewed from 23 different medical schools. Results  Three key areas of problems were identified: issues related to teaching personnel (e.g. conflict of time), teaching resources and impact of teaching on recruitment (e.g. role models; stigma). Eight potential solutions to address the problems were identified and these included improving the quality of teaching, improving the perceived value of the discipline and recruiting teachers. Conclusion  There are several problems facing teachers in psychiatry but the teachers are also able to identify solutions which need support from both education and health if they are to be implemented. Nisha Dogra, BM DCH MRCPsych MA PhD is Senior lecturer and honorary consultant in child and adolescent psychiatry at the University of Leicester. She was involved in the design and supervision, data analysis for the study and drafted the paper. Ruth Edwards, BSc is a research associate at the University of Leicester. She was involved in the design of the project, carrying out the interviews, data analysis and reviewing the final version of the paper. Khalid Karim, MB ChB BSc MRCPsych is Senior Lecturer and honorary consultant in child and adolescent psychiatry at the University of Leicester. He was involved in the design of the study and reviewing the final draft. Susan Cavendish, Cert Ed., BSc, PhD is Head of the Medical Education Research Division of the Leicestershire, Northamptonshire and Rutland Healthcare Workforce Deanery. She was involved in the writing of the paper.     

The Northwest Public Health Information Exchange’s Accomplishments in Connecting a Health Information Exchange with Public Health

In 2007 the Centers for Disease Control and Prevention (CDC) issued a Request for Proposal for the “Situational Awareness through Health Information Exchange” project. The Situational Awareness project’s goals are to connect public health with health information exchanges (HIEs) to improve public health’s real-time understanding of communities’ population health and healthcare facility status. During this same time period the Health and Human Services’ Office of the National Coordinator for Health Information Technology released several reports identifying the growing number of communities involved in health information exchange and outlining the requirements for a Nationwide Health Information Network (NHIN). CDC saw the possibilities of using HIEs and the NHIN to accelerate the real-time sharing of clinical and facility-based resource utilization information to enhance local, state, regional, and federal public health in responding to and managing potentially catastrophic infectious disease outbreaks and other public health emergencies. HIEs would provide a unified view of a patient across health care providers and would serve as data collection points for clinical and resource utilization data while NHIN services and standards would be used to capture HIE data of importance and send those data to public health. This article discusses how automated syndromic surveillance data feeds have proven more stable and representative than existing surveillance data feeds and summarizes other accomplishments of the Northwest Public Health Information Exchange in its contribution to the advancement of the National agenda for sharing interoperable health information with public health.     

Community Associated Methicillin Resistant Staphylococcus aureus Among New York City Men Who have Sex with Men: Qualitative Research Findings and Implications for Public Health Practice

Academic literature has recorded increased microbial resistance in the United States and recent news media has adversely portrayed men who have sex with men (MSM) at increased risk for community associated methicillin resistant Staphylococcus aureus (CA-MRSA) transmission. CA-MRSA is a specific type of bacteria resistant to certain antibiotics, which limits treatment options for those needing clinical care. Infection can manifest as painful abscesses and can cause severe illness. With increased CA-MRSA infections overall, and attention given to MSM populations regarding CA-MRSA, as well as the fact that limited data on sociocultural factors that may facilitate transmission, we undertook a qualitative study to explore contextual influences that may fuel infection among MSM in New York City so that public health professionals can better recognize, and respond appropriately to, potential future outbreaks. In-depth interviews were used to qualitatively investigate perceptions and beliefs regarding transmission, as well as community understandings of treatment options. Participants included thirteen MSM who reported a previous CA-MRSA infection and nine community practitioners. A thematic content analysis of these interviews was conducted and data suggests that behaviors and exposures associated with transmission of CA-MRSA are common in certain MSM networks. Specifically, sociocultural influences and methamphetamine use activities were found to contribute to CA-MRSA transmission. We underscore the role of public health and health services practitioners in providing appropriate CA-MRSA awareness and education to MSM populations.     

Linking Cervical Cancer to the Human Papillomavirus: Findings from a Qualitative Study with Mexican Women

Cervical cancer is an important cause of mortality for women in developing countries. Researchers have established a link between cervical cancer and the human papillomavirus (HPV). We explored Mexican women's beliefs about cervical cancer and sexually transmitted infections (STIs), including HPV, to better understand the social implications of this linkage. We conducted eight focus groups with middle-aged and young women in Mexico City. Cervical cancer elicited different social and emotional responses than STIs; participants generally attached less culpability to it and saw it as more life threatening. Information campaigns should take into account differences in lay conceptions of these illnesses.     

Public Issue: Discrimination's Impact on Public Health Practice

Whereas Pap smear screening has reduced cervical cancer mortality, minority status imposes barriers that limit access not only to screening but also to public health messages. Lesbians are a unique minority group due to multiple factors, and dispelling myths about their health risks has been hindered by a lack of research, knowledge, and outreach, as well as by homophobia. Recent research has bolstered the hypothesis that lesbians require Pap testing just as their heterosexual counterparts do. However, providers and lesbians continue to be largely unaware of this need. Media outreach in Seattle—a project of the Seattle City Council, the Seattle–King County Health Department, and the Seattle Commission for Sexual Minorities—attempted to correct this deficiency. Radio ads urged lesbians to have yearly exams, but complaints of the use of the word lesbian caused the ads to be pulled. The project illuminates the impact of discrimination on good public health strategies and the imperative to manage discrimination as a public health issue. The article describes the campaign and its outcomes.     

Public Health Insurance Enrollment among Immigrants and Nonimmigrants: Findings from the 2001 California Health Interview Survey

We examine whether adult immigrants in California had the same likelihood of having public health insurance as nonimmigrants with comparable characteristics, using 44,434 non-elderly adult samples of the 2001 California Health Interview Survey public use data. Multinomial logistic regression was used to assess the likelihood of public health insurance relative to private (employment-based or privately purchased) health insurance by generation status, controlling for individual characteristics. The outcome of interest was public health insurance among three health insurance categories: private health insurance, public health insurance, and uninsured. Both first and second generation immigrants were more likely to have public health insurance than were nonimmigrants. However, the difference vanished, when demography, socioeconomic status, health status, employment sector, and English facility were controlled for. The combined effect of lower returns to education and lower employment-based insurance offer rates seems to be the underlying cause of higher prevalence of public health insurance among ethnic minorities.