城区社区卫生服务人才现状与对策

对静安寺街道社区卫生服务中心35岁以下的36名职工进行问卷调查。青年技术人才匮乏，人才队伍老化，尤其是35岁以下的公共卫生医师仅占总数的1／10；97％的青年人希望单位能提供更多的学习机会及更好的工作环境。因此只有通过建立健全工作制度、人才规划和分配机制，才能吸引人才、培养人才、留住人才，才能提高社区卫生人员素质，并达到促进社区卫生服务可持续发展的最终目的。     

The health of Indians in Canadian cities: a challenge to the health care system

It is well known that Canadian native people living on reserves have high morbidity and mortality rates, but less is known about the health of those who migrated to urban centres. Several studies have shown that these people have high rates of mental health problems, specific diseases, injuries, infant death and hospital admission. In addition, there is evidence that cultural differences create barriers to their use of health care facilities. The low socioeconomic status, cultural differences and discrimination that they find in cities are identified as the primary blocks to good health and adequate health care. More epidemiologic studies need to be done to identify health problems, needs and barriers to health care. Federal, provincial and civic governments along with the appropriate departments of faculties of medicine should begin working with native organizations to improve the health of native people living in Canada's cities.     

Preconception health: a public health challenge

Minimal attention has been paid to preconception counseling even though good preconception health may be among the most important segments of a woman's life. Only in recent years have most healthcare providers, including obstetricians, realized that the initiation of health care and guidance after conception may be too late to prevent birth defects, low birthweight and infant mortality. The Oklahoma State Department of Health's Birth Defect Registry has developed a Women's Health Appraisal Questionnaire to assist physicians in identifying high-risk behaviors and other condition in the patient's environment that may be linked to detrimental outcomes to the fetus. The Women's Health Questionnaire can be offered to women of childbearing age in the waiting rooms of health clinics. The questionnaire takes about three to five minutes for the patient to complete. Free English and Spanish versions of the Women's Health Appraisal Questionnaire and other preconception tip booklets are being offered to physicians and health departments in Oklahoma. To order the preconception health questionnaire and booklets, there is an order form included in this journal.     

Allocation of health care resources: a challenge for the medical profession.

If current limitations on health care funding continue, medical practitioners will face increasing pressure to conserve scarce resources and to participate in the allocation of funds. This article discusses the ethical and economic aspects of the physician's role and briefly reviews some efficiency measures that might mitigate the effects of rationing of health care services.     

Breastfeeding: a public health challenge

Since antiquity, breastfeeding has been known to benefit the infant. In the past 40 years, some of the reasons have been discovered such as the provision of complete infant nutrition, transfer of antibodies leading to a decreased incidence of infectious disease and psychosocial benefit to both the mother and child. Yet, in spite of this knowledge and increased national and international attention, the United States has not achieved its goal of 75% of mothers who are breastfeeding their infants at hospital discharge. Physicians play a vital role in the encouragement and sustaining of breastfeeding. Each should encourage all new mothers to breastfeeding for the benefits to both the infant and the mother.     

新世纪我国儿童保健面临的任务与挑战

在过去的 2 0世纪 ,我国儿童的健康水平有了极大的提高。进入新世纪 ,伴随快速的经济发展而出现的现代化、工业化、城市化和全球化带来的新的健康问题逐步成为儿童保健的主要内容 ,突出表现在环境因素、社会因素、新的行为和生活方式对儿童健康的影响。一、新中国儿童保健工作的成就5岁以下儿童的死亡率是衡量一个国家儿童总体健康状况的重要指标。据全国妇幼卫生监测报告 ,5岁以下儿童死亡率为 4 6 75‰ ;婴儿死亡率由195 0年初的 2 0 0 %下降到 1980年的 4 2 76‰ ,到1995年的 36 4 0‰。 195 0年至 1980年中国婴儿死亡率的年平均下降…     

Core and comprehensive health care services: 2. Quality-of-care issues.

Health care services are being evaluated and redefined. Terms such as "medically necessary" and "comprehensive" are being supplanted by "core", "basic" and "optional." Quality-of-care concepts and analysis can assist decision making about which services should be insured, core services. A service is more likely to remain or become insured, and core to the system if it satisfies the key dimensions of high quality: effectiveness, appropriateness, efficiency, patient acceptance and safety. Quality of care, combined with ethical and economic considerations, provides an analytic framework for deciding whether services should be insured.     

Core and comprehensive health care services: 3. Ethical issues.

The CMA's Working Group on Core and Comprehensive Health Care Services recognizes ethics to be one of the three key factors in determining which services should be publicly funded. The role of ethics is to identify and make explicit the principles and values, at individual and societal levels, that lie behind judgements and positions. Two types of ethical issues are addressed: one deals with the criteria for these services and the other with the process to be followed. The five ethical criteria discussed are fairness, age, lifestyle, the identifiable versus the statistical patient, and futility. An ethical process incorporates appropriate roles for the public physicians and payers (government) and accountability of all participants. A provided checklist for determining a fair process asks such questions as Do potential users of a service, its providers and the public have an adequate say in the decision about whether the service should be publicly funded? Are the reasons for the decision communicated to those affected by it? and is the service being denied to potential users on the basis of unfair discrimination or lifestyle?     

Core and comprehensive health care services: 4. Economic issues.

This article reviews the economic dimensions of the CMA's decision-making framework on core and comprehensive services. The framework was developed in a policy context characterized by three government objectives: reduction, reallocation and reassignment of health care resources. One economic-evaluation tool for the determination of core services is cost-effectiveness analysis. Some of the critical demand-side and supply-side considerations include the perceived value of medical services, the availability of private insurance and the supply of health care providers. The article concludes that shifting services to the private sector should not be viewed as a panacea for reducing the costs and improving the economic efficiency of the health care system, or for increasing patient access to, or the cost-effectiveness of high-quality care.