集中连片贫困区县级妇幼保健机构现状分析

目的对集中连片贫困区县级妇幼保健机构现状进行摸底,为集中连片贫困区县级妇幼保健机构资源配置和服务能力的提升提供政策依据。方法通过贫困地区卫生计生基线调查平台,收集全国832个贫困县妇幼保健机构相关数据,通过专家咨询法筛选核心指标,对机构的资源配置、服务能力及服务效果的核心指标进行描述性分析。结果集中连片贫困区县级妇幼保健机构危房面积占比3.95%,每万人口编制床位数0.87张。年末在职职工数64人,医护比为1∶1.09,每万人口助产人员数0.11人。全县婚检率为47.24%,住院分娩率97.88%,3岁以下儿童系统管理率89.08%。活产数占比21.54%,剖宫产数占比29.75%,财政补助收入占比45.81%,资产负债率41.06%。结论对房屋、设备的设施进行统一配备体现妇幼保健机构特色,优化集中连片贫困区卫生资源结构。加强妇幼保健机构医务人员人才队伍建设,特别是助产人员和妇幼保健人员的培养。通过组建妇幼服务联合体、远程医疗及对口支援等方式,促进优质妇幼健康服务资源和能力下沉。加强财政投入向基层、贫困地区倾斜力度,同时加强资金的监管,点面相结合实施精准扶贫。     

重庆市产科资源配置现状及公平性分析

目的 了解重庆市产科人力资源、床位资源的利用情况和分布公平性,为调整产科资源配置和制定相关政策提供依据。方法 通过调查问卷收集重庆市40个区县所有提供产科医疗服务机构的人力资源和床位资源配置数据,利用资源密度指数、基尼系数和泰尔指数评价资源配置的公平程度。结果 重庆市每千活产拥有产科医师12.84人、护士18.88人、助产士8.05人、床位39.37张、产床6.20张,每km2拥有产科医师0.05人、护士0.07人、助产士0.03人、床位0.15张、产床0.02张。按活产数分布的基尼系数在0.154～0.267之间,公平性较好;按地理面积分布的基尼系数在0.324～0.514之间,部分资源公平性较差。按地理面积配置的区域间泰尔指数均大于区域内泰尔指数,地理分布不公平性主要来自于区域间。结论 重庆市产科资源总量充足,但资源紧张与浪费的情况并存,建议在制定卫生规划时应重视地理因素,同时大力推行分级诊疗制度,提升基层医疗机构资源利用率,以达到产科资源配置和利用的优化状态。     

长沙市助产机构产科服务能力调查

目的 为了解长沙市助产机构产科服务能力,为政府合理配置医疗资源、提高产科医疗保健服务质量提供依据。 方法 2020年11—12月采用长沙市妇幼保健院设计《长沙市助产机构产科服务能力情况调查表》,收集2019年长沙市助产机构产科服务能力数据,2016—2019年机构活产数从湖南省妇幼卫生信息直报管理系统中获取。 结果 2019年长沙市开展助产技术服务的医疗保健机构共74家,以公立医院为主(33.78%),其次是基层医疗卫生机构(31.08%)和民营医院(22.97%)。全市共有产科床位2 790张,其中床位利用率最高的是妇幼保健机构(58.94),较低的是基层医疗卫生机构(8.65)和其他医疗机构(包括部队医院和职工医院)(4.24)。全市共有产科医师966人,其中服务效率最高的是妇幼保健机构(192.06),较低的是基层医疗卫生机构(27.27)和其他医疗机构(包括部队医院和职工医院)(8.31)。全市共有助产士739人,其中服务效率最高的是妇幼保健机构(233.74),较低的是基层医疗卫生机构(94.69)和其他医疗机构(包括部队医院和职工医院)(8.31)。 结论 各类助产机构、各区域间产科床位利用情况不均衡,助产人员配置待进一步优化;建议通过医疗资源合理配置、加强基层医疗卫生机构产科服务能力建设、加强区域性信息化建设、保证危重孕产妇救治床位等措施,在缓解医疗资源供求矛盾的同时,保障母婴安全。     

嘉兴市医疗保健机构产科服务能力调查

目的了解嘉兴市医疗保健机构的产科服务能力,为提高医疗保健服务质量提供依据。方法自制调查表,对嘉兴市开展助产技术服务的各县(市、区)医疗保健机构的产科业务量、产科床位、产科医生和助产士配置情况进行调查分析。结果嘉兴市各县(市、区)医疗保健机构产科床位使用率为47.90%~99.58%,平均73.57%;每千分娩量产科床位数为27张。产科医师高级、中级和初级专业技术职称分别占31.92%、33.17%和34.91%;助产士高级、中级和初级专业技术职称分别占8.67%、33.24%和58.10%;产妇分娩人数与产科医师人数比为138.72∶1,产妇分娩人数与助产士人数比为160.77∶1。结论嘉兴市医疗保健机构的产科服务能力基本满足要求,但存在产科医务人员紧缺、资源分配不均等问题。     

2017年北京市产科人力资源现状分析

目的了解北京市产科人力资源现状,为政府出台应对生育高峰的决策提供依据。方法用统一格式的表格对全市所有助产机构具有助产资质的人员进行信息调查及数据收集,并采用现场面对面调查的方式对全市所有助产机构实际从事产科工作的人员进行信息调查及数据收集,活产数据来自《北京市医院产科工作质量季报表》。结果北京市活产数呈逐年上升趋势,全市产科人员数也呈增长趋势,但增长比例不能满足活产数的增长比例;实际从事产科工作医生数少于具有助产资质的医生数;产科医生高级职称占36. 8%,中级职称占38. 5%,初级职称占24. 7%;产科人员的平均年龄为(34. 9±9. 7)岁;从事产科工作的医生中实际在产科岗位者占64. 0%;从事产科工作的医生中全年均在产科岗位者占59. 6%;矫正助产服务效率中全市平均医生为130. 69,护士/助产士为63. 19,其中三级机构医生为152. 65,二级机构医生为139. 34;对各区医生、护士/助产士矫正助产服务效率进行排名,从高至低排名前5的除西城区外均为远郊区。结论北京市产科人员数量不足,工作负荷过重,梯队比例倒置,加快对助产人员的培养,切实将文件精神落实到实处,激励产科医务人员的积极性,才能保障产科队伍的稳定性,最终达到保障母婴安全的目标。     

北京市产科床位资源现状分析

目的了解北京市助产机构产科床位资源现状,为政府出台应对生育高峰的决策提供依据。方法通过统一问卷对北京市所有助产机构进行现况调查,同时收集2013年10月、11月及2014年10月、11月所有机构产科住院病历相关数据。结果北京市活产数呈逐年上升趋势,2014年全年达248 814人,各级助产机构床位数也呈增加趋势,但床位增加比例不能满足活产增加比例。相比2013年,除外一级机构病床周转次数略有降低外,各级助产机构无论产科病床周转次数还是病床周转率均有所增加,二三级助产机构产科病床周转次数分别达61.28、86.67,病床周转率分别达到88.85%、108.83%;相比2013年,病床效率指数除一级机构无变化外,各级助产机构均有增加,二三级助产机构分别为2.72、5.55。2015年每千活产拥有产科床位数相比2013年,除一级机构外均有不同程度降低,目前三级机构数值最低,为15.23张;除一级机构外,各级助产机构每床活产数均较2013年有所增加,三级机构增加最多,每床活产数增加5人,现为66人/张;三级、二级、一级、营利性机构产科床位供需比值分别为:0.80、1.03、7.51、2.56。结论北京市产科床位配置不足,二三级助产机构产科床位处于高效运行阶段,一级及营利性助产机构产科床位还有使用空间。     

重庆市区县级妇幼保健机构人力资源配置的公平性研究

目的:分析和评估重庆市区县级妇幼保健机构人力资源状况,为政府决策部门合理配置人力资源及制定卫生人力发展规划提供科学依据。方法:从工作人员的数量、学历、职称、分布等方面对重庆市区县级妇幼保健院人力资源状况进行描述性分析。结果:重庆市区县级妇幼保健机构人力资源的特点是拥有量少、质量低、分布不平衡。截至2013年底,全市区县级妇幼保健机构共拥有工作人员4872人(其中卫生技术人员3972人),卫生技术人员中本科以上学历者仅占29.4%,副高以上职称者仅占7.2%。结论:要改善这种状况,政府部门要加大对妇幼保健机构的投入力度,有针对性地做好妇幼保健人才培养工作。     

重庆市区县级妇幼保健机构资源配置的均衡性分析

目的分析重庆市3大经济圈区县级妇幼保健机构资源分布的均衡性,为合理配置重庆市区县级妇幼保健机构资源,提供科学参考依据和建议。方法根据卫生资源密度指数(HRDI)对重庆市40所区县级妇幼保健机构资源分布的均衡性进行分析。结果以全市区县级妇幼保健机构HRDI为标准,东北翼区县级妇幼保健机构所需要的资源最高,其次是东南翼。区县级妇幼保健机构资源最为缺乏的是东南翼机构。"一圈两翼"区县级妇幼保健机构的资源分布尚不均衡。结论在妇幼保健机构资源配置标准制定中除了考虑地区的经济发展情况,还要兼顾服务人口和服务面积,使之分布达到均衡,实现全市妇幼保健机构的协调发展。     

上海市产科人力资源及其服务现况分析与对策

目的:了解目前上海市产科人力资源及其服务情况,以便对各接产机构的产科服务能力与潜力做出客观评价,为卫生行政部门制定缓解产科医疗服务供需矛盾的决策提供依据。方法:对全市所有助产服务医疗保健机构服务数量、从事产科服务的专业人员情况进行调查。结果:①全市共有产科医生1166人,各机构之间产科医生"助产服务效率"指标悬殊极大(平均55.68,最高265.58,最低6.57),提示产科医生人力资源严重不足与严重浪费并存;②产科医生的职称分布与医院等级密切相关:一、二级医院缺乏产科主任医师,三级综合性医院产科主任最多(11.86%),三级专科医院产科高级职称比例最高(41%),中级职称者比例相对最低(24.1%);③产科医生中本科及以上学历占74.22%,大专学历占22%,中专学历占3.78%。三级医院研究生学历达40%,本科及以上学历高达98%;④全市从事产科服务的护理人员共1342人(其中助产士501人),医生和护士人员比例为1∶1.15,各助产机构之间产科护理人员"助产服务效率"指标悬殊很大(平均48.38,最高227.64,最低9.48)。结论:①调整全市助产机构的数量与布局;②增设外来孕产妇分娩点;③加强产科队伍建设尤其是对三级专科医院的人力配备;④加强三级综合性医院的特色建设以便与专科医院优势互补;⑤提升产科危重急救能力和效率。     

武汉市产科床位与人力资源的配置和利用

目的了解2013-2016年武汉市产科床位与人力资源配置和利用以及变化情况,为迎接生育高峰制定相关政策提供参考。方法收集2013-2016年武汉市全部助产机构产科服务总量和基本情况数据,计算相关指标分析武汉市产科床位和人力资源配置及利用的变化。结果 2013-2016年全市活产数逐年增长,其中公立三级明显增长,公立一级及未评逐年递减。全市每千活产床位数逐年递减,公立二级、一级及未评和民营每千活产床位数均高于公立三级。全市产科床位使用率维持在70.0%~73.0%之间,其中公立三级最高维持在90.0%左右。相比2014年,2016年全市每千活产医生数减少,产科医生年人均门诊量和助产服务效率增加,年人均担负床位数减少,其中公立三级3项指标均高于公立二级、一级及未评和民营。结论调整生育政策对武汉市公立三级和一级及未评的助产机构影响大,其中公立三级床位利用相对紧张,产科医生相对不足,而公立一级及未评存在产科床位和人力闲置,并逐步停止助产服务的现象。     

Salmonellas in pigs and animal feeding stuffs in England and Wales and in Denmark

A comparison has been made between the incidence of salmonellas in pigs and feeding stuffs in England and Wales and in Denmark. In Denmark there is veterinary legislation requiring the sterilization of imported and home produced feed ingredients of animal origin. There is no such legislation in England and Wales. In Denmark 0·3% of resterilized imported meat and bone meal was contaminated with salmonellas. This compared with 23% of meat and bone meal in England and Wales and 20-27% of other ingredients of animal origin. In England and Wales salmonellas were isolated from 7% of caecal samples and 6% of lymph node samples, while in Denmark they were isolated from 3% of caecal samples and 4% of lymph node samples. In England and Wales 25 serotypes were found in both pigs and feeds and these included nearly all the most prevalent human pathogens. In Denmark four of the six serotypes in pigs had been found in resterilized feed. One notable difference between the two studies was the very wide range of serotypes found in pigs in England and Wales and the narrow range in Denmark. A second was that Salmonella typhimurium formed 15% of all Salmonella strains isolated from pigs in England and Wales, and 60% of those in Denmark.     

Lunasin is prevalent in barley and is bioavailable and bioactive in in vivo and in vitro studies

Lunasin, a unique 43-amino acid peptide found in a number of seeds, has been shown to be chemopreventive in mammalian cells and in a skin cancer mouse model. To elucidate the role of cereals in cancer prevention, we report here the prevalence, bioavailability, and bioactivity of lunasin from barley. Lunasin is present in all cultivars of barley analyzed. The liver and kidney of rats fed with lunasin-enriched barley (LEB) show the presence of lunasin in Western blot. Lunasin extracted from the kidney and liver inhibits the activities of HATs (histone acetyl transferases), yGCN5 by 20% and 18% at 100 nM, and PCAF activity by 25% and 24% at 100 nM, confirming that the peptide is intact and bioactive. Purified barley lunasin localizes in the nuclei of NIH 3T3 cells. Barley lunasin added to NIH 3T3 cells in the presence of the chemical carcinogen MCA activates the expression of tumor suppressors p21 and p15 by 45% and 47%, decreases cyclin D1 by 98%, and inhibits Rb hyperphosphorylation by 45% compared with the MCA treatment alone. We conclude that lunasin is prevalent in barley, bioavailable, and bioactive and that consumption of barley could play an important role of cancer prevention in barley-consuming populations.     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

Research and teaching in social and preventive medicine and in public health

Summary Both public health and social and preventive medicine are characterised by the common goal of promoting, maintaining and improving health and preventing disease, and both are concerned with a population-related, preventive and environmental perspective. But whereas public health is interdisciplinary and goes far beyond the medical focus, social and preventive medicine is medically based and forms a bridge between public health and medical practice. Research in a department of social and preventive medicine serves to support preventive and medico-social activities in medical practice as well as in public health. This is illustrated by results from research conducted at the author's department during the last twenty years. Examples are research in support of smoking cessation activities, and research used for the planning of care for the elderly. Both the research and the teaching activities of the department take into account the population focus of public health as well as the focus on individual medicine in clinical practice.

---

Forschung und Lehre in Sozial-und Präventivmedizin und öffentlicher Gesundheit

Zusammenfassung Sowohl das Gebiet der öffentlichen Gesundheit als auch dasjenige der Sozial-und Präventivmedizin sind durch das Ziel der Förderung, Erhaltung und Verbesserung der Gesundheit sowie der Krankheitsvorbeugung gekennzeichnet, und beide beschäftigen sich mit einer bevölkerungsbezogenen, präventiven und umweltbezogenen Perspektive. Aber während die öffentliche Gesundheit stark interdisziplinär ist und weit über den medizinischen Fokus hinausreicht, ist die Sozial-und Präventivmedizin ein medizinisches Fach und stellt eine Brücke zwischen der öffentlichen Gesundheit und der ärztlichen Praxis dar. Die Forschung in einem Institut für Sozial-und Präventivmedizin dient der Förderung präventiver und sozialmedizinischer Tätigkeiten in der ärztlichen Praxis wie auch in der öffentlichen Gesundheit. Dies wird durch die Forschungstätigkeit des Instituts des Autors aus den letzten 20 Jahren illustriert, wobei Beispiele aus den Gebieten der Förderung der Raucherentwöhnung und der Betreuung behinderter Betagter dargestellt werden. Sowohl in den Forschungs-als auch in den Lehrtätigkeiten des Instituts finden der Bevölkerungsbezug der öffentlichen Gesundheit wie auch der individualmedizinische Ansatz der ärztlichen Praxis ihren Ausdruck.

---

La recherche et l'ensignement en médecine sociale et préventive et en santé publique

Résumé La santé publique aussi bien que la médecine sociale et préventive sont caractérisées par le but commun de promouvoir, maintenir et améliorer l'état de santé et de prévenir les maladies, et elles s'orientent vers une perspective de population, de prévention et environnementale. Mais la santé publique est interdisciplinaire et va loin au-delà de la médecine, tandis que la médecine sociale et préventive est basée sur la médecine et représente le lien entre la santé publique et la pratique médicale. La recherche d'un institut de médecine sociale et préventive sert à appuyer les activités préventives et médico-sociales au cabinet médical aussi bien qu'en santé publique. Cela est illustré par des résultats de recherches conduites dans les vingt années passées à l'institut de l'auteur, et les exemples sont tirés de la recherche en appui de la promotion de la cessation de fumée et de la planification de la prise en charge des personnes âgées et handicapées. Les activités de recherche et de l'enseignement de l'institut tiennent compte de la perspective de population cacactéristique de la santé publique, aussi bien que de la dimension de médecine individuelle caractéristique de la pratique clinique.

---

---

Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Eggs enriched in omega-3 fatty acids and alterations in lipid concentrations in plasma and lipoproteins and in blood pressure

Effects of dietary eggs enriched with omega-3 fatty acids on lipid concentrations in plasma and lipoproteins and blood pressure were determined in 11 men and women in two groups. Group 1 consumed four omega-3 eggs per day during the first 4-wk period and four control eggs for the second 4-wk period. Group 2 ate the same number of eggs in the reverse order. Mean plasma cholesterol concentration was significantly increased by control eggs (P less than 0.01) but unchanged by omega-3 eggs. Mean plasma triglyceride concentration was decreased by omega-3 eggs but increased by control eggs. Both systolic and diastolic blood pressures were significantly lowered by omega-3 eggs in group 1 whereas only systolic pressure was significantly decreased on omega-3 eggs in group 2. The control eggs did not change blood pressure. In conclusion, the omega-3 eggs may be more healthful than the control eggs.     

Bacteriology and constitutional health--genomics and proteomics: concepts in medicine and concepts in health insurance in the past and future

Future discussions on health issues on the individual or society level will be fundamentally linked to genetic dispositions. This genetic world will become reality in the same way the world of hygiene and bacteriology has become real for everyone. Approaches of molecular medicine for public health issues have not yet been created so far. The secret dreams of molecular eugenics must be made public and critically discussed. Up to now only a few monogenetically recessive hereditary diseases can be detected by screening. This kind of screening should be carefully considered. However, for the sciences, for medicine and thus for the physicians in practice, for health care sciences as well as for public health care, new tasks will emerge from genetics and molecular medicine. In individual as well as public health these new tasks will at first mainly turn in on the sphere of diagnosis and specific screening as well as health education and consultation. With regard to the considerable social implications the public health care sector should be aware of the coming issues of molecular medicine in time.     

Prevalence and Trends in Overweight in Mexican-American Adults and Children

Overweight and obesity have been increasing in many countries. Our objective is to describe the trends in overweight and obesity occurring in the Mexican-American population in the United States. Data on measured height and weight for Mexican Americans come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982–84), the Third National Health and Nutrition Examination Survey (NHANES III, 1988–94), and NHANES 1999–2002. In 1999–2002, 73% of Mexican-American adults were overweight and 33% were obese. Obesity increased between NHANES III and NHANES 1999–2002, from 24% to 27% for men and from 35% to 38% for women. Increases were also seen for children and adolescents. The Mexican-American population in the United States, both children and adults, is showing trends in overweight and obesity over time that are similar to those seen in other segments of the U.S. population and indeed in many countries