卫生事业发展状况的国际比较分析

依据世界银行和世界卫生组织的有关统计资料,对中国与世界其他人均收入水平相近的19个国家有关数据以及不同收入组国家平均数据进行了国际间横向比较分析,并针对其存在的主要问题,提出了优化中国卫生资源配置、促进卫生事业科学发展的政策建议。     

健康影响评价的国际应用现状及对我国的启示

在梳理健康影响评价在国际上的应用现状基础上,分析健康影响评价在国外相关政策规定、应用领域、实施过程以及存在的挑战,并为推动我国健康影响评价制度的建立和完善提供以下政策建议:在健康融入所有政策的过程中,我国急需建立完善的、政府主导的健康影响评价机制;立法是健康影响评价重要基础,完善的健康影响评价实施机制是健康影响评价发挥政策价值的重要保障。     

国内外卫生总费用及结构比较研究

为分析评价我国卫生总费用的状况，据此提供有益的决策指导，采用了《2004年世界卫生报告》中的数据资料，对我国与世界其他29个国家的卫生总费用占GDP的比重和卫生支出结构进行了比较与分析．并提出了相应的政策建议：增加卫生投入，适当提高卫生总费用占GDP的比重，使之与国民经济发展相适应：改变不合理的费用结构，降低个人卫生支出比例。     

Occupational Health in Lebanon: Overview and Challenges

Abstract

This paper discusses the challenges facing the field of occupational health in Lebanon following 15 years of war. It examines the opportunities for advancing this field and for bringing Lebanese standards up to par with internationll ones. Challenges include the minor contribution of industry to the overall economy, its perception as non hazardous, the lack of standards and enforcement, the scarcity of data, and the obscurity of occupational health on the national agenda. Opportunities, on the other hand, have arisen from the need to rebuild the infrastructure and revive tourism, public awareness of the potential hazards of industries in densely populated areas, international pressure, and the return of professionals in occupational health. The safety and salubriousness of workplaces are perceived as minor concerns in Lebanon, yet desire for economic recovery may prove to be an incentive for increased action on this issue. Three potential approaches for action are presented.     

Exploring Preconception Care: Insurance Status,Race/Ethnicity,and Health in the Pre-pregnancy Period

Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009–2011 (n?=?3929), we created a “Preconception Health Score” (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3?±?0.07) or public insurance (6.3?±?0.08) before pregnancy than no insurance (5.9?±?0.09) (p?<?.001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC.     

Preconception Wellness: Differences in Health by Immigrant Status

Disparities in health between immigrant and non-immigrant pregnant women in the United States is well documented, but few have documented disparities before pregnancy. Using the National Health and Nutrition Examination Survey (1999–2006), we examined the health of reproductive-aged women (8,095), sorted by immigrant and pregnancy pregnant US-born (P-US), pregnant foreign-born (P-FB), non-pregnant US-born (NP-US), and non-pregnant foreignborn (NP-FB). P-US women were 5.2 times more likely to report illicit drug use than P-FB women. NP-US women were 3.7 times more likely to report illicit drugs use, 45% less likely to have a normal BMI, 2.0 times more likely to binge drink, 7.6 times more likely to smoke, 1.6 times more likely to engage in moderate physical activity, and 1.7 times more likely to use birth control than NP-FB women. The lower prevalence of numerous destructive health behaviors among preconceptional immigrant women is an important finding.     

Core State Preconception Health Indicators: A Voluntary,Multi-state Selection Process

This report describes the consensus-based selection process undertaken by a voluntary committee of policy/program leaders and epidemiologists from seven states to identify core state indicators to monitor the health of reproductive age women (aged 18–44 years). Domains of preconception health were established based on priority areas within maternal and child health and women’s health. Measures (i.e., potential indicators) addressing the domains were identified from population-based, state level data systems. Each indicator was evaluated on five criteria: public health importance, policy/program importance, data availability, data quality, and the complexity of calculating the indicator. Evaluations served as the basis for iterative voting, which was continued until unanimous consent or a super majority to retain or exclude each indicator was achieved. Eleven domains of preconception health were identified: general health status and life satisfaction; social determinants of health; health care; reproductive health and family planning; tobacco, alcohol and substance use; nutrition and physical activity; mental health; emotional and social support; chronic conditions; infections; and genetics/epigenetics. Ninety-six possible indicators were identified from which 45 core indicators were selected. The scope of preconception care and the public health components to address preconception health are still under development. Despite this challenge and other measurement limitations, preconception health and health care indicators are urgently needed. The proposed core indicators are a set of measures that all states can use to evaluate their preconception health efforts. Furthermore, the indicators serve as a basis for improving the surveillance of the health of reproductive age women.     

Cultural Capital and Self-Rated Health in Low Income Women: Evidence from the Urban Health Study, Beirut, Lebanon

This paper examines the association between cultural capital and self-rated psychosocial health among poor, ever-married Lebanese women living in an urban context. Both self-rated general and mental health status were assessed using data from a cross-sectional survey of 1,869 women conducted in 2003. Associations between self-rated general and mental health status and cultural capital were obtained using χ ² tests and odds ratios from binary logistic regression models. Cultural capital had significant associations with self-perceived general and mental health status net of the effects of social capital, SES, demographics, community and health risk factors. For example, the odds ratios for poor general and mental health associated with low cultural capital were 4.5 (CI: 2.95–6.95) and 2.9 (CI: 2.09–4.05), respectively, as compared to participants with high cultural capital. As expected, health risk factors were significantly associated with both measures of health status. However, demographic and community variables were associated with general health but not with mental health status. The findings pertaining to social capital and measures of SES were mixed. Cultural capital was a powerful and significant predictor of self-perceived general and mental health among women living in poor urban communities.Khawaja and Mowafi are with the Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon.     

几个发达国家和我国的初级卫生保健状况

初级卫生保健（primaryhealthcare,简称PHC）是指最基本的、人人都能得到的、体现社会平等权利的、人民群众和政府都能负担得起的卫生保健服务。PHC是全球性的战略行动,不论是发展中国家还是发达国家,不论是农村还是城市普遍适用。其核心价值观是社会公平,所信奉的理论是“健康是人类的基本权利”,所追求的目标是“人人享有健康”。2008年10月14日世界卫生报告题为《初级卫生保健一过去重要,现在更重要》,世卫组织总干事陈冯富珍指出：“从目前的趋势来看,初级卫生保健越来越是重返卫生发展正确轨道的明智之举”。     

Health equity in Lebanon: a microeconomic analysis

Background  

The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.     

Health care workers' exposure to blood-borne pathogens in Lebanon

Background Accidental exposure to blood-borne pathogens (BBPs)is a risk for health care workers (HCWs). Aim To study the pattern of occupational exposure to blood andbody fluids (BBFs) at a tertiary care hospital. Methods This study reports a 17-year experience (1985–2001)of ongoing surveillance of HCW exposure to BBFs at a 420-bedacademic tertiary care hospital. Results A total of 1590 BBF exposure-related accidents werereported to the Infection Control Office. The trend showed adecrease in these exposures over the years with an average ±standard error of 96 ± 8.6 incidents per year. In thelast 6 years, the average rate of BBF exposures was 0.57 per100 admissions per year (average of needlestick injuries alonewas 0.46 per 100 admissions). For 2001, the rates of exposurewere found to be 13% for house officers, 9% for medical student,8% for attending physicians, 5% for nurses, 4% for housekeeping,4% for technicians and 2% for auxiliary services employees.The reason for the incident, when stated, was attributed toa procedural intervention (29%), improper disposal of sharps(18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposureof HCWs to BBPs remains a problem. This can be projected toother hospitals in the country and raises the need to implementinfection control standards more efficiently. Similar studiesshould be done prospectively on a yearly basis to study ratesand identify high-risk groups.     

国内外老年人医疗保险制度改革进展

归纳汇总国外医疗保险制度相关研究成果,国内老年医疗保险研究现状与趋势,以及对我国城镇医疗保险制度优化的一些政策探索,为我国城镇老年人医疗保险制度完善提供参考.     

Undergraduate Student Awareness of Issues Related to Preconception Health and Pregnancy

Objectives To assess undergraduate student awareness of issues related to preconception health and pregnancy and to investigate gender differences. Methods Two-hundred forty-one undergraduate students (137 females, 104 males) completed a questionnaire designed to assess awareness of issues related to preconception health and pregnancy. Results Overall, students demonstrated a low to moderate level of awareness, correctly answering 64% of items. Individual student scores varied a great deal, ranging from 33% to 89% correct. Students who had previously taken a course containing information on pregnancy and/or child development correctly answered a greater percentage of items than those who had not taken such a course. Females had slightly, but statistically significantly, higher awareness scores than males. Students self-reported ratings of awareness of behaviors that are dangerous during pregnancy were associated with their composite scores on the questionnaire. Awareness across individual items varied a great deal. Students demonstrated a high level of awareness for substance use, a moderate level of awareness for sexually transmitted diseases and preconception care, and lower levels of awareness for folic acid, prenatal development, health, and pregnancy spacing. Conclusions Efforts to improve preconception health should include increasing awareness of reproductive issues for both males and females. Existing efforts to provide information on reproductive health to students need to be expanded and new strategies developed. Particular attention should be paid to increasing awareness of the benefits of family planning, the early onset and rapid rate of organogenesis, the benefits of folic acid, and the importance of addressing health-related issues.