Injury status and perspectives on developing community safety promotion in China

The objective of this paper is to introduce the epidemiology of injuries in China, and then consider the development of safe communities in regard to injury prevention and safety promotion. The disease spectrum has changed in recent decades in the People's Republic of China. Both in cities and rural areas, injury has become the fifth leading cause of death. At least 800 000 people die from injury each year, and 50 million non-fatal injuries occur, of which 2.3 million lead to disability of varying degrees of severity. The average injury-related death rate in China from 1990 to 1997 was 66 per 100 000, which accounts for 11% of total deaths. The potential years of life lost (PYLL) of injury accounts for 24% of the total, and disability-adjusted life years (DALYs) account for 17%. Main injury causes of death, in descending order, are: suicide, traffic accident, drowning, falling, poisoning, homicide, burn and scald, and iatrogenic injury. Considering China's current injury status and its rapid societal change, injury prevention and safety promotion need to be strengthened further, and there is a special need for the development of Safe Communities programmes. The prevention of injuries through safety promotion has been increasingly focussed on over recent decades. The WHO Safe Community model is recognized as representing an effective and long-term approach to the prevention of injuries at a local level, and has been beneficially applied all over the world. A programme may cover several aspects of injury prevention and safety promotion simultaneously, or only include one or two aspects. In a Safe Community programme in China, children, the elderly, cyclists and their passengers, and farmers should be among the prioritized target populations. However, multi-focussed inter-sectoral programmes have been shown to have additional effects to distinct sectoral programmes.     

Rising mortality from injury in urban China: demographic burden, underlying causes and policy implications

In urban China, mortality from injuries has increased over the past five decades. By contrast, life expectancy has continued to increase and has come to nearly equal life expectancy in developed countries. Currently, most of the life expectancy lost due to injury (65%) in urban China would be recovered if injury rates were the same as in countries with low injury-related mortality. Fundamentally, the rising trend in urban injury mortality in China reflects a continued focus on injury treatment rather than prevention in the face of fast socioeconomic development and increasing exposure to risk factors for injury. Despite improved injury prevention legislation and a "Safe Community" campaign, urban China needs to modify its approach to urban injury management and focus on prevention. The gap between urban China and countries with low injury mortality can be closed by means of legislation, strengthened law enforcement and the establishment of safer communities. Risks affecting children and migrants deserve greater attention, and the government needs to allocate more resources to injury prevention, especially to urban areas in the central-west region of China. Based on the population size of urban China, measures for the prevention of injury mortality would save an annual 436.4 million years of life.     

“强基层”改革下的社区卫生服务供给优化路径探讨

"强基层"是我国医药卫生体制改革的主要方向之一,也是"健康中国"战略的重要组成部分。"强基层"改革以来,我国社区卫生服务已取得长足快速发展,但服务供给质量与效率仍需提升,且在服务项目、人事制度建设、政策财政支持、社区区域间协同等层面也有待完善。有鉴于此,"强基层"改革需进一步优化改革路径,从"量"与"质"两层面并行推进优化社区卫生服务供给体系建设,推动建立中国特色社区卫生服务模式。     

The WHO safe community program for injury prevention: evaluation of the impact on injury severity

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41 000), Östergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2–6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37–45%), while the trivial injuries increased by 16% (9–22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37–41%) from 1983–84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8–9%). The study showed that implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.     

Impact of Community-Based Approach as Policy Tool: World Health Organization-Designated Safe Communities of Korea and Health Action Zones of the United Kingdom

Objectives

The aim of this study is to ascertain and identify the effectiveness of area-based initiatives as a policy tool mediated by societal and individual factors in the five World Health Organization (WHO)-designated Safe Communities of Korea and the Health Action Zones of the United Kingdom (UK).

Methods

The Korean National Hospital discharge in-depth injury survey from the Korea Centers for Disease Control and Prevention and causes of death statistics by the Statistics Korea were used for all analyses. The trend and changes in injury rate and mortality by external causes were compared among the five WHO-designated Safe Communities in Korea.

Results

The injury incident rates decreased at a greater level in the Safe Communities compared with the national average. Similar results were shown for the changes in unintentional injury incident rates. In comparison of changes in mortality rate by external causes between 2005 and 2011, the rate increase in Safe Communities was higher than the national average except for Jeju, where the mortality rate by external causes decreased.

Conclusion

When the Healthy Action Zones of the UK and the WHO Safe Communities of Korea were examined, the outcomes were interpreted differently among the compared index, regions, and time periods. Therefore, qualitative outcomes, such as bringing the residents'' attention to the safety of the communities and promoting participation and coordination of stakeholders, should also be considered as important impacts of the community-based initiatives.     

Local injury information,community participation and injury reduction

Abstract: Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community-focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three-year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a ‘community information’ strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident-related hospital admissions of children (not statistically significant) have been observed over the course of the four-year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury-reduction strategy.     

中国伤害防控工作面临的主要挑战与应对策略

随着中国经济的持续快速发展,伤害在20世纪后期就已成为威胁中国居民健康的重要疾病之一,其死因顺位排名一直靠前。尽管中国政府已将伤害防控工作纳入《“健康中国2030”规划纲要》《健康中国行动(2019―2030年)》《中国儿童发展纲要(2021―2030年)》等国家健康发展规划,但与中国总体卫生健康事业的快速发展相比,国内伤害防控工作发展速度滞后于传染性疾病和慢性非传染性疾病防控工作。目前,我国伤害防控工作面临的主要挑战包括:(1)伤害预防立法不完善,执法力度待加强;(2)缺乏牵头部门协调全国伤害防控工作;(3)缺乏专业队伍落实日常伤害预防工作;(4)伤害预防研究缺乏必要的支持。针对这些挑战,作者提出了相应的应对策略。     

Differences in child injury hospitalizations in Sweden: the use of time-trend analysis to compare various community injury-prevention approaches

AIM: Sweden's child injury fatality rates are among the lowest in the world. The country has engaged in a number of community injury-prevention programmes. The purpose of this study was to compare child injury hospitalization rates from the Skaraborg District with the rest of Sweden. Our study hypothesis was that municipalities that offered comprehensive child injury-prevention programmes would see significant decreases in their child injury hospitalization rates, compared with other areas. METHODS: The study areas comprised three groups, consisting of municipalities in Skaraborg that had adapted the Safe Communities approach to injury prevention programmes, other municipalities in the District, and the rest of Sweden. The aim of the analysis was twofold: (1) to fit time trends for children's injuries in various areas in an integrated manner; and (2) to compare time trends across locations between community safety-promotion programmes as well as with the control areas. Panel data models and parametric splines were used. RESULTS: There were differences between incidence rates in the study areas and with regard to gender. There was a steep decrease in injury rates in one of the Safe Communities study areas for both genders. CONCLUSIONS: The methods applied in this analysis reveal more detailed and sophisticated time trends than the usual simple linear regression approach. The model provided a clearer view of the interactions of gender, area, and time as they impacted on children's injuries, and allowed for better insight into the impact of safety programmes.     

Information system needs in health promotion: a case study of the Safe Community programme using requirements engineering methods

The international Safe Community programme was used as the setting for a case study to explore the need for information system support in health promotion programmes. The 14 Safe Communities active in Sweden during 2002 were invited to participate and 13 accepted. A questionnaire on computer usage and a critical incident technique instrument were distributed. Sharing of management information, creating social capital for safety promotion, and injury data recording were found to be key areas that need to be further supported by computer-based information systems. Most respondents reported having access to a personal computer workstation with standard office software. Interest in using more advanced computer applications was low, and there was considerable need for technical user support. Areas where information systems can be used to make health promotion practice more efficient were identified, and patterns of computers usage were described.     

Health Care in China and the West

While there is a trade-off of medical sophistication for quantity of care, caused by both a desire to avoid “elitism” and a shortage of resources, China has blended traditional and modern medicine into a system that provides basic care for all. With its emphasis on prevention and on use of paramedical personnel, the Chinese model may well hold important lessons for other developing nations at a similar stage in their history.     

Impact of social standing on injury prevention in a World Health Organization Safe Community--intervention outcome by household employment contract

BACKGROUND: Although social inequality in health has been an argument for community-based injury prevention programmes, intervention outcomes with regard to differences in social standing have not been analysed. The objective of this study was to investigate rates of injuries treated in health-care among members of households at different levels of labour market integration before and after the implementation of a WHO Safe Community programme. METHODS: A quasi-experimental design was used with pre- and post-implementation data collection covering the total populations <65 years of age during one year in the programme implementation municipality (population 41 000) and in a control municipality (population 26 000). Changes in injury rates were studied using prospective registration of all acute care episodes with regard to social standing in both areas during the study periods. RESULTS: Male members of households categorized as not vocationally active displayed the highest pre-intervention injury rates. Also after the intervention, males in households classified as not vocationally active displayed notably elevated injury rates in both the control and study areas. Households in the study area in which the significant member was employed showed a post-intervention decrease in injury rate among both men (P < 0.001) and women (P < 0.01). No statistically significant change was observed in households in which the significant member was self-employed or not vocationally active. In the control area, only an aggregate-level decrease (P < 0.05) among members of households in which the significant member was employed was observed. CONCLUSIONS: The study displayed areas for improvement in the civic network-based WHO Safe Community model. Even though members of non-vocationally active households, in particular men, were at higher pre-intervention injury risk, they were not affected by the interventions. This fact has to be addressed when planning future community-based injury prevention programmes.     

Implementing evidence-based substance use prevention curricula in North Carolina public school districts

The Safe and Drug-Free Schools and Communities Act (SDFSCA) provides funding for prevention education to nearly every school district in the nation. Recent federal policy requires SDFSCA recipients to implement evidence-based prevention programs. This paper reports the extent to which North Carolina public school districts implement evidence-based substance use prevention curricula. Results showed that while the majority of school districts use evidence-based prevention curricula, they are rarely the most commonly used curricula. Evidence-based curricula are much more likely to be used at the middle school level than at the elementary or high school levels. Urbanicity, coordinator time, and coordinator experience correlated with extensive use of evidence-based curricula in the bivariate analysis, but only time spent on prevention by the Safe and Drug-Free Schools (SDFS) coordinator significantly predicted extensive use in the multivariate analysis. Increasing district SDFSCA coordinator time is a necessary step for diffusing evidence-based curricula.     

疫情防控常态化下推进“健康中国”战略的启示

文章从疫情防控常态化背景出发,提出推进“健康中国”战略的建议:“健康中国”建设关键在“预防”,推动卫生健康资源整合,让“互联网+健康”成为“健康中国”重要驱动力,采用数字化“智理”手段实现健康大数据精准应用,重视发挥人民群众在“健康中国”建设中的主体作用。     

Community-based injury prevention: effects on health care utilization.

BACKGROUND: Worldwide, an estimated 78 million people are disabled each year because of unintentional injuries and about 3 million die. The WHO Safe Community model is a framework for community-based injury prevention programmes. The aim of this study is to evaluate the outcome on health care utilization of a Safe Community programme. METHODS: The incidence of injuries treated at health care facilities in an intervention municipality (pop. 41,000) was compared to the injury incidence in a control municipality (pop. 26,000). The incidence was recorded immediately before and one year after programme implementation from registrations made during all first-contact health care visits and from examination of hospital discharge registers. RESULTS: The incidence of health care treated injuries in the intervention area had decreased by 13% (95% CI: 9-16%) from 119 (95% CI: 115-122) per 1000 population-years to 104 (95% CI: 101-107). In the control area, the corresponding injury incidences were 104 (95% CI: 100-108) and 106 (95% CI: 102-109). The hospital-treated injuries in the intervention area decreased by 15% (95% CI: 7-24%) from 19 (95% CI: 17-20) per 1000 population-years to 16 (95% CI: 15-17), while in the control area, the incidences remained at 13 (95% CI: 11-14) per 1000 population-years. Utilization of acute care in the intervention area for reasons other than injuries increased by 8% (95% CI: 6-10%), while in the control area, the number of visits did not show significant change. CONCLUSION: This first controlled evaluation showed that an injury prevention programme based on local action groups can significantly reduce injuries requiring health care in a community. Local prevention can provide a complement to national level campaigns.     

建立具有中国特色的环境与健康监测、调查和风险评估体系

经济快速发展的同时,带来了严重的环境污染问题。环境问题带来的健康危害逐渐显现并得到广泛关注。我国政府高度重视环境污染问题及其健康的影响,开展了大量的环境与健康监测、调查和风险评估工作,为探究环境污染的健康危害以及预防控制相关疾病提供了重要的基础数据和科学依据。本文梳理了我国在环境与健康监测、调查和风险评估体系建设的发展历程及主要进展,并对将来一段时期的工作进行了展望。     

2011年上海市某社区意外伤害现状分析

目的了解社区居民意外伤害状况,分析伤害发生的原因,探讨预防措施。方法对上海市某社区卫生服务中心2011年门诊收治的伤害病例资料进行统计分析。结果该医院门诊一年中共收治伤害病例854例。其中,男性344例,女性510例;年龄2～96岁;各季收治病人数有所差异;伤害因素较多的是跌倒、坠落(62.65%),其次是钝器伤(11.71%)和刀/锐器伤(10.66%);伤害多发生在家中(45.67%)和公共居住场所(23.19%)。结论社区伤害对象以中老年人为主,应引起重视,加强伤害预防工作。     

Cost-Effectiveness of Nucleoside Analog Therapy for Hepatitis B in China: A Markov Analysis

ObjectivesThe aim of this study was to investigate the economic consequences of nucleoside analog therapy for hepatitis B treatment in China.MethodsA cost-utility analysis of treatments for HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB) was conducted using a Markov model, in which patients' yearly transitions between different health states were tracked. Patients were tracked as they moved between the following health states: CHB, HBeAg seroconversion (HBeAg-positive CHB patients can have this special health state), virologic resistance, virologic response, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and death. The transition parameters were derived either from systematic reviews of the literature or from previous economic studies. Cost and utility data came from studies based on a Chinese CHB cohort. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.ResultsThe entecavir strategy yielded the most quality-adjusted life years (QALYs) for both HBeAg-positive and HBeAg-negative patients when compared with the “no treatment,” the lamivudine, the adefovir, and the telbivudine strategies. The risks of complications and mortality also decreased. In the economic analysis, the “no treatment” strategy was the least effective, whereas the entecavir strategy was both the least expensive and the most cost-effective option, followed by telbivudine and lamivudine. The probabilistic sensitivity analysis showed that the entecavir strategy would result in improved cost-effectiveness in >90% of cases at a threshold of $20,000 per QALY. In a one-way sensitivity analysis, the most influential parameters impacting the model's robustness were the utilities of the CHB and virologic response health states.ConclusionsIn China, when treating both HBeAg-positive and HBeAg-negative CHB populations, entecavir is the most cost-effective option when compared with lamivudine, adefovir, and telbivudine.     

国内外大学生艾滋病研究热点与前沿趋势

目的 使用文献计量学对国内外大学生艾滋病相关研究进行对比分析,旨在推动未来国内该领域的发展。方法 通过中国知网（CNKI）与Web of Science核心合集检索得1986—2021年国内外大学艾滋病研究的相关文献,借助VOSviewer及R软件对纳入研究的发表时间、作者及单位分布、热点内容与前沿趋势进行剖析。结果 国外相较国内研究起步较早,国内外总体发文量均呈上升趋势,美国占据相关领域英文研究的主导地位。《中国艾滋病性病》（257篇）与J AM COLL HEALTH（46篇）分别是载文最多的中英文杂志,各研究团体间的合作尚不够紧密。中文研究侧重不同教育方式于艾滋病防控的探索,英文研究则更关注于该群体“酒精使用”、“物质滥用”与“心理”等话题,防艾生活技能及暴露前预防（PrEP）等或成为未来研究趋势。结论 刊载大学生艾滋病的期刊类型较多,而高发文量期刊数较少且作者及机构间的合作有待加强,国内应给予该群体物质滥用及心理等方面更多关注,同时今后要加强对艾滋病监测与防艾生活技能方面的训练。     

Economic evaluation of back pain interventions

Despite the rising health care costs of back pain, the evaluation of economic aspects of back pain interventions has received little attention. This paper reviews 23 economic evaluation studies of back pain interventions looking at costs, consequences, and other methodological aspects. This paper gives a detailed summary of the economic evaluation data given by these studies and provides insight into the quality of economic evaluation in the field of back pain. Seven of the studies dealt with injury-prevention programs, six with post-incidence management programs, and ten studies with back injury and pain remedies. The injury prevention programs (except for back pain programs) and post-incidence management programs appear to produce cost savings due to reduced absenteeism. This paper shows that because of differences in the measurement of costs and outcomes and other methodological limitations, it is impossible to draw conclusions in favor of any one type of program.     

2011—2020年中国儿童肥胖研究的文献计量学分析

目的 从文献类型、文献年度、被引频率、学科分析、研究内容、核心作者、研究机构、期刊来源和基金来源方面对我国儿童肥胖相关文献进行分析,了解我国儿童肥胖研究的现状,为之后的相关研究提供参考。方法 以中国知网(CNKI)、万方(Wan Fang Data)、维普(VIP)和Web of Science为文献检索平台,检索2011—2020年我国学者发表的儿童肥胖研究文献,利用文献计量学方法对检索到的4 986篇相关文献进行分析。结果 我国儿童肥胖研究文献数量在2011—2020年总体呈上升趋势,年度发文量保持在400～500篇; 文献涉及的学科主要为医学类,其发文量占总文献量的74.65%; “儿童肥胖的干预与预防”、“青少年肥胖”、“儿童肥胖的影响因素”、“代谢综合征”等成为儿童肥胖研究的主要热点; 发文量8篇以上的作者为本领域的核心作者,其中发文量10篇以上的核心作者共有24位; 研究机构以医科大学、综合性大学、各级各类医院和疾病预防控制中心为主; 载文量排名前五的期刊分别为中国学校卫生、中国儿童保健杂志、中国妇幼保健、中国保健营养和International Journal of Environmental Research and Public Health; 1 493篇文献得到了各级各类基金的资助,资助文献占总文献的29.94%。结论 我国儿童肥胖研究得到了各级组织和机构的关注和重视,但是研究范围还有待于进一步拓宽。