湖北省城市社区卫生服务机构健康教育工作现状调查

目的了解湖北省城市社区卫生服务机构健康教育工作现状,分析存在的问题。方法根据市健康教育所参与社区健康教育的程度,选择湖北省荆门市、黄石市和鄂州市作为研究现场,每个城市随机选择2个城市社区卫生服务中心,每个社区卫生服务中心随机抽取下辖的2个服务站,采用调查表和结构式访谈结合的方式,对社区卫生服务机构健康教育工作现状进行调查。结果调查的18个社区卫生服务机构中,专兼职健康教育工作人员有106人,占在岗人员的36.6％,无人接受过健康教育专业培训。100.0％的机构拥有3项以上基本健康教育设备,无社区健康教育专项经费。80.0％以上的机构建立各种组织网络,社区居委会的配合最为重要。80.0％以上的社区卫生服务机构以面对面教育、知识讲座、街头宣传等为主要活动形式,针对重点人群开展慢性病、传染病及控烟教育的活动。结论湖北省城市社区卫生服务机构健康教育工作已形成一定的工作方式,但还存在着人员、经费、多部门合作及缺乏相关规范制度等方面的问题。     

社区健康教育工作存在的困难及需求比较分析

目的通过对福州市社区卫生服务机构健康教育工作比较分析,为调整社区健康教育策略提供参考。方法采用总体调查方法,利用自行设计健康教育问卷,调查福州市社区卫生服务机构2007年和2012年的健康教育工作,并进行对比分析。结果 2007年调查182家社区卫生服务机构,2012年调查165家社区卫生服务机构。两次调查显示健康教育工作人员学历不高、多为兼职人员、培训率低。社区卫生服务中心2007年主要困难是经费、人员和宣传材料不足,分别为88.89%、81.48%和70.37%,2012年主要问题是人员不足、社区居民不接受、健康讲座无场地,分别为78.72%、57.45%和38.30%;社区卫生服务中心2007年希望在经费、宣传材料和组织培训方面得到的支持,分别为100.00%、85.18%和81.48%,在2012年时最希望在组织经验交流、培训和参观考察方面得到支持,分别为85.11%、82.98%和70.21%。2007年和2012年两次调查显示,社区卫生服务站5年间健康教育工作主要困难均是经费、人员及宣传材料不足,工作需求均为经费、组织培训和增发宣传材料。结论 5年间,福州市社区卫生服务机构健康教育工作有所提高,且社区卫生服务中心优于社区卫生服务站。建议进一步完善健康教育相应政策,支持社区卫生服务机构有效地开展健康教育工作。     

上海市闸北区社区卫生服务站（点）现状研究

上海市闸北区9所街道(地段)医院开设的12个社区卫生服务站(点)的现状资料表明,服务功能不完善,工作人员学历职称较低以及用房面积、技术设备较为落后,管理体制尚未真正建立等问题,制约了社区卫生服务。我们认为社区卫生服务站工作应与社区精神文明建设,与需求为导向扩大服务相结合,与上海市区实行“两级政府、三级管理”新体制相结合,与初级保健相结合才能保证工作方向可持续发展。     

福州市社区卫生服务机构健康教育配置现况调查

目的了解福州市社区卫生服务机构健康教育人力资源、经费和基础设施情况,为制定健康教育工作计划提供参考。方法采用自行设计的问卷,对福州市2012年各社区卫生服务机构的健康教育人力资源、经费和基础设施等情况进行调查。结果福州市有47家社区卫生服务中心、118家社区卫生服务站。从事社区健康教育工作人员的学历普遍偏低,本科及以上学历的人员为17.58%,公卫专业人员太少,仅为7.88%;具有高级职称的健康教育人员所占比例极低,仅有1人(0.61%)。年人均健康教育经费为0.89元。结论目前的社区卫生服务机构的健康教育资源配置情况仍不能很好地满足社区居民的需要。了解福州市社区卫生服务机构健康教育人力资源、经费和基础设施情况,为制定     

广州市某区2007年社区预防保健服务评价探索与实践

目的通过对社区卫生服务机构提供的社区预防保健等公共卫生服务项目进行评价,核拨社区预防保健等公共卫生服务补助经费,引导社区卫生服务机构健康发展。方法组织专家成立社区公共卫生服务评价小组,对9家社区卫生中心(站)进行了社区预防保健等公共卫生服务评价。结果各社区卫生服务机构社区预防保健等公共卫生服务评价分数相差悬殊(32.5～84.5分),其中社区卫生服务中心评价分数(56分)比社区卫生服务站(48分)高。结论本评价体系较适用于现阶段城市社区公共卫生服务的评价,有助于保证政府"购买服务"政策的实施。     

全国城市社区健康教育经验交流与培训会议在杭州召开

中国疾病预防控制中心健康教育所于2006年5月9～12日在浙江省杭州市召开了“全国城市社区健康教育经验交流与培训会议”。中国疾病预防控制中心健康教育所胡俊峰副所长到会并讲话，浙江省卫生厅疾病控制处林绍斌调研员、浙江省疾病预防控制中心徐哨寅、杭州市疾病预防控制中心项海青主任到会祝贺。来自全国29个省、自治区及直辖市的疾病预防控制中心健康教育所60余位社区健康教育的专业人员和40余位社区卫生服务中心主任参加了会议。本次会议主要有3项内容：①北京大学医学部公共卫生学院的钮异教授、吕姿之教授、北京市朝阳区卫生局张晓林主任医师、中国疾病预防控制中心健康教育所胡俊峰教授、孙建国研究员，分别就怎样做好社区健康的传播、社区健康教育诊断、城市社区卫生服务健康教育效果评价、城市社区卫生服务健康教育的进展等内容进行了精彩讲座；②来自全国各地的部分代表进行了健康教育工作的经验交流；③会议代表到杭州社区卫生服务机构现场考察健康教育工作。     

新疆城市社区儿童健康管理服务资源配置调查分析

目的：了解新疆城市社区儿童健康管理服务资源配置现状,为政府提供资源配置决策参考和政策建议。方法采用随机整群抽样的方法,抽取乌鲁木齐、克拉玛依、阿克苏、哈密4个城市,对其城市中所有开展儿童健康管理服务的68家社区卫生服务中心进行调查,了解中心的性质、财务状况、人员编制、业务用房面积和儿童健康管理业务用房、设备和人员的配备情况。结果被调查的社区卫生服务中心多以政府举办为主(97.06%);各项财务收支4个城市均存在差异(P <0.01),财政补助经费普遍较少;中心业务面积和儿童保健业务用房面积达标率分别为72.06%和41.17%;4个城市的儿童保健基本设备数量存在差异(P <0.01),且拥有6种以上儿童保健设备的中心仅12家(17.65%);所有中心均存在编制不足,儿童保健医师数量、专职从事儿童保健工作人员少的现象;从事儿童保健的工作人员以初、中级职称居多,临床、护理及其他非儿童保健专业从事儿童保健工作达到84.11%。结论新疆城市社区儿童健康管理服务资源配置不足,4个城市间存在差异。政府应加大社区卫生服务投入,增加儿童保健基本设备的投入,加强儿童保健医师队伍建设,提高服务能力,减少城市间的差异。     

闸北区社区健康教育工作人力资源的合理配置

目的 为了能适时掌握社区卫生服务中心从事健康教育的工作人员人力分配和使用现状，探索更合理的有效工时。方法 采用问卷调查方法对上海市闸北区辖区内的8个社区卫生服务中心及17个社区卫生服务站(点)的健康教育工作人员进行了日工作时间分布状况的调查。结果 社区卫生服务中心从事健康教育的工作人员每天用于健康教育的工作时间分别为人均3．5h和1．5h和社区卫生服务站(点)表明健康教育工作的有效时数相对低。结论 健康教育作为公共卫生系统的一个重要组成部分，其人、财、物等资源的配置和保障、网络的建设、各个相关部门职责的明确、彼此间的配合机制的建立等等，都需要法律来保证。为了百姓利益，国家应尽快将健康教育纳入法制轨道。     

以人为本 探索多种形式的社区卫生服务发展模式

1997年,湖北省宜昌市西陵区主动适应社会主义市场经济体制及城市现代化建设和管理的要求,以社区为依托,以群众的健康为己任,积极探索融预防、保健、康复、健康教育、医疗、计划生育指导"六位一体"的社区卫生服务体系.现已建成了由1个社区卫生服务中心、9个社区卫生服务站组成的社区卫生服务网络,覆盖28个社区居委会,占社区居委会总数的71.0%,覆盖人口数达107 315人.各社区卫生服务机构,以健康为中心,以人群为对象,以家庭为基础,为社区居民提供了方便、快捷、周到的服务,受到居民的普遍赞誉,并得到了部、省、市各级领导的充分肯定.     

上海市社区卫生服务站建设相关问题调查与探讨

目的探讨社区卫生服务发展建设存在的问题，为完善社区卫生服务功能、促进规范服务提供依据。方法对本市5个区12个社区卫生服务中心的50个社区卫生服务站；包括中心主任与分管科长32名，站长50名进行问卷调查。调查内容包括中心基本情况，服务站的基本情况、人员配置、设施设备及服务开展情况等。结果本市社区卫生服务站的布局不尽合理，工作忙闲不一，服务量极差达20倍；服务站社区护士不足，团队的全科和中医医生各有约1／4具不稳定性；服务站的基本设施、设备配置状况与卫生部的标准存在一定差距，且存在两级化，医保支付系统拥有率仅为24％；能提供外伤处理、临终关怀、计划免疫及急救医疗的服务站比较少；制度建设存在薄弱环节。结论上海市城区社区卫生服务站的合理布局要完善，硬件建设投入应加大，人才队伍建设需加强，配套制度建设应加速。     

Arsenic,cadmium, cobalt,copper, lead,mercury, molybdenum,selenium and zinc concentrations in liver,kidney and muscle in Australian sheep

Matched muscle, liver and kidney samples from 152 sheep in different states of Australia were analysed for trace elements. Mean levels found in muscle, livers and kidneys were 0.010, 0.010 and 0.011 mg kg⁻¹ (fresh weight) for arsenic; 0.0035, 0.280 and 0.853 mg kg⁻¹ for cadmium; 0.006, 0.060 and 0.044 mg kg⁻¹ for cobalt; 0.74, 66.0 and 2.72 mg kg⁻¹ for copper; 0.007, 0.040 and 0.057 mg kg⁻¹ for lead; 0.0025, 0.0034 and 0.0061 mg kg⁻¹ for mercury; 0.014, 1.05 and 0.44 mg kg⁻¹ for molybdenum; 0.09, 0.31 and 0.95 mg kg⁻¹ for selenium; and 40.4, 37.2 and 20.8 mg kg⁻¹ for zinc. The lead, mercury and arsenic concentrations in meat and organs may be regarded as low, but the concentrations of cadmium in kidney and livers are sometimes relatively high. Apart from cadmium, lead and selenium, tissue trace element concentrations were not related to the age of the investigated animals. Differences in essential and non-essential trace element accumulation in sheep reared in different regions (states and territories) of Australia were also evaluated. Cadmium, lead and selenium were the only elements that appeared to show significant regional differences. Overall the results show that concentrations of the elements considered are within current acceptable ranges.     

Homocysteine, folate, vitamin B12, and cardiovascular risk in Indians, Malays, and Chinese in Singapore

OBJECTIVE: To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is partly attributable to differences in blood concentrations of homocysteine, and related blood concentrations of folate and vitamin B12. DESIGN: Cross sectional study of the general population. SETTING: Singapore. PARTICIPANTS: Random sample of 726 fasting subjects aged 30 to 69 years. MAIN RESULTS: Mean plasma total homocysteine concentrations did not show significant ethnic differences; values were Indians (men 16.2 and women 11.5 mumol/l), Malays (men 15.0 and women 12.5 mumol/l), and Chinese (men 15.3 and women 12.2 mumol/l). Similarly, the proportions with high plasma homocysteine (> 14.0 mumol/l) showed no important ethnic differences being, Indians (men 60.0 and women 21.9%), Malays (men 53.9 and women 37.8%), and Chinese (men 56.6 and women 30.6%). Mean plasma folate concentrations were lower in Indians (men 8.7 and women 10.9 nmol/l) and Malays (men 8.5 and women 10.8 nmol/l), than Chinese (men 9.7 and women 13.8 nmol/l). Similarly, the proportions with low plasma folate (< 6.8 nmol/l) were higher in Indians (men 44.9 and women 36.6%) and Malays (men 45.3 and women 24.5%) than Chinese (men 31.4 and women 12.6%). Mean plasma vitamin B12 concentrations were lowest in Indians (men 352.5 and women 350.7 pmol/l), then Chinese (men 371.1 and women 373.7 pmol/l), and then Malays (men 430.5 and women 486.0 pmol/l). CONCLUSION: While there were ethnic differences for plasma folate and vitamin B12 (in particular lower levels in Indians), there was no evidence that homocysteine plays any part in the differential ethnic risk from CHD in Singapore and in particular the increased susceptibility of Indians to the disease.     

Tuberculosis in Salvador, Bahia, Brazil, in the 1990s

The characteristics of tuberculosis (TB) cases and deaths were analyzed in order to characterize the epidemiological profile of TB (incidence and mortality) in Salvador, Bahia, Brazil, in the 1990s. Annual incidence and mortality rates were calculated by gender, age bracket, and clinical forms of the disease using databases from the Tuberculosis Information System of the Bahia State Health Secretariat and the Mortality Information System of the Brazilian Ministry of Health. TB spatial distribution was analyzed according to health district. Cases and deaths were predominantly in males in the 15 to 39 year group. The pulmonary form showed the highest incidence and mortality. The existing data did not corroborate the hypothesis that AIDS/TB co-infection might contribute to maintaining the high mortality rates. The greater occurrence of tuberculosis in certain health districts may be associated with population density and unfavorable living conditions.     

Murine Typhus in Austin,Texas, USA, 2008

In August 2008, Texas authorities and the Centers for Disease Control and Prevention investigated reports of increased numbers of febrile rash illnesses in Austin to confirm the causative agent as Rickettsia typhi, to assess the outbreak magnitude and illness severity, and to identify potential animal reservoirs and peridomestic factors that may have contributed to disease emergence. Thirty-three human cases of confirmed murine typhus were identified. Illness onset was reported from March to October. No patients died, but 23 (70%) were hospitalized. The case-patients clustered geographically in central Austin; 12 (36%) resided in a single ZIP code area. Specimens from wildlife and domestic animals near case-patient homes were assessed; 18% of cats, 44% of dogs, and 71% of opossums had antibodies reactive to R. typhi. No evidence of R. typhi was detected in the whole blood, tissue, or arthropod specimens tested. These findings suggest that an R. typhi cycle involving opossums and domestic animals may be present in Austin.     

Gender,play, language,and creativity in preschoolers

This study explored the effects of a child's gender and school setting on preschoolers' language abilities (receptive vocabulary), creativity, and social play. The participants were primarily European-American children who spoke English as a primary language (nine children were bilingual), and were from middle income socioeconomic backgrounds. There were 20 girls and 33 boys. Ages ranged from 3.11 to 6.60 years with a mean age of 4.66 years. On separate occasions, children individually completed the Goodenough-Harris Draw-a-Person Test and the Peabody Picture Vocabulary Test-IV. We also recorded the children's social play using Howes and Matheson's [1992. Sequences in the development of competent play with peers: Social and social pretend play. Developmental Psychology, 28, 961–974] scale. We employed a time sampling approach and also notated the area in which the child was playing. We found that gender and school setting influenced children's language abilities and social play. For example, children in the preschool that engaged in pretend play with greater frequency performed well on the receptive vocabulary test. We also found that certain classroom areas generated different types of social play. We discuss the applied value of our findings as these relate to future research.     

Vitamins, selenium, iron, and coronary heart disease risk in Indians, Malays, and Chinese in Singapore

STUDY OBJECTIVE: To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is partly because of differences in antioxidants (vitamins A, C, and E, and selenium) and pro-oxidants (iron). DESIGN: Cross sectional study of the general population. SETTING: Singapore. PARTICIPANTS: Random sample of 941 persons aged 30 to 69 years. MAIN RESULTS: There were moderate correlations between vitamin A and vitamin E, and between these vitamins and selenium. Mean plasma vitamins A and E were similar by ethnic group. Vitamin A concentration for Indians were (men 0.66 and women 0.51 mg/l), Malays (men 0.67 and women 0.54 mg/l), and Chinese (men 0.68 and women 0.52 mg/l). Vitamin E concentrations for Indians were (men 12.9 and women 12.8 mg/l), Malays (men 13.6 and women 13.3 mg/l), and Chinese (men 12.6 and women 12.6 mg/l). In contrast, mean plasma vitamin C concentrations were lower in Indians (men 5.7 and women 6.9 mg/l) and Malays (men 5.1 and women 6.4 mg/l) than Chinese (men 6.3 and women 8.4 mg/l). Mean serum selenium was lower in Indians (men 117 and women 115 micrograms/l) than Malays (men 122 and women 122 micrograms/l) and Chinese (men 126 and women 119 micrograms/l). Mean serum ferritin was much lower in Indians (men 132 and women 50 micrograms/l) than Malays (men 175 and women 85 micrograms/l) and Chinese (men 236 and women 92 micrograms/l). MAIN CONCLUSIONS: Lower vitamin C and selenium in Indians, particularly in combination, could play a part in their increased risk of CHD. Vitamins A and E, and ferritin (iron) have no such role. Lower vitamin C in Indians and Malays is probably because of its destruction by more prolonged cooking. In Indians, lower selenium is probably because of a lower dietary intake and the much lower ferritin to a lower dietary intake of iron and its binding by phytates.