新医改前后我国省市县三级卫生监督机构人员配备比较研究

目的:了解新医改前后我国省市县三级卫生监督人员变化趋势,为建立结构合理的卫生监督队伍提供依据。方法:对新医改前后我国卫生监督机构人员配备情况进行定量分析。结果:(1)卫生监督人员数量注重往县级发展,但与监督执法工作的客观需求仍有差距。(2)不同卫生监督岗位人员比例基本合理,卫生执法人员比例在县级逐渐增多。(3)卫生监督人员总体学历有所提高,但仍然偏低。结论:(1)新医改后我国卫生监督人员队伍已具有一定规模,但总体人员数量仍不足,学历仍然偏低。(2)应进一步吸引人才,加强人员在职培训。     

我国新医改前后卫生资源配置公平性分析

目的:描述和对比2006—2015年新医改前后我国卫生资源配置情况、差异及其公平性变化。方法:用省级数据分析执业(助理)医师数和医疗卫生机构床位数配置的公平性,将我国31个省、自治区、直辖市按人均GDP和地理区域分为五个不同收入组和东中西三组,极差法、比例法和集中指数法分别用于比较和评价新医改前后不同组间的绝对差异、相对差异和相对公平性。结果:我国卫生资源配置(1)数量逐年增加,新医改后增长率高于新医改前;(2)不同经济发展水平地区卫生资源差异逐渐减小,新医改后减小速度加快;(3)不同地区床位配置差异减小,执业(助理)医师差异在新医改后有所拉大;(4)我国卫生资源配置公平性得到提高,新医改后的改善程度优于新医改前,但按地理面积分布的卫生资源仍处高度不公平状态。讨论:(1)新医改中加强卫生资源配置的政策得到一定程度的落实;(2)部分地区卫生资源数量仍需增加,尤其需要加强高质量卫生人才的培养;(3)在进行资源配置时,同时兼顾人口数量和地理面积大小。     

不同级别卫生监督机构人员学历水平及专业结构现状分析

目的:了解不同级别卫生监督机构人员学历及专业构成情况,为推进卫生监督队伍建设提供依据。材料与方法:通过普查,获取全国卫生监督机构人员基本资料,应用SPSS16.0软件对数据进行统计分析。结果:(1)省级卫生监督人员学历水平最高,本科以上人员比例为73.13%,具有学位的人员比例为73.07%;(2)从进机构所学专业来看,省市县人员比例差异较大的前三个专业分别为临床医学、公共卫生与预防医学、法学,从最后学位所学专业来看,省市县人员比例差异较大的三个专业分别是临床医学、公共卫生与预防医学、公共管理,专业变动人员比例最高的是县级卫生监督人员,为14.99%。结论:(1)不同级别卫生监督人员学历水平差异较大,但与机构职能定位较匹配;(2)不同级别卫生监督人员学历水平有所提高,但仍与规划要求有差距。(3)不同级别卫生监督人员专业构成有差异,但与机构工作内容相一致。     

全国县级卫生监督派出机构及派出人员数量现状分析

目的 了解县级卫生监督派出机构及人员数量现况,分析其存在的问题,探索改进的方向.方法 通过普查,获取全国县级卫生监督派出机构及人员数量资料,分东中西部进行描述和分析.结果 (1)全国有59.16％的县级地区既无派出人员也无派出机构;(2)63.73％的县级地区既无派出人员也无编制;(3)平均每县级地区派出人员、派出机构和编制数量分别为14.60人、1.17个和3.31人;(4)推算得全国派出机构总数为3 564个,平均每乡镇(街道)0.09个.结论 县级卫生监督派出人员、派出机构和派出人员编制均严重短缺,西部地区尤为严重.     

不同地区、不同级别卫生监督人员岗位分布情况

目的:了解不同地区、不同级别卫生监督机构人员岗位分布情况,以期为探索各类岗位人员比例的合理配置提供参考。材料与方法:通过普查,获取全国卫生监督人员的基本资料,应用SPSS16.0软件对数据进行统计分析。结果:(1)分地区来看,从事综合业务、卫生执法、行政、后勤四类岗位人员比例最高的地区依次是东部、中部、西部和东部;(2)分级别来看,从事综合业务、行政和后勤岗位人员比例均是省级最高,从事卫生执法岗位人员比例县级最高;(3)从不同地区、不同级别来看,从事综合业务、卫生执法岗位的人员比例最高的分别是中部省级和中部县级卫生监督机构,而行政、后勤岗位的人员比例最高的均是西部省级卫生监督机构。结论:(1)卫生监督机构人员岗位分布在不同地区间差异小,不同级别间差异大;(2)卫生监督人员岗位比例在不同级别、不同地区卫生监督机构间有所差异。     

全国省级卫生监督机构人员概况分析

目的 了解省级卫生监督机构人员的年龄、性别、学历、学位、专业分布等情况,以发现其人员队伍建设过程中存在的问题,为卫生监督队伍和体系建设提供参考.材料与方法 通过普查,获取全国卫生监督机构人员基本资料,选取省级机构人员数据,应用SPSS 16.0软件进行统计分析.结果 在省级卫生监督机构人员中,年龄为40～49岁的比例为首(38.51％),大学本科学历(62.97％)和学士学位(63.89％)比例最高,公共卫生与预防医学专业较多(33.06％).结论 省级卫生监督机构人员数量配备合理性有待完善,人数有待补充;东中西部地区卫生监督人员在年龄、专业、人员学历、学位等各方面存在差异.     

171家不同地区卫生监督机构食品与职业卫生职能项目开展情况研究

目的在前期分级别对卫生监督机构食品与职业卫生职能项目开展情况分析的基础上,从不同地区的角度来进一步了解我国卫生监督机构食品与职业卫生职能项目的开展情况。方法采用分层整群抽样方法,抽取不同地区样本171家。结果(1)食品卫生监督职能开展项目最高的是东部地区为77.53%,项目开展比例最低的是西部职业卫生监督职能为47.18%;(2)食品与职业卫生职能具体项目开展比例分析发现,西部职业卫生许可项目开展比例较低,为26.32%。结论东中西部卫生监督机构食品与职业卫生监督职能项目开展比例呈递减趋势。     

全国学校卫生和传染病防治监督岗位人员结构分析

目的:了解全国卫生监督机构中学校卫生监督和传染病防治监督岗位设置情况、人员数量和结构现状,分析其差异及存在的问题,为学校卫生监督和传染病防治监督岗位人才队伍建设提供依据。方法:通过普查,获取全国学校卫生监督和传染病防治监督岗位人员基本资料,分东中西部和省市县级进行描述和分析。结果:从学校卫生监督和传染病防治监督岗位的总体情况来看,设岗机构比例以西部和县级最低;东部和省级的人员学历学位水平较高;东部和市级人员专业以公共卫生与预防医学专业比例最高。结论:学校卫生监督和传染病防治监督岗位人员配备存在不足,同时其数量和结构在不同地区和不同级别之间存在差异,且不同级别之间的差异大于不同地区之间的差异。     

全国县级卫生监督机构人员结构分析

目的 了解东中西部县级卫生监督机构人员数量和结构现状及差异,分析存在的问题,为县级卫生监督机构人才队伍建设提供依据.方法通过普查,获取全国县级卫生监督机构及其人员基本资料,分东中西部进行描述和分析.结果 (1)全国平均每县级卫生监督机构25.64人;(2)年龄集中在30～39岁和40～49岁,分别占36.10％和33.93％;(3)专科人数最多,占调查总人数的40.75％;(4)无学位人数最多,占调查总人数的69.56％;(5)医学类其他专业人数最多,占调查总人数的36.65％.结论 县级卫生监督人员年龄梯度不合理、学历和学位水平低、专业机构不合理,中西部地区尤其严重.     

全国职业、放射卫生监督岗位人员结构分析

目的:了解全国职业、放射卫生监督岗位设置情况以及人员结构现状,分析存在的问题,为卫生监督机构职业放射卫生监督岗位的人才队伍建设提供依据。方法:通过普查,获取全国卫生监督机构职业卫生监督岗位和放射卫生监督岗位人员基本资料,分东中西部和省市县级进行描述和分析。结果:西部和县级设置职业、放射卫生监督岗位的机构比例最低;西部县级机构从事职业放射卫生监督、职业卫生监督、放射卫生监督工作的人员均数均不足2人;学历以专科和本科为主,分别占37.44%和35.92%;学位以无学位为主,占61.29%;专业以公共卫生与预防医学、临床医学为主,分别占39.53%和18.38%。结论:全国已有部分机构设置职业、放射卫生监督岗位,但部分机构的人数还不足,需继续加强人才队伍建设;人员的学历学位水平较低,而无专业的人员比例较高。     

论农村卫生事业的发展与卫生政治学

卫生工作具有政治性,发展卫生事业必须讲政治。一个国家整个人群的健康不是取决于单个的公民或医生,而是取决于社会制度和社会关系。只有通过政治才能改变社会制度和社会关系。解放后我国农村卫生事业取得了令国际社会赞赏的辉煌成就,根本原因在于中国共产党注重从政治的高度认识并开展农村卫生工作。市场经济条件下,我国农村卫生事业发展遇到了挫折,需要我们重新审视农村卫生与政治的关系,探索建立卫生政治学新学科,为农村卫生工作提供理论指导。     

The association between health risk status and health care costs among the membership of an Australian health plan

Health promotion in Australia has developed into an accepted strategy for solving public health problems and promoting the health of its citizens. However, there are few evidence-based research studies in Australia that measure health risk status or track health changes over time with defined cost outcome measures. Those individuals with more high-risk lifestyle behaviors have been associated with higher costs compared with those with low-risk behaviors. Although intuitively it was believed that the health promotion programs had a positive impact on health behaviors and consequently on health care costs, the relationship between health risk status and health care costs had yet to be tested in the Australian population. Consequently, a verification study was initiated by the Australian Health Management Group (AHMG) to confirm that those relationships between health risks and medical costs that had been published would also hold in the Australian population using Australian private health care costs as the outcome measure. Eight health risks were defined using a Health Risk Appraisal (HRA) to determine the health risk status of participants. Consistent with previous studies, low-risk participants were associated with the lowest health care costs (377 Australian dollars) compared with medium- (484 Australian dollars) or high-risk (661 Australian dollars) participants and non-participants (438 Australian dollars). If the health care costs of those at low risk were considered as the baseline costs, excess health care costs associated with excess health risks in this population were calculated at 13.5% of total expenditures. Health risk reduction and low-risk maintenance can provide important strategies for improving/maintaining the health and well-being of the membership and for potential savings in health care costs.     

Multi-sectoral health promotion and public health: the role of evidence

BACKGROUND: Evidence-informed health promotion and public health is an emerging and ever-changing theme in research and practice. A collaborative approach to gathering and applying evidence is crucial to implementing effective multi-sectoral health promotion and public health interventions for improved population outcomes. This paper presents an argument for the development of multi-sector evidence and discusses both facilitators and challenges to this process. METHODS: Sector-specific contacts familiar with decision-making processes were selected from referrals gained through academic, government and non-government networks and interviewed (in-person or via telephone) as part of a small scale study to scope the use of evidence within non-health sectors where decisions are likely to impact on public health. RESULTS: The views gathered are preliminary, and this analysis would benefit from more extensive consultation. Nonetheless, information gathered from the interviews and literature search provide valuable insights into evidence-related decision-making paradigms which demonstrate similarities with, and differences from, those found in the health sector. CONCLUSIONS: Decisions in health promotion and public may benefit from consideration of the ways in which disciplines and sectors can work together to inform policy and practice.     

骨骼肌肉功能失调对卫生专业技术人员职业活动和健康影响的研究

目的骨骼肌肉功能失调是一个危害广泛的职业卫生问题。本研究旨在了解我国骨骼肌肉功能失调对职业活动和健康的影响。方法对334名卫生专业技术人员进行了骨骼肌肉功能问卷调查,内容包括骨骼肌肉功能失调的身体部位及对职业活动和健康的影响。结果本次问卷调查的应答率为99.4%,其中308人主诉在过去12个月有骨骼肌肉功能失调的表现如疼痛、不适或麻木,以颈部、肩部和腰部最多,分别为72.2%、59.9%和59.9%。在这些症状中持续时间超过24小时的占56%,影响到职业工作的占23%,需要医院就医的占15.9%。手腕部和肩部骨骼肌肉功能失调的持续时间多超过24小时,其OR值分别为3.1(95%CI1.6~6.4,P<0.01)和2.6(95%CI1.4~4.7,P<0.01);而腰部、大腿和手腕部骨骼肌肉功能失调常常引起工作能力的下降,其OR值分别为2.7(95%CI1.6~4.7,P<0.01)、2.4(95%CI1.1~5.0,P<0.05)和2.2(95%CI1.3~3.9,P<0.01);腰部和膝部骨骼肌肉功能失调到医院就医的需求最高,OR值分别为2.8(95%CI1.5~5.4,P<0.01)和2.1(95%CI1.1~4.0,P<0.05);女性职业者出现骨骼肌肉功能失调的相对危险性为男性5.2倍(OR=5.2,95%CI1.3~21.0,P<0.05)。结论在卫生专业技术人员中,骨骼肌肉功能失调是影响健康和职业活动的重要因素之一。     

Health education and primary health care in Costa Rica: the role of the health assistant

Health status indicators for the population of Costa Rica comparedfavorably in the 1980s to those of more developed nations. Morbidityand mortality had been lowered, and health status differentialsbetween population subgroups had been narrowed. By 1984, mostof the objectives set by the World Health Organization had beenexceeded. These outcomes have been attributed to the successof a national primary health care program and to the role ofthe health assistant/asistente de salud in the operation ofthis program. This article examines the approach taken in achieving theseoutcomes. Of particular interest is the role of the health assistantas health educator in attaining the health promotion and diseaseprevention goals of the primary care program. Contemporary challenges which may diminish the role of the healthassistant and the possible consequences of this for public healthare considered, as is a recent government experiment which affordsa potential response to these issues. The latter, a new modelfor the organization and delivery of health services, featuresa partnership between government and a private sector providergroup. This arrangement retains the traditional role of thehealth assistant in primary care and enhances the health educationfunction of the health assistant. Under pressure and in transition, the health sector in CostaRica is striving to safeguard the admirable achievements ithas attained and to plan for further advances. It is clear thatunder present circumstances difficult choices must be made.One hopes that in the trade-offs made, those elements of theprimary health care program which have been essential to thisnation's success are not assigned a lower priority.     

The role of the schools of public health in the development of primary health care

Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.     

合理调整卫生资源 建立城市三级服务网推动社区卫生服务工作深入发展

山东省淄博市人民政府根据《中共中央、国务院关于卫生改革与发展的决定》精神,围绕着合理调整卫生资源,建立和完善卫生服务体系,使全市城乡人民都能就近获得基本医疗卫生服务的目标,坚持以区域规划原则为指导,针对卫生资源存在的主要问题,通过开展社区卫生服务,探索出实施区域卫生规划,合理配置和有效利用现有卫生资源的新路子。     

‘Health and well-being’: Questioning the use of health concepts in public health policy and practice

In recent years, health and well-being have been ‘mainstreamed’ as a policy issue and have become the concern of a widening range of agencies. Simultaneously, increasing weight has been placed on the measurement of population health status, the implementation of evidence-based practice in public health and the more effective evaluation of policy interventions targeted at health gain and health inequalities. Thus, at a time when greater conceptual clarity is crucial, there are more stakeholders in ‘health’, each with a potentially different perspective and understanding of what ‘health’ is. In this study, we explore the need for greater conceptual clarity in relation to health, using the term ‘well-being’ as an exemplar. We draw on findings from a research project undertaken with community and professional groups in the Black Country and Shropshire that explored shared ways to measure aspects, and determinants, of health. We suggest a lack of attention to health concepts and their clarification, as indicated by the use of ‘well-being’ as an ill-defined tag to health, is having a negative impact on public health's ability to deliver health gain, and that commitment to clarifying concepts would lead to a range of benefits. At present, however, the term ‘well-being’ muddies the waters, acting more as an open-ended catch-all category than a clearly considered component of ‘health’.     

妊娠期妇女的口腔卫生预防保健

目的 调查妊娠期妇女的口腔健康状况及口腔健康教育状况.方法 对500例孕妇患龋率、牙周病及自我保健意识进行调查分析.结果 妊娠期龋齿及牙龈炎患病率分别为49.67%和75.68%, 软垢及牙石发生率分别为86.87%和52.41%,而龋齿和牙龈炎就诊率仅为3.38%,92.32%的孕妇未接受过口腔健康教育.结论 缺乏口腔保健意识和不良口腔卫生习惯是影响孕妇口腔健康状况的主要原因.     

公共卫生和公共卫生突发事件

该文从理论角度阐述什么是现代公共卫生观念 ,公共卫生应在公共卫生突发事件处理中发挥什么作用和怎样发挥作用 ,希望对确定我国现代公共卫生理论体系有所启发