乡镇卫生院体制改革与运行机制创新的实践探索

针对乡镇卫生院在管理体制、补偿机制、运行机制等方面存在的问题，简阳市将乡镇卫生院改为公有制，卫生院人、财、物上划县管，卫生事业费纳入县级财政预算并全部兑现；同时改革卫生院内部运行机制，拓宽医疗服务范围，使卫生院增强了竞争实力，实现经济效益和社会效益的双丰收。     

乡(镇)卫生院上划县管的难点与对策

《中共中央、国务院关于进一步加强农村卫生工作的决定》(以下简称《决定》)中明确指出 :“卫生院的人员、业务、经费等划归县级卫生行政部门按职责管理。”乡 (镇 )卫生院上划县管已经成为农村卫生管理体制改革的核心环节。鹰潭市乡 (镇 )卫生院上划县管还存在不少难点 ,现分析如下 :一、观念转变难乡 (镇 )卫生院上划县管是农村卫生管理体制的一项重大改革 ,是中共中央、国务院进一步加强农村卫生工作的重大决定 ,各级党委、政府应责无旁贷地贯彻这一决定。但在具体操作中 ,上划时间、上划程序、上划范围以及上划顺利与否都和各级领导观念…     

农村卫生院"两权"分离改革新模式租股合作制--湖南省宜章、桂阳农村卫生院"两权"分离改革研究报告

农村卫生的发展如何,直接影响到我国整个现代化建设,关系到全面建设小康社会的进程.     

医疗和防保功能在乡镇卫生院经营活动中的地位分析

该对乡镇卫生院日常经营活动中医疗和防保服务提供的基本情况进行了分析，结果显示在卫生人力和财力的配置上，倾向于医疗科室而忽视防保科室，医疗支出的增长明显快于防保支出增长，呈现明显的“剪刀差”；生存活力较高的卫生院对防保工作的投入相应增加，防保业务开展能力提高；防保科室在业务开展中，重视收入较高或有收益的防保项目，对收入较低或无收益的项目投入较少。即乡镇卫生院日常经营活动中，“重医轻防”、“以医养防”以及“重有偿轻无偿和重有收益轻少收益”的现象同时并存。     

武进市乡镇卫生院健康教育宣传阵地建设情况的调查

对武进市90年代末乡镇医疗单位健康教育宣传阵地的建设情况进行了调查分析。结果表明：2000年各类健康教育宣传阵地的拥有率和达标率均较1997年高，“创卫”乡镇卫生院（医院）的健康教育宣传阵地建设情况好于非“创卫”镇。为此，要进一步扩大创卫范围，做好农村医疗卫生单位的健康教育目标管理和考核工作，加大行政干预力度，保证农村医疗单位健康教育工作持续有效地开展。     

农村防保工作存在的问题与对策

随着市场经济的建立、农村经济体制改革的不断深入，农村卫生事业补偿机制发生了重大变化，目前，乡镇防保体制现状及问题是：(1)经费不足，影响预防保健工作正常开展。(2)目前，乡镇卫生院的功能仍以医疗服务为主体，预防保健工作还未从思想、组织、人员、经费、设备等方面确定其主导地位，在一定程度上影响防保工作的开展。(3)     

祖国是海外游子的"大岸"——访全国人大代表、山东保法医疗科技公司董事长于保法

采访于保法那天，正值全国人大会议开幕的第二天。傍晚，在山东代表团驻地中苑宾馆，记者有幸采访了这位集专家学者、企业家、人大代表于一身的颇具传奇色彩的人物。     

卫生系统吹响集结号(一) 河南:重温“长征路”

5O多年前的长征精神在亿万同胞的心中深深地打下了烙印.经历了几十年的沉睡,而今这种精神又一次被四川大地的震动敲晌了.     

Walking,sustainability and health: findings from a study of a Walking for Health group

Not only is it tacitly understood that walking is good for health and well‐being but there is also now robust evidence to support this link. There is also growing evidence that regular short walks can be a protective factor for a range of long‐term health conditions. Walking in the countryside can bring additional benefits, but access to the countryside brings complexities, especially for people with poorer material resources and from different ethnic communities. Reasons for people taking up walking as a physical activity are reasonably well understood, but factors linked to sustained walking, and therefore sustained benefit, are not. Based on an ethnographic study of a Walking for Health group in Lincolnshire, UK, this paper considers the motivations and rewards of group walks for older people. Nineteen members of the walking group, almost all with long‐term conditions, took part in tape‐recorded interviews about the personal benefits of walking. The paper provides insights into the links between walking as a sustainable activity and health, and why a combination of personal adaptive capacities, design elements of the walks and relational achievements of the walking group are important to this understanding. The paper concludes with some observations about the need to reframe conventional thinking about adherence to physical activity programmes.     

Complexity in Built Environment,Health, and Destination Walking: A Neighborhood-Scale Analysis

This study investigates the relationships between the built environment, the physical attributes of the neighborhood, and the residents’ perceptions of those attributes. It focuses on destination walking and self-reported health, and does so at the neighborhood scale. The built environment, in particular sidewalks, road connectivity, and proximity of local destinations, correlates with destination walking, and similarly destination walking correlates with physical health. It was found, however, that the built environment and health metrics may not be simply, directly correlated but rather may be correlated through a series of feedback loops that may regulate risk in different ways in different contexts. In particular, evidence for a feedback loop between physical health and destination walking is observed, as well as separate feedback loops between destination walking and objective metrics of the built environment, and destination walking and perception of the built environment. These feedback loops affect the ability to observe how the built environment correlates with residents’ physical health. Previous studies have investigated pieces of these associations, but are potentially missing the more complex relationships present. This study proposes a conceptual model describing complex feedback relationships between destination walking and public health, with the built environment expected to increase or decrease the strength of the feedback loop. Evidence supporting these feedback relationships is presented.     

Health Literacy,Pedometer, and Self-Reported Walking Among Older Adults

Objectives. We examined the association of health literacy with physical activity and physical activity guideline adherence in older adults.Methods. We used cross-sectional data from a 2012 population-based study in Alberta, Canada, assessing health literacy, and deriving moderate-to-vigorous physical activity (MVPA) and metabolic equivalent of task (MET) minutes per week from the Godin Leisure-Time Exercise Questionnaire, and steps per day via a pedometer.Results. Mean age of participants (n = 1296) was 66.4 (SD = 8.2) years, 57% were female, and 94% were White. Nine percent had inadequate health literacy, and 46% met guidelines for self-reported physical activity and 18% for steps per day. Participants with inadequate health literacy had nonsignificant adjusted decrements of 58 MVPA minutes and 218 MET minutes per week and were less likely to meet physical activity guidelines (MVPA: odds ratio = 0.63; 95% confidence interval [CI] = 0.41, 0.97; P = .037; MET: odds ratio = 0.65; 95% CI = 0.42, 1.01; P = .057) compared with their health-literate counterparts. Such differences were nonsignificant for steps per day.Conclusions. Inadequate health literacy was associated with less likelihood of meeting MVPA guidelines based on self-reported physical activity, but not based on an objective measure of steps per day.Physical inactivity has been recognized as a modifiable risk factor for cardiovascular disease and a widening variety of other chronic conditions, which are mostly common in the elderly population. Evidence from 3 large systematic reviews of the benefits of physical activity on health suggests that regular aerobic activity and short-term exercise programs are associated with functional independence; a positive effect on primary prevention of several chronic conditions including heart disease, hypertension, stroke, type 2 diabetes, some types of cancers, dementia, and Alzheimer’s disease; as well as a reduction in total mortality among adults.1–3 Because of the rapidly increasing proportion of older adults worldwide, which is imminently expected to exceed that of children aged 5 years or younger for the first time in history,4 and recent reports indicating that approximately 31% of adults worldwide are physically inactive,5 physical inactivity represents an increasing global public health problem.Previous research has identified several factors that are directly or indirectly linked to physical activity in adults, including age, gender, income, self-efficacy, motivation, and safe, accessible locations for walking and other activities known to improve health.6–9 Furthermore, physiological, cognitive, and social changes that occur with aging are also important factors to consider when one is examining physical activity in older adults; however, very little attention has been paid to how other unique factors might influence health behaviors in older adult populations. For instance, health literacy, a relatively new concept in health research, has been the focus of recent literature.Health literacy (HL), which is commonly defined as the ability to obtain, read, understand, and communicate about health-related information needed to make informed health decisions,10 has been recognized as a stronger predictor of a person’s health than conventional correlates such as age, income, education, employment status, and race.11 Inadequate HL disproportionately affects older adults and other disadvantaged groups (e.g., people with low levels of income and education, and those for whom English is a second language), adversely affecting several aspects of their health care management and outcomes.12–14 Several studies have suggested an important link between HL and several health-related outcomes among community-dwelling elders, including poorer medication knowledge,15 poorer physical and mental health,16 higher hospitalization rates, and increased cardiovascular and all-cause mortality.17,18 A behavioral pathway has been suggested to explain some of these associations, whereby HL was found to be associated with several health-promoting behaviors including physical activity,19 and consumption of healthy foods20,21 that are potentially linked to these outcomes. Despite these findings, the evidence is inconclusive because of a paucity of studies and potential methodological limitations in existing literature.22,23The primary objective of this study was to investigate whether inadequate HL is associated with self-reported moderate and vigorous physical activity (MVPA) in community-dwelling older adults. We hypothesized that those with lower HL would not meet current physical activity guidelines. Secondarily, because walking is the most commonly reported form of MVPA among older adult populations, we also elected to explore this relationship by using objectively assessed ambulatory activity (walking) with a pedometer. We hypothesized that those with lower HL would report fewer steps per day.     

Review: Offering Domestic Partnership Health Benefits: An Economic Concern?

In the United States, employers are an important source of health insurance for citizens less than 65 years of age. Yet despite the country's increasing number of unmarried partner households, fewer than 1 in 4 workers are employed by firms that offer healthcare benefits to same-sex and/or opposite-sex domestic partners. This paper presents the main arguments, from societal and employer perspectives, for offering domestic partnership benefits. As the number of companies offering such benefits has grown, data on the direct costs of insurance have become available. The experience of insurers and employers suggests that adverse selection is not a substantial problem. Domestic partners usually account for only a small percentage of an employer's risk pool, which also limits the potential effect on total insurance costs. Although low enrollment attenuates their potential economic impact on national healthcare, domestic partnership health benefits remain important from a sociopolitical standpoint—acknowledging the value of equity and diversity in the workplace.     

Walking in the sun: heat stroke and heat exhaustion during the Four-Day March in Nijmegen, in 2006

The annual Four-Day March in Nijmegen, The Netherlands, in July 2006 was cancelled after the first day because two participants had died, men aged 65 and 57 years, and many had become unwell while walking in unusually high ambient temperatures. However, the cause of death of the two who died turned out to be cardiovascular and not heat-related. The case of two of the people that became unwell, men aged 58 and 59 years, respectively, shows that heat stroke and heat exhaustion were important causative conditions. Heat-related illnesses are relatively uncommon in the Netherlands due to its temperate climate. Heat stroke is the most severe of these and associated with a high mortality rate if not recognised and treated promptly. The primary cause is accumulation of heat due either to diminished loss or increased endogenous heat production, such as by physical exertion. Heat exhaustion is caused by salt or water depletion.     

Walking and Cycling to Health: A Comparative Analysis of City, State, and International Data

Objectives. We sought to determine the magnitude, direction, and statistical significance of the relationship between active travel and rates of physical activity, obesity, and diabetes.Methods. We examined aggregate cross-sectional health and travel data for 14 countries, all 50 US states, and 47 of the 50 largest US cities through graphical, correlation, and bivariate regression analysis on the country, state, and city levels.Results. At all 3 geographic levels, we found statistically significant negative relationships between active travel and self-reported obesity. At the state and city levels, we found statistically significant positive relationships between active travel and physical activity and statistically significant negative relationships between active travel and diabetes.Conclusions. Together with many other studies, our analysis provides evidence of the population-level health benefits of active travel. Policies on transport, land-use, and urban development should be designed to encourage walking and cycling for daily travel.Many nations throughout the world have experienced large increases in obesity rates over the past 30 years.^1,2 The World Health Organization estimates that more than 300 million adults are obese,³ putting them at increased risk for diseases such as diabetes, hypertension, cardiovascular disease, gout, gallstones, fatty liver, and some cancers.^4,5 Several studies have linked the increase in obesity rates to physical inactivity^6–8 and to widespread availability of inexpensive, calorie-dense foods and beverages.^1,9The importance of physical activity for public health is well established. A US Surgeon General''s report in 1996, Physical Activity and Health,¹⁰ summarized evidence from cross-sectional studies; prospective, longitudinal studies; and clinical investigations. The report concluded that physical inactivity contributes to increased risk of many chronic diseases and health conditions. Furthermore, the research suggested that even 30 minutes per day of moderate-intensity physical activity, if performed regularly, provides significant health benefits. Subsequent reports have supported these conclusions.^11–13The role of physical activity in prevention of weight gain is well documented.¹⁴ Strong evidence from cross-sectional studies has established an inverse relationship between physical activity and body mass index.^15,16 In addition, longitudinal studies have shown that exercisers gain less weight than do their sedentary counterparts.^6,8 Thus, the obesity epidemic may be explained partly by declining levels of physical activity.^1,17,18A growing body of evidence suggests that differences in the built environment for physical activity (e.g., infrastructure for walking and cycling, availability of public transit, street connectivity, housing density, and mixed land use) influence the likelihood that people will use active transport for their daily travel.^19,20 People who live in areas that are more conducive to walking and cycling are more likely to engage in these forms of active transport.^21–25 Walking and cycling can provide valuable daily physical activity.^26–30 Such activities increase rates of caloric expenditure,³¹ and they generally fall into the moderate-intensity range that provides health benefits.^32–35 Thus, travel behavior could have a major influence on health and longevity.^29,30,36,37Over the past decade, researchers have begun to identify linkages between active travel and public health.^38–40 Cross-sectional studies indicate that walking and cycling for transport are linked to better health. The degree of reliance on walking and cycling for daily travel differs greatly among countries.^39,41 European countries with high rates of walking and cycling have less obesity than do Australia and countries in North America that are highly car dependent.²⁶ In addition, walking and cycling for transport are directly related to improved health in older adults.⁴² The Coronary Artery Risk Development in Young Adults Study found that active commuting was positively associated with aerobic fitness among men and women and inversely associated with body mass index, obesity, triglyceride levels, resting blood pressure, and fasting insulin among men.^26,39,41,43Further evidence of the link between active commuting and health comes from prospective, longitudinal studies.⁴⁴ Matthews et al. examined more than 67 000 Chinese women in the Shanghai women''s health study and followed them for an average of 5.7 years.³⁷ Women who walked (P < .07) and cycled (P < .05) for transport had lower rates of all-cause mortality than did those who did not engage in such behaviors. Similarly, Andersen et al. observed that cycling to work decreased mortality rates by 40% among Danish men and women.³⁶ A recent analysis of a multifaceted cycling demonstration project in Odense, Denmark, reported a 20% increase in cycling levels from 1996 to 2002 and a 5-month increase in life expectancy for males.⁴⁵We analyzed recent evidence from a variety of data sources that supports the crucial relationship between active travel, physical activity, obesity, and diabetes. We used city- and state-level data from the United States and national aggregate data for 14 countries to determine the magnitude, direction, and statistical significance of each relationship.