广州市中小学校医公共卫生知识认知及培训效果分析

目的了解广州市中小学及托幼机构校医和保健教师公共卫生知识认知情况,为促进校医和保健教师能力建设提供参考依据。方法对广州市1 515所中小学校及托幼机构的1 527名校医和保健教师进行公共卫生知识培训前后的问卷调查,并对培训前后相关知识的知晓情况进行对比分析。结果广州市中小学及托幼机构校医和保健教师培训前公共卫生知识知晓率为68.73%,知识测试得分为71.7分,其中幼儿园最低,综合性学校较高;培训后公共卫生知晓率达80.83%,提高12.1个百分点,知识测试得分达82.3分,提高了10.6分(P值均<0.01)。结论卫生与教育部门应通力合作,对薄弱环节进行重点培训,提高校医和保健教师的理论基础和实践能力。     

高水平公共卫生学院建设在疾病预防控制中心发展中的作用

教育部等四部门联合发布《关于开展高水平公共卫生学院建设的通知》, 提出要用十年时间建设一批高水平公共卫生学院, 形成适应现代化公共卫生体系建设的高质量教育发展体系。目前国内各高校高水平公共卫生学院的建设发展迅速。高水平公共卫生学院和疾病预防控制中心(CDC)在国家公共卫生体系和人类健康共同体建设中具有重要地位和作用。建设一批中国特色的高水平公共卫生学院对学院自身发展定位、对各级CDC的建设与发展具有战略意义和重要价值。本文就高水平公共卫生学院在CDC建设中的作用以及面临的机遇和挑战阐述思考。     

Communities of solution: the Folsom Report revisited

Efforts to address the current fragmented US health care structure, including controversial federal reform, cannot succeed without a reinvigoration of community-centered health systems. A blueprint for systematic implementation of community services exists in the 1967 Folsom Report--calling for "communities of solution." We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. Current policy reform efforts should build upon Folsom Report's goal of transforming personal and population health.     

Child public health: A new basis for child health workers

To treat and alleviate diseases in children is an importanttask that demands extensive knowledge, skills and training.It forms the basis of our understanding of sick children andtheir needs, and its quality is a measure of the efforts ofsociety to care for its citizens. With the health of children,however, a much broader view must be taken, including otheraspects of children's well-being than their diseases and theirmedical care. To reach the goals set by international organizationsand national governments for the populations' health, policiesbased on public health ideas and functions must be vigorouslypursued. Although these actions are valid for the whole population,there are major reasons why children should be seen as particularlyimportant. Merging the broad aspects of health and public healthfunctions with children's special needs creates child publichealth, which aims to place the health of children and adolescentsin its full social, economic and political context. It is nota new speciality; rather it is a counterbalance towards thefullness of health. Its activities - in teaching, research andservice - should be practical and relevant and include knowledgeand experience from many professions and sciences. With sucha broad competence, child public health is fit to take on awide range of child health issues, be it healthy public policyfor children and adolescents, support for vulnerable groups,education and training or creating centres of relevance forresearch and surveillance of children's and adolescents' health.     

Public health in practice: the three domains of public health

This paper outlines a conceptual model for public health practice by proposing the three domains as a framework to organize and to deliver public health programmes. The model builds on the recognition that public health is everybody's business and therefore, needs a common definitional base. Different levels of skill and a wide range of contributions are needed if public health programmes are to make the most impact. The different domains of practice help to construct a basis for understanding the necessary elements of the public health system and their interactions. Using teenage pregnancy as a case study of a public health programme highlights the characteristics of the model. It demonstrates not only the importance of the role of directors of public health in taking a population-based overview, but also the need for multi-sectoral, multidisciplinary working. The relevance of the public health approach not only to primary care but also to the hospital-based sector becomes apparent, as does its relevance to communities, voluntary sector and local government. Integration of the three domains, a common definition and the framework for the public health system will support effective delivery of health improvement.     

Public Health Renaissance and the Role of Schools of Public Health

In these turbulent times of political, social and economic changesin Europe public health is again coming into focus. Schoolsof public health, for long the basis for education of publichealth leaders will also in the future play a key role in promotingthe ‘new’ public health agenda. Based on ecologicalawareness and public involvement in health their teaching, researchand policy development should make them be seen as Centres ofRelevance and not only as Centres of Excellence, thus gearingtheir activities to the needs of new generations of practitionerswho can be both activists and advocates for health. If trainingand research are made relevant for practice and community service,then schools will be in the centre of public health insteadof in the periphery of medicine. Elements of a strategy to achievethese objectives are discussed.     

Moving from intersection to integration: public health law research and public health systems and services research

Context: For three decades, experts have been stressing the importance of law to the effective operation of public health systems. Most recently, in a 2011 report, the Institute of Medicine recommended a review of state and local public health laws to ensure appropriate authority for public health agencies; adequate access to legal counsel for public health agencies; evaluations of the health effects and costs associated with legislation, regulations, and policies; and enhancement of research methods to assess the strength of evidence regarding the health effects of public policies. These recommendations, and the continued interest in law as a determinant of health system performance, speak to the need for integrating the emerging fields of Public Health Law Research (PHLR) and Public Health Systems and Services Research (PHSSR). Methods: Expert commentary. Findings: This article sets out a unified framework for the two fields and a shared research agenda built around three broad inquiries: (1) the structural role of law in shaping the organization, powers, prerogatives, duties, and limitations of public health agencies and thereby their functioning and ultimately their impact on public health (“infrastructure”); (2) the mechanisms through which public health system characteristics influence the implementation of interventional public health laws (“implementation”); and (3) the individual and system characteristics that influence the ability of public health systems and their community partners to develop and secure enactment of legal initiatives to advance public health (“innovation”). Research to date has laid a foundation of evidence, but progress requires better and more accessible data, a new generation of researchers comfortable in both law and health research, and more rigorous methods. Conclusions: The routine integration of law as a salient factor in broader PHSSR studies of public health system functioning and health outcomes will enhance the usefulness of research in supporting practice and the long‐term improvement of system performance.     

从公共卫生内涵看我国公共卫生走向

本文从分析公共卫生内涵入手，准确认识公共卫生的功能定位；针对今春我国SARS突发中凸现出的公共卫生体系存在的问题，提出我国公共卫生发展走向的设想：加强法制建设，改革公共卫生管理体制，完善公共卫生内部运行机制，加强公共卫生的政策和策略研究。     

The institutionalization of public health training and the health sciences

The health of the population is determined by a number of ecological determinants in addition to medical care. Therefore a close relationship exists with the social and political context in a society. With regard to the health care system, schools of public health as institutions for training, research, and services have to focus on four main deficits in the area of information, prevention, social gradients, and the regulation of health care delivery. A task profile derives which comprises (a) training for research and services, (b) monitoring population health and setting of priorities, (c) applied research on public health, (d) consulting the decision makers, and (e) intervention and public accountability. How to perform in these areas has to be related to basic ethical principles, notably, equity, participation, subsidiarity, sustainability, and efficiency. Furthermore, international trends in modern education have to be considered as for the European Union in the Bologna Declaration of 1999, with reference to academization and internationalization of advanced studies. The resulting institutional profile of modern schools of public health is characterized by their academic basis, interdisciplinarity, and multi-professionality. The paradigm of the New Public Health is an equal merger of medical and social sciences, a predominantly postgraduate study program, an international scope, close links to the government, local networks with service institutions, and a focus on contemporary health issues. In the former socialist economies of Central and Eastern Europe a regional collaboration beyond borders (the concept of regionality) is apt to support the achievement of international standards of excellence for newly developing schools of public health.     

Role of schools of public health on maternal and child health programmes in the Asia-Pacific region

This paper assessed the role of public health schools on maternal and child health programmes in the Asia Pacific region. Economic development and its associated effects, particularly in the ASEAN countries, for example, migrant labour, ageing, environmental health, turbulence and social climate, has a tremendous impact on maternal and child health. Based on these current issues, it is evident that public health schools can play a major role in maternal and child health in terms of policy formulation and programme development. Several areas were proposed as to what schools of public health can do, namely, through networking, communication, research and training.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

Regional collaboration in public health training and research among countries of South Eastern Europe

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. KEY POINTS: South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. A regional approach in public health training would enable an efficient use of resources in countries of South East Europe.     

疾控机构参与基本公共卫生服务均等化情况分析

目的了解浙江省疾控机构参与基本公共卫生服务均等化情况,为制定相关政策提供依据。方法设计专项调查表,调查各级疾控机构相关业务人员基本公共卫生服务认知情况、参与基本公共卫生服务项目情况、存在问题及对策等。结果被调查者对基本公共卫生服务均等化疾控相关知识认知程度较高（＆gt;90%）,但对于服务主体、服务特征等认知较差。大部分疾控机构制订并实行了针对社区医疗卫生机构的基本公共卫生服务指导方案或要点,开展了相关培训并参与了考核工作,分别占94.90%、96.94%和92.86%,但在省级项目基础上增加本地项目的机构仅占13.27%;疾控机构参与基本公共卫生服务项目存在参与人员不足（91.10%）、政府经费保障不足（86.64%）,以及疾控机构与社区卫生服务机构资源整合不足、缺乏合力（82.07%）等问题。结论疾控人员对于基本公共卫生服务均等化的认知程度普遍较高;疾控机构基本公共卫生服务项目参与率较高,但主动增加项目不足;人员不足、经费保障不到位以及医防整合不足是目前疾控机构参与基本公共卫生服务均等化的主要问题。应进一步增加基层疾控机构人员,保证相关工作经费投入,加强医防整合,更好地发挥疾控机构在促进基本公共卫生服务均等化中的作用。     

Proposals for collaboration in European public health training

The drastic changes in European politics, economy, environmentand technology during the last decade have profoundly influencedthe role and scope of public health practice and training. Aresponse to training in public health was given by the Associationof Schools of Public Health in the European Region (ASPHER)and WHO by creating a joint task force in order to propose aEuropean Master's Degree in Public Health, based on the ‘healthfor all’ principles. Attempts to develop curricula andlearning materials were not very successful and, instead, apeer review system as a means of establishing a European standardin public health training, together with mutual recognitionand a common standard in professional qualifications has beensuggested. Principles, criteria and practical steps for thisPublic Health Education European Review(PEER) are outlined.     

105个项目县村卫生人员状况研究

目的：了解村卫生人员的基本情况，了解各类卫生人员工作情况、收入、培训等诸方面的差异。方法：采用问卷调查的形式对28个省的2239名村卫生人员进行调查。结果：被调查卫生人员中40．2％文化程度在中专或中专以上；51．2％的人看病有记录和处方；81．4％的人在从医后接受过专业培训；79．8％的人实际担负着村里的卫生保健工作，其中仅68．1％有保健工作的报酬。结论：必须加强卫生人员的岗前和在岗培训，提高基层卫生人员的素质；加强对村级卫生人员的管理，规范农村医疗行为，合理利用卫生人力资源；完善目前的保健工作体制，激发卫生人员从事保健工作的积极性。     

中小学校突发公共卫生事件应急处置能力调查

  目的  厘清中小学校应对突发公共卫生事件的应急处置能力现状,探讨存在的问题和主要困难,并提出针对性建议。  方法  2021年1—3月,采用分层整群抽样方法,以北京、重庆、云南三地的2 988所学校疫情相关工作负责人及教师为主要调查对象,开展关于学校一般情况、学校卫生及突发公共卫生事件相关知识、态度以及培训情况等内容的问卷调查。  结果  调查对象职务、职称、学历不同,各相关知识正确率不同:学历越高,相关知识正确率越高(χ2=50.73~203.36,P值均 < 0.05);高中学校定期开展健康相关课程情况最差(50.0%);配备具有执业资格的卫生保健人员情况,城区学校(42.0%)高于农村学校(18.2%),民办学校(48.5%)高于公办学校(24.7%);存在的主要困难是缺乏专业技术人员的指导和相关检测设备(84.91%,74.03%)。  结论  三地区学校突发公共卫生事件应急处置能力虽与时俱进,但仍存在诸多不足,知识掌握情况仍有疏漏,建议增加学校卫生工作岗前与专项培训, 疾控机构要加强对学校传染病管理技术指导和工作督导。     

Rôles des patients dans le système de santé, la formation et la recherche en santé : une perspective française

In 2002, patients were transformed into users of the French health system. As this opinion piece demonstrates, in 2021 they may at least potentially participate more actively than before. They can convey their knowledge of a disease and its treatments, and voluntarily share their experience. They can intervene in user representation and therapeutic patient education, the objective being to increase the autonomy of one and all, patients and public, in the training of professionals, clinical research and evolution of the health system. The rationale for the involvement of patients and their roles in provision of care, training and clinical research are analyzed from a French perspective. The obstacles to overcome and improvements to be achieved are reviewed, the objective being to promote enhanced health democracy through increased patient engagement. In 2021, however, the role of patients in the design and implementation of therapeutic patient education (TPE) and in the development of medical studies curricula remains limited if not restricted; this is due not only to a lack of information, but also to the resistance of health professionals and universities. Patients could and should assume a major role, fostering evolution toward a more just and effective health care system.     

Changes in primary health care centres over the transition period in Slovenia

BACKGROUND: Primary health care centres (PHCCs) were a characteristic of the former Yugoslav health care system introduced widely in Slovenia. Transition brought structural changes to health care and the position of the PHCC's was challenged. This paper investigates (i) PHCCs' perception of transition changes in health care, (ii) changes in resources and services, and (iii) changes in the relationships between PHCCs and new primary health care providers. METHODS: We mailed a self-administered questionnaire with 42 questions divided into 8 chapters and related to the period between 1990 and 2000 to all 65 PHCCs in Slovenia. Questions were of three types, grouped according to the aspects we were trying to explore: perceived changes, actual changes and relations with new providers. RESULTS: We obtained 57 questionnaires representing PHCC catchment areas covering 93.7% of the Slovenian population. Municipalities' position versus PHCCs was reinforced but their role remains ambiguous. The number of employees was reduced by one third, capital investments are still ongoing, but the scope and volume of services has shrunk. Relations with the Health Insurance Institute of Slovenia (HIIS) were considered controversial while the influence of the public providers' association is perceived as marginal. CONCLUSIONS: PHCCs have survived the transition both structurally as well as functionally. However, an unstructured approach to system changes in primary care, a poorly managed process of introducing private provision, and a monopoly position of the HIIS affected their situation. The challenges for the future will be in preserving their public health functions, in increasing efficiency and in establishing clearly defined relations with private providers.     

Evaluating the effectiveness of public health interventions: the role and activities of the Cochrane Collaboration

Public health decision makers, funders, practitioners, and the public are increasingly interested in the evidence that underpins public health decision making. Decisions in public health cover a vast range of activities. With the ever increasing global volume of primary research, knowledge and changes in thinking and approaches, quality systematic reviews of all the available research that is relevant to a particular practice or policy decision are an efficient way to synthesise and utilise research efforts. The Cochrane Collaboration includes an organised entity that aims to increase the quality and quantity of public health systematic reviews, through a range of activities. This paper aims to provide a glossary of the terms and activities related to public health and the Cochrane Collaboration.