河北省儿童疾病综合管理项目实施效果分析

目的:分析河北省儿童疾病综合管理项目实施取得的成绩及存在的问题,为项目进一步开展提供指导。方法:根据WHO的评估方法,进行实施前的基础调查和实施后随访及开展1年半后再次评估,分析比较前后资料。结果:实施IMCI后,医务人员的病例管理水平、卫生机构的设备及药品供应以及家长的健康知识都有显著改善。结论:IMCI是改善和加强儿童卫生服务的1个有效策略,应该继续执行和扩展。     

Improving performance with clinical standards: the impact of feedback on compliance with the integrated management of childhood illness algorithm in Niger, West Africa

The joint BASICS/Quality Assurance Project tested several research-based interventions in three districts in Niger, West Africa to improve case management of sick children. The research design was a non-concurrent, prospective case control design. Quality of care was determined as the degree of compliance of health care workers with the Integrated Management of Childhood Illness (IMCI) standards of assessment, treatment and counselling of sick children and their caretakers. The interventions tested were (1) structured feedback of health worker performance data and (2) formal IMCI training and (3) team-based quality improvement. Performance feedback had a significant effect on compliance. Performance feedback alone created a significant short-term impact on health care worker compliance, which improved between 34% and 85% in areas of assessment of sick children (p < 0.05). In addition, performance feedback was significantly cheaper than formal training ($108 per health worker versus $430 per worker for IMCI training). However, this impact was not universal over all areas of compliance following each feedback. Instead, performance feedback had the greatest effect in areas in which health care workers performed poorly, while areas in which compliance was high eventually saw declines. In settings such as Niger, which has the highest child mortality in the world according to UNICEF figures, low-cost techniques for supporting health workers once they have been trained in clinical standards are sorely needed. Performance feedback shows promise as a technique for improving quality of care with clinical algorithms such as IMCI.     

Increases in correct administration of chloroquine in the home and referral of sick children to health facilities through a community-based intervention in Bougouni District, Mali

Save the Children/USA in collaboration with the Ministry of Health of Mali has established over 300 village drug kits in southern Mali since 1996. A cluster-randomized trial was conducted between November 2001 and February 2002 in 10 health zones of Bougouni District to evaluate an intervention to (i) improve the skills of the village drug kit managers to counsel parents on correct home administration of chloroquine (CQ), and (ii) increase the referral of sick children to community health centres (CHC). Children's carers were interviewed 5 d after the sale of CQ about knowledge of danger signs requiring referral, quality of counselling, administration of CQ, and referral. The intervention was associated with significant increases in knowledge of danger signs requiring referral, reported quality of counselling by the manger of the drug kit, and correct administration of CQ in the home. Parents reported that 42.1% of children in the intervention group were referred to the CHC by the drug kit manager compared with 11.2% in the comparison group (odds ratio = 7.12, 95% CI 2.62-19.38). CHC registers indicated that 87.0% of referrals recorded in drug kit referral notebooks arrived at the health centre. Further research is needed to increase the effectiveness of the counselling and the community referral mechanism tested in this study.     

Factors associated with vaccination coverage in children < 5 years in Angola

OBJECTIVE

To analyze vaccination coverage and factors associated with a complete immunization scheme in children < 5 years old.

METHODS

This cross-sectional household census survey evaluated 1,209 children < 5 years old living in Bom Jesus, Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children’s individual, familial, and socioeconomic factors as independent variables.

RESULTS

Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother’s level of education, family size, ownership of household appliances, and destination of domestic waste.

CONCLUSIONS

Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups.     

An overview of national clinical guidelines for the management of childhood obesity in primary care

Study design

Review of clinical guidelines.

Background

Most national clinical guidelines for the management of childhood obesity in primary care were published since 2003. It is unknown whether there is international consensus concerning the diagnosis and management of childhood obesity.

Objective

To present an overview of available guidelines for the management of childhood obesity in primary care

Methods

Guidelines were included if they met the following criteria: (1) the guideline makes recommendations concerning the management of childhood obesity, (2) the target group consists of primary care health practitioners, (3) the guideline is available in English or Dutch.

Results

Clinical guidelines from six different countries published from 2003 until 2010 met the selection criteria and were included in this review. The recommendations of the guidelines regarding the management of childhood obesity appeared to be quite similar. A consistent feature was the recommended combined intervention, with diet, physical activity and counselling being the three most important elements. There were discrepancies between the guidelines for recommendations regarding diagnostic classification criteria for childhood obesity.

Conclusion

The present review shows that there is international consensus regarding the recommendations for management of childhood obesity. There is less international consensus regarding the diagnostic classification of childhood obesity.     

Evaluation of the Integrated Management of Childhood Illness guidelines for treatment of intestinal helminth infections among sick children aged 2-4 years in western Kenya

Anthelmintic treatment of sick preschool-age children at health facilities is a potentially effective strategy for intestinal helminth control in this age-group. We conducted a study from July 1998 to February 1999 in western Kenya to determine whether the Integrated Management of Childhood Illness (IMCI) guidelines' clinical assessment can be used to identify helminth-infected children, and to evaluate the nutritional benefit of treating sick children without pallor with an anthelmintic (mebendazole is already part of IMCI treatment for sick children aged 2-4 years with palmar pallor in areas where hookworm and Trichuris trichiura infections are endemic). Sick children aged 2-4 years seen at 3 rural health facilities were clinically evaluated and tested for haemoglobin concentration, malaria parasites, and intestinal helminths. Children without pallor were randomly assigned to receive a single dose of 500 mg of mebendazole or a placebo and re-examined 6 months later. Among the 574 children enrolled, 11% had one or more intestinal helminths. Most infections were of light intensity. Selected clinical signs and symptoms available from the IMCI assessment, including palmar pallor and low weight-for-age, were not associated with helminth infection. Six months after enrollment, no differences in growth of children without pallor were observed between the mebendazole (n = 166) and placebo (n = 181) groups. However, there was a significantly greater mean increase in weight, height, and weight-for-age Z score among the helminth-infected children in the mebendazole group (n = 22) as compared with helminth-infected children in the placebo group (n = 20). We conclude that even lightly infected preschool-age children without palmar pallor benefit from anthelmintic treatment; however, in this study setting of low helminth prevalence and intensity, helminth-infected children could not be identified using the IMCI guidelines. Cost-effectiveness studies are needed to help define helminth prevalence thresholds for routine anthelmintic treatment of sick preschool-age children seen at first-level health facilities.     

以综合优化管理提升科室核心竞争力

从制度管理、人力资源管理、标杆管理、文化管理等4方面,分析了综合优化管理在持续提升科室核心竞争力中的作用,并总结了主要做法.     

儿童疾病综合管理地方术语研究

目的：使医务人员在进行儿童疾病综合管理（IMCI）病例管理时准地评估儿童和更好地咨询母亲。方法：根据WTO提供的人类学研究方法对IMCI病例管理涉及的12人关键的医学术语所对应地方术语进行研究。结果：在湖南茶陵，宁夏盐池分别找到了12个医学术语所对应的一个或二个正确的地方术语，并得到了当前地医务人员的认可。结论：本次研究的结果不仅有助于医务人员在IMCI病例管理中准确地评估儿童和更好地咨询母亲，也可以为这二个县其它相关的卫生工作提供参考资料。     

复诊患者一体化管理平台构建与应用

为解决门诊复诊患者就医难题,上海市胸科医院围绕“诊前、诊中、诊后”流程与“医技检查、医生看诊”服务,构建了复诊患者一体化管理平台,打造患者自主精准预约复诊日期、一键缴费、一日完成复诊的便捷就医流程。平台应用后,优化了复诊患者就医流程,提升了复诊效率,改善了患者就医体验。     

儿童疾病综合管理早期实施研究

目的：分析儿童疾病综合管理（IMCI）早期实施阶段取得的及存在的问题，为进一步扩展提供指导。方法：根据WHO的评估方法，进行实施前的基础调查和实施后随访，比较分析二者的资料。结果：实施IMCI后，医务人员的病例管理水平，卫生机构的设备及药品供应以及家长的健康知识都有显著改善。结论：IMCI是加强儿童卫生服务的一个有效策略，应该根据中央和省级实施IMCI的能力继续加以扩展。     

两城市艾滋病病毒感染者/艾滋病病人随访管理工作现状分析

目的:分析A城市、B城市对艾滋病病毒感染者/艾滋病病人随访工作管理现状。方法:用随访工作人员调查表和个人深度访谈的方法收集资料,定量资料应用SPSS11.5进行统计学分析,定性资料采用ATLAS.TI软件进行分析。结果:从感染者随访工作的方式、开展感染者随访工作的机构、感染者随访工作的职能分工、感染者随访工作的培训四个方面进行了研究。结论:应探索以社区为基础的艾滋病随访工作模式,加强对非政府组织的正确引导,加强艾滋病病毒感染者/艾滋病病人随访工作相关制度、规范的建设和随访工作人员能力建设等。     

A Test of Factors Mediating the Relationship Between Unwanted Sexual Activity During Childhood and Risky Sexual Practices Among Women Enrolled in the NIMH Multisite HIV Prevention Trial

SUMMARY

This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection.     

《儿童青少年近视防控适宜技术指南》专题解读

儿童青少年近视防控是一项系统工程,需要政府主导、全社会共同努力.为扎实推进近视防控工作,普及近视防控的适宜技术,国家卫生健康委员会颁布实施了《儿童青少年近视防控适宜技术指南》(简称《指南》).本文围绕《指南》的背景、意义和主要内容等方面进行解读,以提高公共卫生专业工作者和关注儿童青少年近视防控工作相关人员对《指南》内容的理解.     

基于中国高血压防治指南的简化方法筛查苏州市儿童青少年血压偏高的效果

目的 评价不同简化方法筛查苏州市儿童青少年血压偏高的效果.方法 采用分层整群随机抽样方法,招募7340名6～17岁儿童青少年,测量身高、体重和血压.以中国高血压防治指南为金标准,评价公式法、身高别法、年龄组别表格法和性别年龄别表格法的筛查效果.结果 根据金标准和4种简化方法,血压偏高检出率分别为17.3％、17.9％、...     

在青少年性和生殖健康与权利项目中融入社会性别视角

青少年性与生殖健康至关重要。以WHO 的项目管理思路为指导,将青少年性与生殖健 康与权利（SRHR）相关项目分为4类：①一般项目（无害）。②有害项目。③具有社会性别敏感性项目。④ 创新性项目。社会性别为分析青少年性与生殖健康问题提供了重要视角和工具,其在青少年性与生殖健 康项目中应当成为一条鲜明的主线;具有社会性别敏感性项目和创新性项目为青少年SRHR 提供了全新 的视角,将更富有创造性且具有更高的效率,更能够动员社区成员特别是女性更深层次的参与,因而也就 更具有可持续性。     

HIV/AIDS and the teachers of young children

More than half the children with HIV infection in the United States now live long enough to attend school. However, most studies of teachers’ knowledge and attitudes about HIV in schools have not assessed content that is relevant to the needs of preschool or elementary‐aged children with HIV or AIDS. We propose that content included in teachers’ training and assessment should be specifically related to HIV/AIDS in young students, including transmission of HIV in the classroom, routes of HIV transmission in children, disease processes for children with HIV, effects of HIV on intellectual and emotional functioning, and safety procedures in the classroom. The assessment of attitudes will also be critical to the success of any training program, and we discuss issues that affect teachers’ attitudes about having children with HIV or AIDS in their classrooms.     

对妇幼保健院经营管理的探讨

妇幼保健院的性质和职能，决定了其自身具有的特征。认真分析研究这些特征，才能准确认识、把握妇幼保健院的运行规律，提高其经营管理水平。因此，在创新经营管理理念时，必须注重妇幼保健院产品的公益性和运行的市场性特征；在调整经营管理策略时，必须注重妇幼保健院服务功能的多样性和资源的稀缺性特征；在突出经营管理重点时，必须注重妇幼保健院学科的综合性和技术的创新性特征；在转变经营管理模式时，必须注重妇幼保健院服务对象的独特性和组织机构的网络性特征。     

Psychological distress among HIV adolescents in the REACH study: effects of life stress, social support, and coping

Purpose: To investigate the effects of life events, social support, and coping on anxiety and depression among human immunodeficiency virus (HIV)-infected adolescents. It was hypothesized that higher levels of stressful events would be associated with higher levels of anxiety and depression, but that this association would be moderated by satisfaction with social support and by adaptive coping.

Methods: HIV-infected adolescents from 16 locations in 13 U.S. cities (N = 230, median age 16.09 years, standard deviation 1.2, range 13–19; 77% females) were recruited into the Reaching for Excellence in Adolescent Care and Health (REACH) project. REACH is the first large-scale disease progression study of HIV⁺ adolescents infected through sexual behavior or injection drug use. The adolescent assessment was conducted by audio-computer assisted self-interview. Least squares regressions were used to test hypotheses.

Results: Life events with high impact were associated with higher levels of depression and anxiety. Frequently reported events included: being prescribed medications (74%), family financial problems (61%), and parental alcohol abuse (20%). Contrary to expectations, the buffering hypotheses of social support and adaptive coping were not supported. Satisfaction with social support and adaptive coping methods were both associated directly with lower levels of depression, but no association was detected between these two measures and anxiety.

Conclusions: Although life event distress was directly associated with psychological distress, neither social support nor adaptive coping seemed to moderate this association. However, both satisfaction with support and adaptive coping were associated directly with depression in HIV-infected adolescents.