Socio-economic health differences among the elderly population in Krakow, Poland

Summary. Objectives: To assess whether socio-economic health differences persist into old age in Poland and if there are SES-related differences in health by age group and gender.Methods: 528 randomly chosen, not institutionalized elderly people aged 65–85 living in Krakow were interviewed about their socio-economic status (occupation, education, income, house ownership), health status (self-rated health) and quality of life (Cantril’s ladder).Results: People with higher level of education and higher occupational status reported significantly better health and better quality of life compared to people who were not as well off. Income level and house ownership had a significant influence on the quality of life of elderly people. In addition, some findings indicate differences in the patterning of health inequalities across particular age and gender groups.Conclusion: There are socio-economic differences in health and quality of life among the urban elderly population in Poland which are unfavourable for lower social strata.

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Zusammenfassung. Unterschiede im Gesundheitszustand bedingt durch sozioökonomischen Status der Älteren in Krakau, PolenFragestellung: Überprüfen, ob sozioökonomische Gesundheitsunterschiede in Polen bis zum hohen Alter überdauern und wie sie sich zwischen den einzelnen Altersgruppen und Geschlechtern ausdifferenzieren.Methode: 528 zufällig ausgewählte, nicht-institutionisierte und in Krakau lebende Personen im Alter von 65–85 Jahren wurden nach ihrem sozioökonomischen Status (Beruf, Ausbildung, Einkommen, Eigentumswohnung), Gesundheitszustand (Selbstbeurteilung des Gesundheitszustands) sowie nach Lebensqualität (Cantril-Leiter) befragt.Ergebnisse: Die aus statushöheren Berufsgruppen stammenden Personen und Personen mit Hochschulausbildung haben einen besseren Gesundheitszustand und eine bessere Lebensqualität angegeben als Personen mit niedrigerem sozioökonomischem Status. Die Höhe des Einkommens und Hausbesitz hatten einen signifikanten Einfluss auf die Lebensqualität der älteren Personen. Einige Ergebnisse bestätigen Unterschiede im Muster der gesundheitlichen Ungleichheit zwischen den einzelnen Alters- und Geschlechts-Gruppen.Schlussfolgerung: Im Gesundheitszustand sowie in der Lebensqualität der älteren städtischen Bevölkerung Polens wurden Unterschiede festgestellt, die durch sozioökonomischen Status bedingt sind und negative Auswirkungen auf die niedrigeren Schichten der Gesellschaft haben.

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Résumé. Santé des personnes âgées et statut socio-économique à Cracovie, PologneObjectifs: Vérifier la persistance des différences socioéconomiques à un âge avancé et en vérifier les éventuels effets sur l’état de santé des personnes âgées, selon l’âge et le sexe.Methodes: Interviews d’un échantillon aléatoire de 528 personnes âgées de 65 à 85 ans, non institutionnalisées, et vivant à Cracovie (Pologne). Indicateurs utilisés: statut socio-économique (profession, formation, revenu, propriété de son logement), état de santé (auto évalué), qualité de vie (échelle de Cantril).Résultats: Les personnes bénéficiant d’un statut professionnel élevé ainsi que celles ayant une formation poussée ont rapporté un meilleur état de santé et une qualité de vie plus élevée que les personnes ayant un statut socio-économique inférieur. Le niveau de revenu ainsi que le fait d’être propriétaire de son logement exercent une influence significativement positive sur la qualité de vie des personnes âgées. De plus, certains résultats suggèrent que les inégalités de santé varient selon les groupes d’âge et de sexe.Conclusions: Des différences existent au niveau de l’état de santé et de la qualité de vie des populations âgées vivant en milieu urbain en Pologne. Ces différences sont en lien avec le statut socio-économique et exercent une influence négative sur les couches inférieures de la société.

     

镇江市中小学生营养与健康状况分析

目的 分析镇江市中小学生营养健康状况，为采取有效干预措施及制订相关营养策略提供科学依据。方法 整群收集1998～2003年镇江市城区中小学生健康体检资料，用SPSS11．0软件进行统计分析。结果 6年来营养不良率（以轻度为主）、肥胖率分别为28．15％、11．33％；营养不良呈下降趋势、肥胖呈上升趋势；贫血率平均为22．77％，贫血主要发生在12～16岁；男生及高中、初中学段高血压率具有逐年增高趋势；视力低下率女生〉男生，小学〈初中〈高中，差异均具有显著意义。肺活量呈逐年下降趋势。结论 中小学生营养健康问题不容忽视，应针对性地采取综合预防控制措施。     

社区居民膳食营养与健康状况的调查分析

目的以卢湾区社区居民为基础,探讨不同人群营养状况与营养相关性疾病的患病情况,为实施针对性的干预和政府公共卫生决策提供科学依据。方法采用多阶段分层随机整群抽样的方法,样本的基本单位为住户,覆盖卢湾区4个街道的480户居民家庭、1 390人。结果调查结果显示,该区婴幼儿、儿童青少年及中老年居民的食物消费品种丰富,水果、畜肉类、奶及其制品较2002年上海市营养调查分别增加了16.59%、23.49%和19.35%;但蛋白质、脂肪摄入过剩,脂肪供能比已超过了世界卫生组织（WHO）推荐的最高上限值30%;胆固醇摄入水平亦较高,全区平均为531.33 mg,超过了WHO建议低于300 mg的水平;粮谷类食物摄入呈下降趋势,蔬菜摄入不足,低于推荐值20%。监测人群中18岁及以上居民高血压患病率为26.40%,糖尿病患病率为7.21%,高血脂患病率为7.49%。吸烟率为23.76%,每周饮酒率为15.27%,18～44岁和45～59岁年龄段居民参加体育锻炼的仅有33.95%和34.08%。结论卢湾区不同人群的食物消费品种丰富,均能满足不同人群的营养需要;但仍严重存在膳食结构不平衡现象,营养相关性慢性病仍然是现在的重要公共卫生问题;居民锻炼率不高,在上班族中尤为突出,应重点加强相关健康教育。     

某医学院贫困大学生健康状况及营养膳食分析

目的了解贫困大学生的能量和营养素（膳营养素、营养制剂和食品营养强化剂）摄入量,判断机体营养健康水平,为大学生保健工作提供依据。方法选择山西大同大学医学院189名贫困大学生作为研究对象,其中男生85人,女生104人;采用问卷调查及膳食调查的方法,对贫困大学生健康及营养状况进行评价。结果贫困大学生膳食主要以谷物为主,鱼虾类、水果、奶类、蔬菜、肉类和蛋类明显少于参考摄入量标准,尤其是钙、锌和V-C的摄入量仅占参考摄入量的1/3。贫困大学生牙龈出血率为56.61%,口腔溃疡发生率为46.03%,皮肤粗糙出现率为33.33%,视力不良率为80.42%。结论贫困大学生的膳食结构及各种营养素的摄入不合理,应加强贫困大学生营养知识的宣传教育,改善贫困大学生膳食营养,从而提高贫困大学生的健康水平。     

Financing health services in Poland: new evidence on private expenditures

This paper estimates total expenditure on health care in Poland in 1994 and provides new evidence on high levels of private spending on health care. The analysis shows that health care expenditures in Poland are higher than has usually been maintained, and are comparable with the prevailing levels in many other European countries. Private expenditure on health is a significant proportion of total expenditure on health, and in particular on financing outpatient care. Available evidence indicates that informal payments made by patients to physicians contribute as much as double of the physician's salary, and thus form an important source of earnings for physicians. This situation of high private expenditures on health care and informal payments to physicians is likely to be true of other transitional economies of Central and Eastern Europe as well. One policy implication that emerges is these transitional economies face a big challenge in managing existing resources, as opposed to finding new resources, in the health sector more effectively to meet the health care needs of their population. The paper highlights the need for better understanding of the current availability and distribution of resources in the health sector and their directions of flow, in both public and private sectors, and suggests using tools such as National Health Accounts to track and monitor changes in the financing of the health care system. © 1998 John Wiley & Sons, Ltd.     

我国营养学事业发展的辉煌成就

新中国成立70年,尤其是改革开放40年以来,在国家政策及措施的带动下,我国营养学事业发展迅速,在营养缺乏病防治、营养改善行动、慢性非传染性疾病改善计划、营养学研究及知识普及等方面成绩显著。随着国家重视营养工作的加强,营养科学技术的快速发展,一大批营养新技术、新方法的广泛应用必将极大地促进和提高了人类的健康水平。     

上海市部分地区老年人营养与健康状况调查分析

[目的]了解上海市老年人营养和健康状况。[方法]采用2002年全国营养调查上海地区资料,对老年人的营养与健康状况进行分析。[结果]老年人每人每天粮谷类、蔬菜、水果、畜禽肉类、水产类、奶类及其制品、干豆类、豆制品、食用油、盐的摄入量分别为381.36 g、394.86 g、133.24 g、140.49 g、146.65 g、114.04 g、1.75 g、28.93 g、50.17g和9.78 g,每人每天能量摄入量为2762 kcal,蛋白质、脂肪、视黄醇当量、维生素B1和维生素B2、维生素C、钙、铁的摄入量分别为101.58 g、105.21 g、794.69μg、1.23 mg、1.29 mg、100.02 mg、742.35 mg、30.76 mg;来自脂肪的能量超过了中国居民膳食营养素参考摄入量和世界卫生组织推荐的30%的上限,优质蛋白质的比例超过1/3。老年人的营养不良率、超重率、肥胖率和向心性肥胖率分别为5.09%、35.33%、5.17%和17.43%;高血压患病率、知晓率、治疗率分别为57.31%、68.13%、62.32%;血脂异常患病率为24.19%,其中低高密度脂蛋白血症、高三酰甘油血症、高胆固醇血症患病率和血胆固醇边缘升高率分别为7.23%、15.21%、7.46%、6.97%;糖尿病患病率为14.17%,空腹血糖受损率为2.18%。[结论]老年人营养缺乏和营养过剩并存,营养相关性慢性非传染性疾病的预防和控制迫在眉睫。     

学龄儿童营养健康教育效果评价

目的:了解营养健康教育对学龄儿童营养相关知识、态度和行为的影响。方法:以372名学龄儿童为研究对象,于营养健康教育前后,对学龄儿童进行营养知识、态度和行为方面的不记名问卷调查。结果:教育后学龄儿童营养基础知识平均得分由教育前的10.0分提高到17.8分(满分22分),两者相比差异有显著性。教育后学龄儿童对营养相关问题的正向态度率均明显高于教育前,教育后学龄儿童营养相关行为较教育前明显改善。结论:在学龄儿童中开展营养健康教育,易于被学龄儿童接受,效果较好,对学龄儿童获取营养基础知识、树立与合理营养有关的正确态度、培养健康的饮食行为都有积极的影响。     

顺义区城区学龄前儿童营养与健康状况评价

目的研究顺义区部分学龄前儿童的生长发育及营养健康状况,制定干预措施。方法采用整群抽样法,随机抽取5所幼儿园999名1～7岁学龄前儿童,进行医学体检、实验室检测。采用WHO和卫生部标准评估学龄前儿童营养与健康状况。结果999名学龄前儿童营养状况正常的占77．8％,营养不良和超重肥胖分别占总调查儿童的5．71％和16．51％。平均血红蛋白125．86g/L,贫血16人．检冉率为1．60％,铁不足者占19．52％。结论要提高学龄前儿童的健康水平,教育和卫生行政部门要进一步加强个体幼儿园管理．加强对幼教人员的培训．提高其业务素质,监督幼儿园落实各项卫生保健制度。     

食品营养标签现状及卫生监督对策

作者分析了食品营养标签国内外的现状,并通过剖析食品标签监督管理中存在的主要问题,提出应尽快健立健全食品营养标签相关法律、法规、标准和技术支持性体系、探索建立综合监督管理机制、重视卫生营养学监督管理、加强营养知识的宣传教育工作等建议,以加强卫生监督管理效力,保障食品安全。     

Consumer perceptions of nutrition and health claims

The number of food products containing extra or reduced levels of specific ingredients (e.g. extra calcium) that bring particular health benefits (e.g. stronger bones) is still increasing. Nutrition- and health-related (NH) claims promoting these ingredient levels and their health benefit differ in terms of the (legal) strength with which the claim is brought forward and the specific wording of the claim, both of which may differ between countries. Using a large-scale cross-national internet-based survey in Italy (n=1566), Germany (n=1620), UK (n=1560) and US (n=1621), the purpose of the study described here is to investigate consumer perceptions of NH food product claims, across different countries. NH claims are systematically varied as a function of six health benefits (cardiovascular disease, stress, infections, fatigue, overweight and concentration) and five claim types (content, structure-function, product, disease-risk reduction and marketing claim). The general results indicate that consumer perceptions differ substantially by country and benefit being claimed but much less by the claim type. Implications of these findings are being discussed.     

Poland—an “experimental range” for health care system changes. Two reforms: decentralization and centralization and their consequences

Background In Poland, the new regulations establishing a decentralized system based on the regional sickness funds were implemented in 1999. However, the inconsequence of central government policy in Poland caused a significant reorganization of the model in 2001 towards the opposite direction. Aim The objectives of this article are to analyze the organizational shape of the health care system in Poland after its reforms, separate the consequences of both reforms, and provide a possible generalization of the findings. Methodology The authors applied a modified decision space map based on a model by T. Bossert. The types of decentralization are according to Rondelli et al. Assumptions of both reforms, and their consequences, are based on political documents and reports and articles published in international and Polish scientific journals. Results The comparison of reforms shows that in 2001 the main changes referred to the institution of payer and financial matters. In both cases incorrect preparation of the political process and legislative faultiness were noted. Decentralization in 1999 was not followed by instruments needed for increasing the efficacy of the system; in the second case reorganization of the payer appears to be missing the expectations of health system participants. Conclusions The comparison of reforms may suggest that decentralization is a better solution in the context of increasing organizational and financial efficacy of the health system, but because of numerous additional factors and specifics of political conditions in Poland generalizations are not possible.     

不同健康传播方式对居民营养知信行的影响

目的 探索以社区为载体的人群合理营养干预方式。方法 对两组居民采取不同健康传播方式进行营养干预,Ⅰ组是通过人际交流方式,Ⅱ组是通过大众传媒方式。结果 干预前,两组调查对象之间营养知识知晓率、营养态度方面均无显著性差异。干预后,营养知识知晓率Ⅰ组高于Ⅱ组,知晓率的改善程度Ⅰ组好于Ⅱ组,对改变不良饮食习惯和早餐重要性认识方面,Ⅰ组有了明显改善,Ⅱ组则没有改善;日常饮食与中国居民膳食指南推荐摄入量的符合情况以及每天吃早餐情况两组均无明显改善。结论 开展社区营养健康教育能提高居民的营养知识水平,不同传播方式对社区居民营养知识、态度有一定影响。     

上海市区高中生健康和营养状况调查

目的为了解上海市区高中学生健康和营养状况及存在主要问题，为政府制定学校卫生保健工作发展规划，促进学生健康成长提供科学依据。方法采用整群随机抽样方法进行问卷调查，收集高中学生的健康、饮食、运动、生活习惯等资料并进行分析。结果高中生健康营养状况不尽人意，存在营养过剩与营养不良并存、视力不良大于2／3、挑食偏食严重、饮食不合理、睡眠和运动严重不足。结论提高青春期身心健康，重视合理营养、加强体育锻炼、优化生活方式等改善外界环境因素是重要途径。     

Child health indicators of life and development and the challenge of nutrition

This paper reports on the Child Health Indicators of Life and Development (CHILD) European project, which was reported in 2002. It outlines the scientific principles and operational approach adopted by that project, with a particular focus on the problem of reporting on nutrition. The paper then discusses the conceptual approaches and related challenges of measuring nutrition at the population level in children from infancy to adolescence and the linked determinant factors of lifestyle and behaviour. The paper concludes with a summary of the challenge that has needs to be addressed, echoing an unmet need reported in the CHILD project report.     

承德市南园社区2～7岁儿童营养与健康状况调查

目的为促进儿童健康发育,了解本地区儿童营养与健康状况情况,探索较为有效干预儿童发育的方法。方法选择2009年1月～2010年12月期间承德市某社区内250名2～7岁儿童。对照分析不同年龄组营养状况、健康状况及饮食行为及结果评分。结果﹤4岁儿童组和≥4岁儿童组严重营养不良者对照显示,差异无统计学意义(P﹥0.05);﹤4岁儿童组低体重率(3.7%)、发育迟缓率(0.9%)及肥胖率(4.6%)比≥4岁儿童组低体重率(12.7%)、发育迟缓率(7.0%)及肥胖率(19.7%)显著低(P﹤0.05)。﹤4岁儿童组龋齿率(0.0%)及缺铁性贫血率(0.9%)比≥4岁儿童组龋齿率(4.9%)及缺铁性贫血率(7.0%)显著低(P﹤0.05);而佝偻病率(7.4%)比≥4岁儿童组佝偻病率(1.4%)显著高(P﹤0.05)。﹤4岁儿童组饮食行为评分[(82.3±8.4)分]及饮食结构评分[(80.3±7.6)分]比≥4岁儿童组饮食行为评分[(76.1±7.3)分]及饮食结构评分[(74.6±5.8)分]显著高(P﹤0.05)。结论该社区在孩子添加辅食的过程中,培养孩子健康的饮食行为方面较为欠缺,需要儿童保健部门加强此方面的宣教,以促进孩子的健康发育。     

10798名职校学生营养状况及健康教育对策

目的了解职校学生营养状况，制定针对性的健康教育对策，为改善学生营养状况提供依据。方法按照《中小学生健康体检管理办法》，参考《学生体质健康标准》，统计分析2005--2009年10798名职校在校学生体检结果。结果2005--2009年学生营养不良率为15．96％，肥胖率为7．74％，肥胖率呈逐年上升趋势。结论应构筑学生营养健康教育实施的基础，有计划、分阶段实施学生营养健康教育。     

中南大学学生饮食营养调查报告

目的为了解中南大学在校大学生饮食营养与健康状况,及时发现膳食结构中存在的问题,同时帮助在校大学生了解营养知识并养成良好的饮食习惯。方法随机抽取322名在校大学生进行问卷调查,并将调查结果整理统计,与其他相关资料进行比较分析。结果中南大学在校大学生几乎所有同学的膳食纤维摄入量不足,约90%的同学维生素A摄入严重不足,其他的营养摄入情况也不乐观。结论建议在校大学生注意多食用蔬菜、水果以及粗粮,以补充膳食纤维和维生素A的摄入量。     

Household income and health care expenditures in Mexico

The purpose of this paper is to examine the determinants of household health expenditures in Mexico. Our analysis involves the estimation of household monetary health care expenditures, using the economic and demographic characteristics of the household as covariates. We pay particular attention to the impact of household income on health expenditures, estimating the elasticity of health care expenditures with respect to income for different income groups and according to health insurance status. For the empirical analysis, we use the Mexican National Survey of Income and Expenditures of 1989. Our principle findings show that monetary health expenditures by Mexican households are sensitive to changes in household income levels and that the group which is most responsive to changes in income levels in the lower-income uninsured group. This suggests that in times of economic crisis, these households reduce cash expenditures on health care by proportionately more than higher-income and insured households.