对农民工公共卫生服务的认识和提供意愿研究

为了解基层卫生工作人员对农民工公共卫生服务的认识和提供服务的意愿,用填写意愿调查表和深度访谈的方法对成都市部分卫生工作人员进行了调查。结果表明,基层卫生工作人员对农民工公共卫生服务有比较客观的认识,但总体上服务提供意愿不强,服务主动性有待进一步提高。     

Practicing Preventive Health: The Underlying Culture Among Low-Income Rural Populations

Context: Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. Purpose: The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. Methods: Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. Findings: Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. Conclusions: The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.     

京郊农村公共卫生服务追溯及其重要性分析

2020年新冠疫情突发对农村公共卫生相关政策的实施是一次极大的考验.课题组通过网络及电话访谈,就追踪研究多年的某几个京郊村卫生室在这次疫情中的表现为切入点,以历史政策纵向发展为主线,分别对中华人民共和国成立后农村公共卫生服务历史回溯、"非典"疫情促进农村公共医疗卫生服务发展以及新冠疫情防治中村医充分发挥公共卫生服务的积...     

农村公共卫生服务中存在的问题及建议

通过分析当前基层医疗卫生机构提供公共卫生服务中存在的问题,如农村公共卫生服务专业人才缺乏、工作量偏大、开展公共卫生服务的能力偏低、考核和激励机制不完善、日常管理机制不健全、公共卫生服务信息化程度低及不能满足当前农村居民对健康的卫生需求等问题,进而提出加大政府财政投入、加强基层公共卫生服务队伍建设、优化和调整基层卫生服务人才结构、完善公共卫生服务考核机制和激励机制、加强公共卫生服务日常监管及加强基层医疗卫生服务机构信息网络建设等建议。     

Rural Adolescent Health: The Importance of Prevention Services in the Rural Community

Context: Adolescence is a pivotal developmental period for the establishment of positive health and health practices. However, developmentally propelled risk behaviors coinciding with barriers to health services may increase the propensity for untoward health outcomes in adolescence. In addition, the sociocultural context of the rural environment can present challenges to the health of adolescents. Limited data on rural adolescent health, particularly among population subgroups, hinder the ability to adequately advocate for adolescent health prevention services. Methods: A secondary analysis of the 2005 California Health Interview Survey Adolescent questionnaire was conducted. Selected survey items corresponding to the Healthy Youth 2010 objectives were analyzed for 663 adolescents aged 12‐17 residing in rural regions of California. Adolescent subgroup analysis included race/ethnicity, age, and poverty level. Findings: Adolescent health issues of particular concern in this study include sexual health, substance use, mental health, and risk factors for obesity. Predictably, risk behaviors increase with the age of the adolescent. Minority and poor youth demonstrate the greatest vulnerability to untoward health outcomes. Conclusion: Significant risk behaviors and health concerns exist among the rural adolescent population, particularly among poor and minority youth, arguing for the creation and preservation of prevention services for youth in the rural community. Future research using alternative sampling methodologies may be necessary to adequately represent the higher‐risk adolescent in the rural community. More data are needed on vulnerable adolescent populations in the rural community in order to adequately advocate for prevention services.     

Health Needs and Health Care Utilization Among Rural,Low-Income Women

ABSTRACT

This study examined the correlates of health service utilization in a sample of low-income, rural women. Self-reported data were from Rural Families Speak (N = 275), a multi-state study of low-income, rural families in the U.S. collected in 2002. Findings indicated that women with health insurance, a regular doctor, and poorer overall physical health had higher incident rates of physician visits. Women who were divorced, separated or widowed and had more chronic health problems had higher incidence rates of emergency department (ED) use, while women living in counties with higher primary care physician rates had lower incidence rates of ED use. Future research and policies should focus on improved access to health insurance, increasing physician availability in rural areas, and providing rural women with a usual source of care, so as to reduce emergency services utilization for non-emergent needs and improve health status for this population.     

大力实施农民健康工程推动农村卫生事业又好又快发展

1998年我省在全国率先实现以县为单位达到初级卫生保健标准的目标,但农村卫生投入不足、人才短缺、保障能力有限等问题仍然十分突出。2006年,江苏省委、省政府决定在全省组织实施农村新五件实事,将农民健康工程列入其中。经过全省上下努力,2008年新农合参合率达95％,人均最低筹资达到100元,各县最高封顶线提高到6万元以上,在全国率先启动实施农村基本公共卫生服务项目,切实加强农村卫生机构服务能力建设。下一步要切实抓好并不断巩固完善新型农村合作医疗制度、深入推进农村公共卫生建设、进一步健全完善农村卫生服务网络、加大力度培养农村适宜卫生人才四个重点,努力为广大农村居民提供“安全、有效、方便、价廉”的基本医疗卫生服务。     

一个需要重新认识的问题——对城乡卫生资源比例反差的思考

从城乡居民医疗服务需求出发,结合城乡卫生机构的性质、所承担的任务以及卫生资源利用状况,认为除部分城市医院盲目扩大规模、重复建设等原因外,城市卫生资源高于农村有其合理性,不能一概否定。居民对医疗服务的需求是配置卫生资源的基本前提。改变城乡卫生资源配置的“反差”是一项系统工程,需要很长的过程,只能随着农村经济的发展、农民收入的增加和医疗需求水平的提高而缩小“反差”;只能随着小城镇建设的进程、改变农与非     

参与性农村评估在改善生育卫生服务项目中的应用

在ＲＨＩＰ项目中大量运用了参与性农村评估（ＰＲＡ）方法,简要地回顾了ＰＲＡ的发生和发展,ＰＲＡ的概念和来源,农村快速评估（ＲＲＡ）与ＰＲＡ的区别,ＰＲＡ的应用范围,结合ＰＲＡ在改善生育卫生服务项目中培训和现场应用的实践,阐明了ＰＲＡ在改善生育卫生服务项目中应用的必要性、工作思路和方法及主要工作领域;描述了ＰＲＡ现场应用的工具和方法及ＰＲＡ原则;建议加强高质量ＰＲＡ的培训和实践;在注重行为和态度转变     

Patterns and Correlates of Public Health Informatics Capacity Among Local Health Departments: An Empirical Typology

Objective: Little is known about the nationwide patterns in the use of public health informatics systems by local health departments (LHDs) and whether LHDs tend to possess informatics capacity across a broad range of information functionalities or for a narrower range. This study examined patterns and correlates of the presence of public health informatics functionalities within LHDs through the creation of a typology of LHD informatics capacities.Methods: Data were available for 459 LHDs from the 2013 National Association of County and City Health Officials Profile survey. An empirical typology was created through cluster analysis of six public health informatics functionalities: immunization registry, electronic disease registry, electronic lab reporting, electronic health records, health information exchange, and electronic syndromic surveillance system. Three-categories of usage emerged (Low, Mid, High). LHD financial, workforce, organization, governance, and leadership characteristics, and types of services provided were explored across categories.Results: Low-informatics capacity LHDs had lower levels of use of each informatics functionality than high-informatics capacity LHDs. Mid-informatics capacity LHDs had usage levels equivalent to high-capacity LHDs for the three most common functionalities and equivalent to low-capacity LHDs for the three least common functionalities. Informatics capacity was positively associated with service provision, especially for population-focused services.Conclusion: Informatics capacity is clustered within LHDs. Increasing LHD informatics capacity may require LHDs with low levels of informatics capacity to expand capacity across a range of functionalities, taking into account their narrower service portfolio. LHDs with mid-level informatics capacity may need specialized support in enhancing capacity for less common technologies.     

样本地区农村公共卫生成本项目构成分析

目的测算上海市、江苏省和青海省3个样本县农村公共卫生服务项目实际成本,按职能和项目分析成本构成,为指导样本地区乃至其他类似地区职能和项目经费配置提供科学依据。方法通过对3个县93家县、乡、村三级卫生机构的成本消耗调查,运用成本测算的思路和方法测算项目成本。结果2006年,农村公共卫生服务的8大职能中,3样本县均以基本医疗、疾病预防控制和妇幼保健3项职能所占比例较大,分别占总成本的87.97%、87.01%和77.87%,其他包括疾病监测与报告、突发公共卫生事件、卫生监督、爱国卫生和新型农村合作医疗管理5项职能分别仅占总成本的12.03%、12.99%和22.13%。结论在当前财政有限的条件下,不同经济地区政府和卫生服务机构对公共卫生项目重视程度各异,工作侧重点和内容存在较大差异,对公共卫生项目内容及其要求以及投入的规范化、标准化研究显得非常重要。     

Involving Local Health Departments in Community Health Partnerships: Evaluation Results from the Partnership for the Public’s Health Initiative

Improving community health “from the ground up” entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an “inter-sector” enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public’s Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative’s five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served. Cheadle is with the Department of Health Services, University of Washington, Seattle, WA, USA; Hsu, Pearson, and Beery are with the Center for Community Health and Evaluation, Seattle, WA, USA; Schwartz is with the Kaiser Foundation Health Plan and Hospitals, Oakland, CA, USA; Greenwald is with the School of Policy, Planning, and Development, University of Southern California, Los Angeles, CA, USA; Flores is with the The California Endowment, San Francisco, CA, USA; Casey is with the Partnership for the Public’s Health, Oakland, CA, USA.     

全国农村公共卫生项目投入标准测算研究

目的模拟测算全国农村公共卫生项目投入标准,为完善我国农村公共卫生服务项目投入标准提供科学的依据。方法运用经济学上成本测算的思路与方法,数据来源于江苏、上海和青海省3个样本县93家县、乡、村三级卫生机构的现况调查与全国和样本地区常规报表资料。结果现有国力水平下,如果县、乡、村三级基本医疗均不纳入国家财政补助范围,100%落实现有项目任务,全国需投入696.48亿元,人均50.53元;如果将乡、村两级基本医疗纳入财政补偿范围,则需人均投入84.30元,全国732.84亿元;而如果将县、乡、村三级基本医疗均列入国家财政补助范围,则需人均投入132.84元,全国投入1154.87亿元。