我国青少年生殖健康政策回顾和发展趋势分析

目的：回顾我国青少年生殖健康政策,分析其发展趋势,为完善相关政策体系提供依据。方法：采用社会学内容分析法,对政策内容进行比较分析。对决策者进行定性访谈,采用主体框架方法对资料进行分析。结果：解放后,我国共颁布了青少年生殖健康相关政策140条,其中包括相关权利政策9条、教育政策116条、服务政策8条和未婚青年流动人口政策7条。1996年之前性与生殖健康教育相关政策的发文数量波动在1-3条／年,其他3类政策的发文数量为0。此后青少年生殖健康相关政策的发文数量呈平稳上升趋势。国际环境、决策层的主流观念及社会变迁等因素都影响了政策的内容和数量。结论：我国青少年生殖健康政策体系建设需要出台专项政策,完善现有的相关教育政策体系,通过政策和财政支持促进青少年对性与生殖健康服务的可及性,关注未婚青年流动人口的权益保障,倡导长效的多部门合作机制。     

联合国人口基金项目官员考察云南省项目工作

<正> 2004年2月9～11日,联合国人口基金驻华代表处生殖健康/计划生育项目技术顾问艾斯特拉·苏拉诺女士,玛丽斯特普国际组织驻华执行机构代表李查德先生,联合国人口基金驻华代表处项目助理任亚楠女士到云南省曲靖市沾益县现场考察指导实施中国/联合国人口基金第五周期生殖健康/计划生育项目,听取了项目实施总体情况介绍,与县项目领导小     

“广西母婴安全担架行动”政策形成与发展的定性分析

目的：分析＂广西母婴安全担架行动＂产生和实施的过程、特点和意义,探讨公民社会组织在行动过程中的作用。方法：采用定性研究的方法,主要包括文献分析法和关键知情人访谈。结果：＂广西母婴安全担架行动＂是在特定的地理、经济、交通条件下产生的,由政府部门发起,由包括共青团、妇联在内的公民社会组织积极响应实施,在实施过程中,得到了社会各界支持,成功地使＂担架行动＂成为产科绿色通道的一部分。结论：＂广西母婴安全担架行动＂的形成基于全社会对母亲安全的共识,其发展与政府对＂母亲安全＂的高度承诺是密不可分的,是具地方特色的政策过程。实施过程中,作为特殊公民社会组织的共青团、妇联担当了主要力量,并倡导了更多的公民社会组织加入行动。行动过程体现了公民社会组织在中国政策过程中的重要性日趋明显,但其在政策制定过程中的作用仍需进一步加强。     

联合国人口基金第五周期生殖健康/计划生育项目问答

<正> 活动9:实施青少年生殖健康活动 青少年占我国人口的比例相当大。使他们得到生殖健康的信息和服务既是一大挑战也是当务之急,尤其是在当前艾滋病肆虐的情况下。第四周期方案成功地开展了青少年生殖健康试点项目,该项目包括同伴教育和促进安全套使用。鉴于第四周期方案下的青少年生殖健康项目所取得的成果和积极投入,中期评估和技术评估都建议在项目的第五周期将经过试点的青少年生殖健康项目推广到其他的城市和地区,还包括生殖健康服务。 青少年生殖健康倡导 第四周期方案下的各种项目也开展了一些倡导活动,其中包括目的在于加强中国开展倡导活动的能力和在4个方面开展倡导活动的倡导项目,其中之一是青少年生殖健康(青少年生殖健康这一主题是生殖健康倡导战略的4个主题之一,它是由第四周期倡导工作组开发的)。     

四川省实施“生殖健康促进行动”项目

2007年,四川省人口计生委按照省委、省政府关于大力实施“惠民行动”要求,在全省人口计生系统组织实施了“计划生育惠民行动计划项目”。“生殖健康促进行动”作为惠民行动计划项目之一,对“国优”、“省优”县和百万人口大县100万名农村已婚育龄妇女进行免费的生殖道感染疾病普查;免费为全省10000名退出育龄期农村妇女进行生殖健康检查;免费为流动人口提供避孕药具;在6市的6个县开展出生缺陷干预试点,直接受益人群达6000人。2006年,由四川省人口计生委牵头并组织实施,妇儿工委、卫生、妇联等部门参与配合,在31个县开展了“关爱妇儿生殖健康…     

青少年和青年友好服务

无论在发达国家还是发展中国家,青少年和青年人群都面临着生殖健康的诸多问题,如:首次性行为低龄化、多性伴侣和无保护性行为发生率高,非意愿妊娠以及不安全流产,性传播疾病和HIV/AIDS的威胁。然而这些国家在政策、社会文化、医疗机构、青少年本身和服务提供者等方面的因素阻碍了青少年和青年人群获得生殖健康服务。在20世纪90年代末,国际组织提出了青少年/青年友好服务的模式,强调友好服务的内容应该反映每一个国家流行病学、经济发展、社会和文化的特点,并积极倡导多部门协调合作的机制。     

流动青少年的生殖健康服务：相关政策、现状与需求

目的：了解流动青少年的生殖健康服务需求以及为其提供服务的现状与现有相关政策的基本情况,探索设计适应青少年特点的生殖健康政策体系及相应的服务模式.方法：本研究主要采用文献资料综述和相关政策评估等定性方法,通过专题座谈会、个体访谈和实地考察等方法收集定性资料.结果：青少年生殖健康服务的政策环境尚未形成,青少年生殖健康教育虽然已经起步,但服务相对滞后,现有服务与流动青少年需求存在较大差距.建议：首先需要良好的政策环境,其次应建立有效的工作机制,相关政府部门应提升面向青少年的生殖健康服务管理,并在探索和创新的同时总结和推广成功经验.     

农村青少年及家长对青少年保健门诊服务的需求调查

根据联合国人口基金与中国政府第六周期合作方案中“计划生育和生殖健康项目”的实施方案，将在全国30个省项目县大力推行青少年生殖健康服务。为此卫生部和中国疾病预防控制中心妇幼保健中心组织专家编写了项目地区青少年保健门诊服务指南。为使青少年保健门诊服务指南进一步完善，妇幼保健中心深入部分项目县（河北承德县、吉林东辽县、重庆铜梁县）了解农村地区青少年及其父母对青春期保健服务的具体需求，以及服务提供者对青少年保健门诊服务内容、服务形式的建议。     

未婚女性青少年生殖健康治疗服务需求的调查研究

目的:了解未婚女性青少年生殖健康治疗服务的需求现状,为改善健康服务提供科学依据。方法:利用北京大学人口研究所中国青少年生殖健康可及性政策发展研究项目"2009年中国青少年生殖健康全国抽样调查"数据,选取其中关于青少年生殖健康服务需求相关的数据进行卡方检验和logistic分析。结果:共回收未婚女性青少年有效问卷10970份;在最近12个月中,女性青少年的治疗需求率为35.5。回归分析显示,青少年年龄越大、个人可支配收入越高,其生殖健康服务的需求越高;有宗教信仰、初中及以下文化水平的青少年需求较高;农村地区青少年的需求高于城镇青少年;中部地区和西部地区需求高于东部地区。结论:未婚女性青少年的生殖健康服务需求率较高,不同特征者需求不同。应为青少年提供多层次多角度的生殖健康服务保障,重点关注低文化水平、农村和西部地区青少年的服务需求;引导高收入、有性行为的青少年降低高风险行为,促进其生殖健康。     

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。     

医护人员实施临床路径的依从性评价——基于河南省医疗服务供方支付制度改革前后的比较

目的：通过对河南供方支付制度改革的实践调研,分析在支付改革背景下医护人员对临床路径依从性的变化。方法：将试点地区临床路径文本与国家和省级标准比对,调查医护人员对临床路径的认知,考察临床路径执行吻合度以评估其依从情况。结果：目前实施的临床路径样本已经在国家或省级标准下进行机构级别的细化;医护人员参与制定和细化的临床路径更能够得到医护人员的认同和依从;从实施情况来看,县级医院人员临床路径依从性情况要好于乡镇卫生院。结论：临床路径的实施态度,决定了依从情况,进而决定最终效果。临床路径的制定与开发既需要落实已有标准,更要让医护人员参与制定过程,以保证其对临床路径的依从。     

校外青少年预防艾滋病健康教育政策落实情况调查及建议

目的了解校外青少年预防艾滋病健康教育政策措施的制定落实情况,分析存在问题并提出建议。方法采用现场调查和文献回顾的方法。结果有关部门制定落实了校外青少年预防艾滋病健康教育政策措施,开展了"青春红丝带"行动、"中国儿童青少年预防艾滋病活动"等工作,目前校外青少年健康教育主要包括依托当地共青团委开展活动、通过家长学校开展相关家庭教育以及开展青少年同伴教育等3种模式。目前还存在诸多挑战如校外青少年尚缺乏明确定义,健康教育的多部门协调机制尚未形成,社会组织参与较少,健康教育工作的人员、经费保障不足,健康教育针对性不强且缺乏效果评估。结论建议将艾滋病防治领域的校外青少年定义为达到法定入学年龄,不在学校接受教育、无职业的25周岁以下青少年;结合社会管理创新、医改的深入推进,落实校外青少年预防艾滋病经费等保障措施;通过开展需求评估,增强健康教育的针对性,通过将健康教育与就业技能等培训相结合,提高健康教育的综合性;开展健康教育效果评估,推广有效模式,针对难点问题进一步探索试点。     

国家基本药物制度框架下的乡镇卫生院筹资测算方法研究:以S县为案例

目的:围绕乡镇卫生院执行国家基本药物制度面临的筹资困难问题,研究乡镇卫生院筹资测算技术方法,以服务决策、完善政策设计。方法:以S县乡镇卫生院筹资为个案,进行测算技术方法的研究。资料来源于2009年S县卫生财务年报数据库,并开展了关键人物访谈。结果:S县乡镇卫生院因取消药品加成减少2317万元收入,为弥补这一损失,经测算,财政补助收入和医疗服务收入分别需新增719万元和1598万元。为此,S县医疗服务数量若增长10%,则需将医疗服务价格提高40%。结论:实行基本药物制度并得到补偿后,整个社会福利得到改进;卫生筹资和经济补偿得到优化;地方政府财政供给能力面临挑战。建议:建立政府补助为主导的筹资机制;逐步提高新农合筹资水平;适当提高乡镇卫生院医疗服务收费水平。     

“I believe this team will change how society views youth in disasters”: the EnRiCH Youth Research Team: a youth-led community-based disaster risk reduction program in Ottawa,Canada

SettingThe Sendai Framework for Disaster Risk Reduction promotes an “all-of-society” approach to disaster risk reduction (DRR). Since 2013, the EnRiCH Research Lab has implemented a community-based, participatory program to promote youth development and engagement in DRR in Ottawa-Gatineau. The EnRiCH Youth Research Team used an existing community education program called the Enrichment Mini-Course Program as a framework to engage youth in DRR. We aim to share the implementation process and lessons learned from this innovative “all-of-society” approach to DRR.InterventionThe EnRiCH Youth Research Team provides high school and university students with a platform to be heard on disaster and climate change issues. Youth are given opportunities to design and lead knowledge dissemination projects intended to educate members of the community about disaster prevention and preparedness. Students have opportunities to connect with academics, governmental and non-governmental organizations, and public health practitioners to share their ideas on youth participation in DRR in Canada.OutcomesTo date, this public health intervention has produced DRR training modules that can be used as curriculum support by teachers, a children’s book on earthquake preparedness, an educational video about youth participation in DRR, and several conference presentations. Members of the team have become well versed in disaster preparedness strategies.ImplicationsThis program has demonstrated that youth can contribute to DRR through knowledge mobilization, and support public education about disaster preparedness. Offering this opportunity at a grassroots level can support participation by youth by allowing flexibility in design and adaptation to individual environmental and social contexts.     

上海市公共卫生优秀青年人才科研能力培养效果分析

目的:分析评价上海市第二轮“公共卫生三年行动计划”优秀青年人才(简称优青),科研能力与学术水平.方法:采用定量及定性的方法对优青的科研能力进行评估.结果:研究对象在承担课题数量、金额及学术产出上,与计划实施前相比有明显提高,差异具有统计学意义.结论:相比行动计划之前,优青的科研能力和学术水平有了不同程度的上升,仍需完善培养机制促进其进一步的发展.     

One state's response to the malpractice insurance crisis: North Carolina's Rural Obstetrical Care Incentive Program.

In the period 1985-89, there was a severe drop in obstetrical services in rural areas of North Carolina, partly because of rising malpractice insurance rates. The State government responded with the Rural Obstetrical Care Incentive (ROCI) Program that provides a malpractice insurance subsidy of up to $6,500 per participating physician per year. Enacted into law in 1988, the ROCI Program was expanded in 1991, making certified nurse midwives eligible to receive subsidies of up to $3,000 per year. To participate, practitioners must provide obstetrical care to all women, regardless of their ability to pay for services. Total funding for the program has increased from $240,000 to $840,000, in spite of extreme budgetary constraints faced by the State. The program and how its implementation has maintained or increased access to obstetrical care in participating counties are described on the basis of site visits to local health departments in participating counties and data from the North Carolina Division of Maternal and Child Health. The program is of significance to policy makers nationwide as both a response to rising malpractice insurance rates and reduced access to obstetrical care in rural areas, and as an innovative, nontraditional State program in which the locus of decision making is at the county level.     

Youth health in Canada

Youth Health in Canada is at a favorable level and adolescents have access to a reasonable standard of health care services. The framework is evolving in response to changing concepts and to the participation of youth themselves. The role of the academic and research leadership in Canada is described. The youth population is healthy and contributes in a positive way to the national fabric and the needs of the majority are adequately met. However, there are sub-populations of youth, who continue to warrant a special focus and are deserving of the attention of youth health professionals. Youth health in Canada is emerging as an adaptation of the American Adolescent Medicine model of the early 1960s. It is a challenging multidisciplinary field in which should play a significant role in shaping its future. Its mandate will be to exercise leadership in addressing the changing needs of the general adolescent population and bringing renewed focus to the special needs of identifiable sub-populations.     

学历和工作岗位对公共卫生优秀青年人才培养效果评价的影响

目的:通过分析评价上海市第二轮"公共卫生三年行动计划"优秀青年人才的学历和工作岗位对人才培养效果的影响,为新一轮卫生人才培养计划提供思路。方法:优秀青年人才根据工作岗位分为4组,采用定量描述性研究对优秀青年的学历和工作岗位进行分析。结果:优秀青年人才的学历构成在各单位组别间不均衡,优秀青年人才培养项目的进展和绩效在不同单位组别之间存在一定的差异。结论:应积极鼓励优秀青年着眼于各自不同岗位,有所侧重地提高理论和实践水平;同时应避免"一刀切",探索按照不同的岗位性质,完善评价指标体系,以便更好地服务于对优秀青年人才培养效果的评估。     

Public Participation in the Process of Local Public Health Policy,Using Policy Network Analysis

Objectives:

To assess the current public participation in-local health policy and its implications through the analysis of policy networks in health center programs.

Methods:

We examined the decision-making process in sub-health center installations and the implementation process in metabolic syndrome management program cases in two districts (‘gu’s) of Seoul. Participants of the policy network were selected by the snowballing method and completed self-administered questionnaires. Actors, the interactions among actors, and the characteristics of the network were analyzed by Netminer.

Results:

The results showed that the public is not yet actively participating in the local public health policy processes of decision-making and implementation. In the decision-making process, most of the network actors were in the public sector, while the private sector was a minor actor and participated in only a limited number of issues after the major decisions were made. In the implementation process, the program was led by the health center, while other actors participated passively.

Conclusions:

Public participation in Korean public health policy is not yet well activated. Preliminary discussions with various stakeholders, including civil society, are needed before making important local public health policy decisions. In addition, efforts to include local institutions and residents in the implementation process with the public officials are necessary to improve the situation.     

Prevalence of Youth Violence in the U.S., 1999–2009: Ethnic Comparisons and Disaggregating Asian Americans and Pacific Islanders

This study examined ethnic and gender differences in youth violence in the U.S. across time, especially when disaggregating Asian Americans and Pacific Islanders and examining adolescents with mixed ancestry. National data from 1999 to 2009 of the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System were analyzed. The analyses were performed on individual items and three factors (i.e., carry weapon, felt unsafe, fights). Overall, 43.9 % responded to at least one indicator of violence. In general, males reported higher rates than females. American Indians/Alaska Natives and Native Hawaiians/Pacific Islanders tended to have the highest rates, while Asians and Whites tended to have the lowest rates. However, significant interaction effects between ethnicity and sex indicated a more complex relationship. The findings highlight the (1) parsimony in utilizing the three factors; (2) importance of disaggregating the heterogeneous “Asian/Pacific Islander” population; and (3) need to conduct more research on youth of mixed ancestry. These findings better inform program design and implementation, as well as policy making in youth violence prevention.