北京市东城区社区医护人员健康生活方式相关知信行调查

目的了解社区医护人员健康生活方式相关知信行情况,为全民健康生活方式活动提供建议。方法随机抽取北京市东城区社区医护人员132名,采用面对面询问方法进行调查。结果北京市东城区社区医护人员健康生活方式知晓率除全民健康生活日时间（22．5％）和千步活动量定义（10．8％）认知较低外,其余均高于65．0％;对不健康生活方式与高血压、冠心病、糖尿病、肿瘤、高血脂、脑卒中有关的态度认同率均高于65．0％;除锻炼（25．8％）和参与社区居民健康生活行动（57．5％）较低外,其余健康生活方式行为发生率均高于70．0％。40岁以下的社区医护人员对体质指数（BMI）计算方法、“全民健康生活日时间”的知晓率高于40岁及以上人员,而锻炼的行为发生率低于40岁及以上人员。结论北京市东城区社区医护人员健康生活方式相关知信行水平较高,但对40岁及以上者应加强理论指导和培训,对40岁以下者应加强锻炼教育的宣传力度,促使社区医护人员在全民健康生活方式活动中更好地发挥指导和示范作用。     

社区卫生人员的个人—组织契合度分析

目的:个人—组织契合度理论是个人与组织之间的匹配程度,可以从个人和机构两方面来分析和改善工作态度。本文目的是验证社区卫生人员个人—组织契合度与总体工作满意度的相关性,并分析契合度的现状。方法:采用个人—组织契合度的自制问卷,对全国四个省(市)做了社区卫技人员现场问卷调查,得到有效问卷656份。用因子分析、线性回归等方法分析了归属和成就需要的契合度。结果:个人—组织契合度与总体工作满意度存在显著性的相关。总体上,个人—组织契合度小于零,说明机构资源无法满足社区卫技人员的个人需要。归属需要是社区卫生人员的主要需要,其次是成就需要。归属需要的契合度要高于成就需要,尤其以同事关系的契合度最高,契合度最低的是收入和职业发展两项。结论:个人—组织契合度是工作满意度的影响因素。当前社区卫生人员的个人—组织契合度较低,尤其是成就需要的契合度。建议机构应改善归属需要的契合度,政府应调整政策提高收入、改善职业前景。     

Opportunities for community health workers to contribute to global efforts to end tuberculosis

ABSTRACT

Tuberculosis (TB) has emerged as the leading infectious cause of death globally. New paradigms are needed to reduce TB rates and mortality. Programs harnessing the potential of community health workers (CHWs) to enhance TB prevention and care have shown great promise. In this perspective article, we review the history of CHW-based efforts to prevent and treat TB, present evidence illustrating the effectiveness of CHWs across the entire cascade of TB care, and outline additional opportunities for CHWs to address challenges particular to the TB pandemic. Despite many promising studies, knowledge gaps persist and we suggest an agenda for future research on the role of CHWs in TB prevention and care.     

基于社区家庭的母婴健康监护系统设计

目的：研究设计基于社区家庭的母婴健康监护系统,用户可在家中得到便捷的健康服务和实时健康监护.方法：在Windows系统上,以VS2010和MySQL5.0为开发平台,使用C＋＋语言进行开发设计.结果：该系统实现了用户的个人信息、生理参数的管理,能够记载个人生活习惯,跟踪疾病,提醒亚健康症状.根据用户对各项详细信息的评估,给出相应的健康建议.通过无线通信技术实现了医生和用户的实时在线聊天交流功能.结论：母婴健康监护系统操作简单,计算机界面友好,能够确保用户（孕妇）的健康安全,有效地提高胎儿健康发育的质量.     

家庭远程监护网络系统设计

本文设计了一种家庭医疗保健远程监护网络系统，并详细介绍了远程监护技术与家庭医疗保健相结合的应用实例——家庭远程监护网络。     

社区“国医堂”员工工作满意度调查

目的研究社区＂国医堂＂员工工作满意度现状,探索满意度影响因素。方法采用方便抽样的方法选取石家庄市23所和天津市11所社区卫生服务机构中的＂国医堂＂员工作为调查对象,利用工作满意度调查量表调查其工作满意度。结果工作满意度平均得分为3.50分。工作相关的6个因素平均得分分别为：领导与管理3.36分,晋升与培训3.15分,人际关系4.05分,工作条件3.18分,报酬与福利3.12分,工作本身3.20分。其中无离职想法较有离职想法的员工满意度显著增高（P〈0.05）。结论社区＂国医堂＂员工工作满意度受多方面因素影响,满意度有待进一步提高。     

医护人员诊疗操作时手消毒方法探讨

目的 加强医护人员诊疗操作之间手的清洁消毒，切断因医护人员手污染造成医院感染的途径。方法 以3种不同手消毒方法，对3个普通病区的治疗班护士分3组进行实验观察。实验1组，双手浸泡于“84”消毒液内消毒；实验2组，用浸有“84”消毒液的小毛巾搓擦双手；实验3组，用洗必泰-醇皮肤消毒液喷涂双手。每组连续监测10例次操作。结果 实验1组消毒后手指采样合格率为92％，实验2，3组合格率均为100％。实验1，2组手部皮肤有不同程度的粗糙、干裂。结论 医护人员手消毒方法以用洗必泰-醇皮肤消毒液喷涂较好，其消毒效果好，干燥快，对手部皮肤损伤小，是较好的诊疗操作之间手消毒方法。     

Effect of multiple interventions on community health workers' adherence to clinical guidelines in Siaya district, Kenya

Evaluation of a community health worker (CHW) programme in Siaya district, Kenya, showed CHWs commonly made errors in managing childhood illness. We assessed the effect of multiple interventions on CHW healthcare practices. A sample of 192 ill-child consultations performed by 114 CHWs in a hospital outpatient department between February and March 2001 were analysed. The mean percentage of assessment, classification and treatment procedures performed correctly for each child was 79.8% (range 13.3-100%). Of the 187 children who required at least one treatment or referral to a health facility, only 38.8% were prescribed all treatments (including referral) recommended by the guidelines. Multivariate analyses found no evidence that the intervention-related factors studied (refresher training, supervision, involvement of community women in the CHW selection process, adequacy of medicine supplies, and use of a guideline flipchart during consultations) were significantly associated with overall or treatment-specific guideline adherence. A multivariate linear regression analysis revealed that several non-intervention-related factors, such as patient characteristics, were significantly associated with overall guideline adherence. Given that our study was cross-sectional and our measurement of exposure to several interventions was based on CHW recall, the estimated effects of the interventions should be interpreted with caution. Despite these limitations, however, our results raise questions about the effectiveness, in the setting of Siaya district, of several interventions commonly used to improve the quality of care given by CHWs.     

Health literacy training for Australian home care workers: Enablers and barriers

The rapidly expanding Australian home care workforce represents an untapped resource for improving health literacy (HL) and health outcomes of their clients. Nine home care workers (HCWs) were interviewed for this study to gain data around their experiences of providing HL support to their clients, key HL needs and priorities, and training that would best these needs. Findings indicate that HCWs are providing HL support, and identify a number of enablers and barriers to providing this support. Core inclusions for a HL training checklist are suggested. Implications for future research are considered.     

Village health workers as medicine sellers?

The Bamako Initiative proposed improving the sustainability of primary health care in Africa by requiring payment for health services; in particular, for drugs. The suggestion that the sale of drugs should be put into the hands of village health workers was almost unanimously rejected, however. The author argues that it is worthwhile, nevertheless, to explore the feasibility of this idea. The cautious commercialization of the sale of medicines by village health workers may prove advantageous for the entire community.     

城市社区卫生服务中心电子病历系统优化服务环境探讨

构建了城市社区卫生服务中心基于优化服务环境的电子病历系统,并依托医生工作站,实现门诊医疗服务信息一体化.此系统在5个方面优化了门诊医疗服务环境:①各项医疗服务流程实现电子化操作,提高了工作效率和服务质量;②电子病历模板的使用减少了医生书写病史的时间,提高了问诊和检查时间;③通过LIS、PACS及心电系统等,可以查阅病人检验结果和影像诊断资料,掌握病人健康状况;④通过诊疗记录子系统,可以调阅病人既往病史的电子记录,了解疾病控制情况;⑤通过医联共享子系统,可以获得病人在“上海医联”机构就诊的病历记录,了解病人的疾病程度,以便制定治疗方案.电子病历系统的开发与应用,既提高了全科医生的诊疗水平,又为病人提供了良好的医疗服务环境.     

遵义市口腔医疗机构医务人员手卫生管理现状调查

目的了解遵义市口腔医疗机构医务人员手卫生管理现状,为科学管理手卫生提供依据。方法2014年10—12月采取现场观察及问卷调查的方式对遵义市127所口腔医疗机构手卫生管理现状进行调查。结果遵义市口腔医疗机构洗手池、水龙头、清洁剂、速干手消毒剂、干手用品配备合格率分别为60.63%、11.02%、92.13%、22.05%、37.80%。除清洁剂及洗手池外,遵义市各级口腔医疗机构其他洗手设施配备情况均不乐观。口腔医疗机构医务人员洗手正确率为33.07%（42/127）,医院口腔科、综合门诊部、口腔诊所、洁牙店医务人员洗手方法合格率分别为50.00%、23.08%、23.53%、0。结论遵义市基层口腔医疗机构手卫生设施配备不完善,卫生行政部门对医务人员手卫生监管不到位,医务人员手卫生相关知识知晓率及手卫生依从性较低。     

深圳市劳务工和非劳务工社区卫生服务利用及满意度对比分析

目的:了解劳务工和非劳务工对社区卫生服务利用情况及其满意度。方法:在深圳市宝安区随机抽取街道及其社区卫生服务中心,以拦截调查的方式共调查社区卫生服务利用者8 000人,运用SPSS18.0软件对数据进行统计分析。结果:劳务工最近一年到社区卫生服务中心就诊次数为3次及以上的比例高于非劳务工,差异有统计学意义(P0.000 1);劳务工和非劳务工就诊人群满意度前三位分别是服务态度(73.29%,73.46%)、技术水平(65.29%,67.50%)、看病方便(63.16%,64.98%);73.47%的就诊者愿意接受社区首诊制,劳务工人群相比非劳务工人群更愿意接受社区首诊(74.16%,69.71%)。讨论:深圳市劳务工社区首诊制的实施使居民社区卫生服务利用有所提高,劳务工和非劳务工对社区卫生服务的满意度较高,且差别不大。以深圳为借鉴,在全国逐步推进社区首诊制具有一定的可行性。     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

以社区为导向的初级卫生保健：比利时社区卫生服务案例分析及启示

比利时的社区卫生服务模式对我国社区卫生服务改革具有借鉴意义。在对比利时一家典型的社区卫生服务中心进行现场考察和案例研究的基础上,总结了其开展社区卫生服务的做法：虽然存在缺乏首诊制度和沟通协调方面的问题,但以社区为导向的多学科协同服务和按人头付费的支付方式改革等做法成效显著。针对我国社区卫生服务改革中存在的问题,提出相关的政策建议,包括建立和完善法律、政策和制度设计;加强多学科的服务团队建设,推动医学模式在社区转变;完善医保配套政策支撑与激励;以社区需求为导向开展跨部门行动,引导社会资源整合。     

社区医院282名医护人员A型行为与心理健康状况

目的调查和分析社区医护人员的A型行为与心理健康状况的关系,为提高社区医护人员心理健康水平提供参考。方法采用症状自评量表(SCL-90)和A型行为量表对社区医院282名医护人员进行调查,数据用SPSS 17.0软件进行统计学处理。结果 A型行为医护人员SCL-90总均分以及5项症状因子(躯体化表现、强迫症状、人际关系敏感性、敌对、偏执)均高于全国常模,其中敌对和偏执差异具有统计学意义(P0.05);A型行为人员的躯体化表现、敌对和偏执3项阳性心理症状检出率明显高于非A型行为人员(P0.01或P0.05)。结论社区医院A型行为医护人员的心理健康状况较差,应采取措施给予改善。     

浅议完善我国社区卫生服务

通过对我国社区卫生服务的发展及不足做出系统的梳理,并结合世界发达国家的社区卫生服务系统,对我国社区卫生服务的改革与发展做出探讨。     

Are community health workers more effective in identifying persons in need of home and community-based long-term services than standard-passive approaches

Consumers prefer home and community-based long-term care (LTC) services (HCBS) but lack information on those services. We examined the use of community health workers (CHWs) to find and help Medicaid beneficiaries with unmet LTC needs access HCBS compared to standard HCBS outreach approaches. We found that CHWs were very effective at finding persons with greater needs and were better able to help them access a greater range of HCBS services. We also found that five times fewer HCBS beneficiaries helped by CHWs had to use nursing home care services than those not helped by the CHWs despite the fact that their health status was poorer than those not helped by the CHWs. Our study provides evidence of the effectiveness of CHWs for HCBS service awareness and navigation.