2010年扬州市居民健康素养调查分析

目的:了解扬州市居民健康素养状况及影响因素,为制定相关政策提供依据.方法:根据<全国健康素养监测指导手册>,采用统一问卷入户调查.结果:扬州市居民素养水平为15.14%,其中,具备科学健康观的居民占28.7%,具备传染病防治素养的占24.6%,具备慢病防治素养的占24.3%,具备安全急救素养的占54.8%,具备基本医疗...     

Continuity of care and health care cost among community‐dwelling older adult veterans living with dementia

ObjectivesTo estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community‐dwelling older veterans with dementia.Data SourcesCombined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014‐2015.Study DesignFY 2014 COC was measured by the Bice‐Boxerman Continuity of Care (BBC) index on a 0‐1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long‐/short‐stay nursing home, and noninstitutional long‐term care (LTC) cost for medical (like skilled‐) and social (like unskilled‐) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders.Data CollectionCommunity‐dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073).Principal FindingsMean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long‐stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short‐stay nursing home cost.ConclusionsCOC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.     

Health literacy and knowledge of antenatal care among pregnant women

Health literacy has a direct impact on pregnancy from the perspectives of both the mother and the baby. This study aimed to determine the level of health literacy and assess the knowledge of antenatal care among pregnant women. From among all pregnant women who presented to the hospital's obstetric polyclinic during the study's timeline, the study group consisted of 460 women who agreed to take part (492 women were invited and a response rate of 93.5% was achieved). A questionnaire prepared based on the literature in line with the study's objectives was completed by the participants under supervision. The Turkish Health Literacy Scale (THLS-32) was used to assess health literacy. In order to determine the women's prenatal care knowledge levels, a total of 20 knowledge-testing statements prepared using the literature were applied, 14 of which were true and six of which were false. The internal consistency of antenatal information questions during pregnancy was made and the Cronbach alpha coefficient was calculated as 0.77. It was determined that 33.9% of the participants had a sufficient level of health literacy. Health literacy was sufficient in young married women (19 years and less) in their first pregnancy and those who had regular reading habits, participated in healthcare activities and received postpartum care at a family health clinic (p < 0.05 for each). While the most accurately evaluated statement about antenatal care was ‘It is normal to experience nausea/vomiting in the first trimester of pregnancy’, the least accurately evaluated statement was ‘Over 35% of women incorrectly believed it was normal to gain 20 kg of weight during pregnancy’. It was found that pregnant women with sufficient health literacy had higher levels of knowledge about antenatal care (p < 0.05). In this study, it was determined that approximately two-thirds of the participants had insufficient health literacy and the women with insufficient health literacy had low levels of knowledge about antenatal care.     

Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo

Objectives

Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans.

Study design

Cross-sectional study.

Methods

A cross-sectional study was conducted in Kosovo between November 2012–February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics.

Results

Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed.

Conclusions

Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context.     

临床医护人员消毒灭菌知识、态度及行为知晓率调查

目的了解临床医护人员消毒灭菌知识、态度及行为知晓状况。方法采用问卷调查方式随机对200例临床医护人员进行调查。结果临床医护人员消毒灭菌知识、态度和行为的平均知晓率分别是71.49%、63.79%和86.45%。其中,物品灭菌有效期、传染病分类及生物监测相关知识的知晓率偏低,分别是49.43%、42.53%、23.56%;临床医护人员消毒灭菌态度:是否关注消毒供应专业的新技术新业务总知晓率最低,为26.44%;86.45%的临床医护人员自认为能够掌握无菌操作技术和无菌器械及相关物品的正确使用方法,却易忽视操作前检查无菌包完整性及指示卡等标识(67.24%)。结论临床医护人员消毒灭菌的知识、态度及行为仍有待提高,应加强对医护人员消毒灭菌知识培训及技术指导。     

泰州市居民健康行为素养水平的影响因素分析

  目的   了解湖北省居民健康知识素养及健康行为素养水平,为制定合理的健康教育、健康干预方案提供理论依据和可行性建议。   方法   采用多阶段分层抽样方法,于2014年10月 — 2015年1月抽取湖北省武汉、荆州、黄冈市,共调查610名城乡居民的健康知识、健康行为素养的基本情况。  结果   居民总体健康知识素养水平为28.36 %,健康行为素养水平为31.97 %。单项健康知识素养具备率最高的是高血压病人是否可以大量饮酒（90.33 %）、孕妇吸烟是否会影响胎儿发育（90.00 %）,具备率最低的包括蚊虫叮咬是否可以传播艾滋病（35.74 %）、正常成年人每天摄入食盐量（26.39 %）;单项健康行为素养中戒烟限酒率最高,为78.03 %;合理膳食（35.08 %）、锻炼身体（29.51 %）的行为素养具备率较差。χ²检验结果显示,健康知识素养在性别、年龄、文化程度、职业、个人年收入方面呈现差异分布（P均 < 0.05）;健康行为素养在性别、年龄、职业方面呈现差异分布（P均 < 0.05）。多因素logistic回归分析显示,影响健康知识和理念素养的主要因素包括文化程度、个人年收入,影响健康行为素养的主要因素包括性别、职业。   结论  调查居民总体健康知识素养和健康行为素养水平较低,居民的健康知识素养与健康行为素养水平存在分离现象;健康教育工作应因人口特征而异,促进健康知识向健康行为的转化。     

Dietary advice, nutritional knowledge and attitudes towards nutrition in primary health care

The high priority of health promotion within primary health care in the UK is evidenced through the acceptance, by the primary health care team (PHCT), of a contractual responsibility for health promotion, including the provision of dietary advice. This study sought to investigate the level of advice given on dietary matters, the methods used to give this advice and the nutritional knowledge and attitudes towards nutrition of Sheffield PHCTs; general practitioners (GPs) and practice nurses (PNs) were compared. All active practices ( n = 100) on Sheffield Health Authority's GP practice lists were invited to participate. A total of 58 interviews in 46 practices were completed, representing a response rate of 46%. Information was collected using an interviewer-administered questionnaire. Data analysis was carried out using MINITAB (Minitab Inc., Pennsylvania, USA); differences between groups were tested using the x² test.
It was found that PNs gave dietary advice more frequently than GPs ( P <0.05). GPs were more likely ( P <0.05) to give verbal advice only, whereas PNs tended to take a dietary history and to give both written and verbal advice. GPs were less likely than PNs to give comprehensive advice for type II (maturity onset) diabetes, hypercholesterolaemia and obesity. There were appreciable gaps in the nutritional knowledge of both groups. The majority of GPs and PNs believed nutrition to be important in disease prevention and expressed a desire for nutritional teaching as part of their medical training. The primary health care team is in a prime position to give dietary advice, however, it is evident that there is a need for improved nutrition education and training in dietary counselling.     

留守与非留守儿童监护人健康素养比较分析

目的了解农村留守与非留守儿童监护人健康素养差异情况,为进行农村留守儿童身心健康干预提供理论依据。方法随机整群抽取山东省聊城市高唐县735名学龄前儿童监护人进行健康素养问卷调查。结果735名学龄前儿童中,留守儿童269人,占36.6%,非留守儿童466人,占63.4%;监护人知晓每年要健康体检1次的占57.7%,知晓保健品不能代替药品的占76.2%;了解孩子近期膳食情况的占41.5%,平时给孩子服用营养保健品的占28.0%,平时注重孩子饮食营养搭配的占78.6%,平时给孩子购买食物时注重营养价值和卫生状况的占43.8%;留守与非留守儿童监护人健康素养比较,其中健康生活方式、保健食品不能代替药品、膳食要清淡少盐、避免超重与肥胖、饭菜要熟食、生熟食品要分开存放和加工、孩子出生后要预防接种、每年要做1次健康体检、注重饮食营养搭配、购买食物选择营养和卫生10项差异均有统计学意义（P<0.05）。结论与非留守比较,留守儿童监护人部分健康素养知识、态度及行为欠佳,有待进一步提高。     

中国妇幼保健人员艾滋病相关知识态度的调查

目的探究我国妇幼保健人员对艾滋病相关知识的了解和态度。方法2010年10月,在我国30个县采用分层、三阶段与规模成正比的容量比例抽样方法获得调查对象,对2696名妇幼保健人员进行面对面的问卷调查。结果仅有55．7％的调查对象全面了解与艾滋病病毒传播途径相关的10个问题,对接吻和蚊虫叮咬等6个非传播途径的回答正确率较低（56．6％）,不同类型的调查对象回答正确率不同（χ2＝96．578,P＜0．01）。有93．4％的调查对象了解艾滋病病毒传播的预防方法,不同类型的调查对象回答正确率不同（χ2＝18．818,P＜0．05）。不支持艾滋病病毒感染者享有生育权利者占19．5％,认为应该将艾滋病病毒感染者隔离起来者占7．8％。认为可以将使用后的一次性针头重新套上针头套和认为使用安全套前应吹气检查是否漏气者分别为16．2％和37．6％。结论妇幼保健人员对于艾滋病病毒非传播途径、职业暴露职业防护措施以及安全套的使用上还存在错误的认识,非常有必要对其进一步加强艾滋病相关知识态度的培训。     

医护人员医院感染防控知识、态度、行为调查

目的了解重点部门医护人员医院感染防控知识、态度、行为现状,并采取干预措施,为医疗机构医院感染防控工作提供科学依据。方法选择儿科、呼吸科、急诊科3个医院感染防控重点部门所有医护人员进行调查,比较干预前后不同职称医护人员医院感染防控知识、态度、行为变化。结果参与调查人员317名,干预前调查有效问卷275份,问卷有效率86.75%;干预后调查有效问卷311份,问卷有效率98.11%。采取干预措施后,高级、中级、初级及以下职称医护人员知识得分分别为(9.15±2.36)、(7.69±2.05)、(7.73±2.32)分,均高于干预前,分别为(6.46±2.12)、(5.30±1.55)、(6.16±1.80)分,差异均有统计学意义(均P0.05)。干预后初级及以下职称医护人员态度、行为得分分别为(91.50±9.26)、(86.40±14.52)分,均高于干预前,分别为(85.95±13.36)、(76.01±15.25)分,差异均有统计学意义(P0.05);而高级、中级职称医护人员态度、行为得分,差异均无统计学意义(均P0.05)。结论与医院感染防控知识相比,医护人员医院感染防控态度、行为的改变,需投入更多的精力才能取得成效;职称级别相对低的医护人员医院感染防控态度、行为的改变更易于实现。     

Increased access to palliative care and hospice services: opportunities to improve value in health care

Context: A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. Methods: This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high‐quality palliative care. Findings: Palliative care and hospice services improve patient‐centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. Conclusions: Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions.     

Mixed care networks of community‐dwelling older adults with physical health impairments in the Netherlands

As part of long‐term care reforms, home‐care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home‐dwelling older adults. Information on the variety in mixed care networks may help home‐care organisations to develop network type‐dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home‐care organisations in Amsterdam, the Netherlands, we selected 74 frail home‐dwelling clients who were receiving care in 2011–2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal–informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients’ activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home‐care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning co‐ordination tasks to specific dyads in large mixed care networks.     

吉林省儿童口腔健康素养及其保健行为现状分析

目的 了解吉林省儿童的口腔健康素养的掌握情况与行为的实施情况,为制定口腔保健干预提供科学依据。方法 整群抽取吉林省内8所学校一至五年级9 391名小学生,采用自行设计问卷进行调查。结果 口腔健康素养调查结果显示,在口腔保健知识中,使用含氟牙膏、更换牙刷时间和睡前刷牙的正确回答率分别为46.7%、70.3%和85.5%;口腔保健技能中,牙齿缝隙刷洗、牙齿表面刷洗及刷牙时间各为68.5%、64.7%和75.2%;口腔保健行为中,早晚都刷牙、睡前不吃东西和饭后漱口分别为77.5%、93.7%和84.6%。结论 吉林省儿童的口腔健康素养偏低,口腔保健行为有待于提高。学校、社区和家庭共同推动儿童健康促进,提高儿童口腔健康素养和保健行为,促进儿童口腔健康。     

城市失能老人口腔健康知识、态度及行为调查

目的:了解城市失能老人的口腔健康知识、态度及行为(KAP)现状,为开展失能老人口腔健康教育提供依据。方法:采用自制调查问卷对杭州市两个街道的全部95名失能老人的口腔健康知识、态度及行为现状进行调查和统计分析。结果:失能老人口腔健康知识知晓率较低,不同文化程度、不同年龄段的失能老人口腔健康知识知晓率、口腔健康态度和行为有显著差别(P<0.05)。结论:城市失能老人口腔健康意识较为欠缺,口腔健康行为不良,应加强对城市失能老人的口腔健康教育,提高其口腔健康意识。     

上海市青少年生殖健康相关知识与态度现状研究

目的 了解上海市青少年的生殖健康相关知识、态度及行为现状。方法 本研究于2013年5-9月,采用分层整群抽样法,选取上海市4个区8所普通高中、8所职业高中、8所初级中学和2所普通高校,共计4 942名学生接受自行设计的问卷调查。结果 被调查者中男性2 456名,女性2 486名,平均年龄(16.84±1.53)岁。青少年生殖健康知识知晓率较低,尤其是妊娠和避孕知识,且存在明显的性别和阶段差异。青少年对性相关行为的态度较开放,对婚前性行为、未婚同居、未婚先孕、一夜情和多性伴的接受率分别为66.9%、62.7%、34.0%、28.1%和28.1%。多因素logistic回归分析显示,青少年对婚前性行为的接受态度与性别、教育阶段、安全套与性病知识及恋爱行为有关(P<0.05)。结论 上海市青少年掌握的生殖健康知识较匮乏,对性相关行为的态度较开放。应重视青少年生殖健康知识教育及观念引导,帮助青少年构建系统、完整、全面的生殖健康知识技能体系。     

Constructing a new role for family carers and volunteers providing care towards the end of life: an action research approach exploring a new model of hospice care

The objective of this study was to understand the conceptualisation and development of a novel way of providing end-of-life care in a Cottage Hospice setting, with a focus on the role of family carers and volunteers within this care model. A participatory action research design enabled a situational analysis, together with change processes. The study setting was a hospice in the South of England, and its network of wider associates in the local health economy. Participants were purposively sampled to provide relevant information. Data collection (2017–2018) included documents (e.g., meeting minutes) and interviews (individual and group) with external (e.g., GPs) and internal (e.g., staff, managers, volunteers, patients, family carers) stakeholders. These were followed by action cycles conducted by a core action group which explored issues related to family and young carers, the relationship between the main and Cottage Hospices and workforce engagement with the change process. Iterative, inductive, thematic analysis was followed by axial coding facilitated within NVivo. Twenty-six individual and eight follow-up interviews, two group interviews and five discrete action cycles were completed. At the core was a focus on disruption of the norm of professionally provided and mediated care, with three main themes: imagining the future of Cottage Hospice (growing demand, a home-like space, innovative roles for families and volunteers); developing the role of family caregivers (making agreements, meeting needs, social inclusion and the ‘unknown’ expectations) and quality and safety issues (negative perceptions, personalised care and volunteer roles). Change was viewed as both a threat and an opportunity. Cottage Hospice represents the possibility of a truly new way of meeting the needs of dying people and their families, and could act as a template for progressive service developments elsewhere.     

Implementing a community‐based self care training initiative: a process evaluation

Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long‐term conditions. In contrast, this paper reports on a community‐based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings.