Preventive and episodic health care of inner-city children

Children in low-income, inner-city households who used different sources of ambulatory care were analyzed with regard to their experiences in securing preventive and episodic illness care. This analysis is derived from a larger study that investigated the utilization of health care systems by groups within an inner-city community; it focused on the Outpatient Department of a large teaching hospital and on the impact of a new Health Maintenance Organization (HMO). Data were obtained through household interviews of three sample populations: enrollees in an HMO, residents of a public housing project, and persons from the general community. When preventive health care was examined, our findings showed that, while the majority of children of school age were immunized, only about half of the children under age 6 were. Among children aged 3 through 5, those attending day care centers were more likely to be immunized than those not in such programs. There were indications that children using the HMO were more frequently receiving preventive services, particularly general physical examinations. There was no relationship between the usual source of care, or day care participation, and whether a child received care for an episode of illness. There were differences by age and usual source of care in seeking care for earaches and in receiving regular care for asthma. The patterns of health care utilization found in this study promote interest in the influence of the source of ambulatory care for children in other socioeconomic groups.     

Preventive health care strategies for health maintenance organizations.

This paper reports the results of a study of preventive health care services offered by Health Maintenance Organizations and other health care deliverers in the U.S. Nine areas have been selected for review — initial and periodic screening, health hazards appraisal, health education, chronic disease prevention, the maternity cycle and the neonate, childhood and adolescence, mental health services, drug abuse and alcoholism, and preventive dentistry. Recommendations are made as to how preventive health care services might be provided by an HMO with suggestions for appropriate medical histories to formulate a baseline health profile of each participant.     

Assessing the quality of preschool child health surveillance in primary care: a pilot study in one health district

OBJECTIVE: To develop a framework for measuring the quality of preschool child health surveillance acceptable to primary health care teams and measurable at individual primary health care team level. DESIGN: Published research evidence was identified and criteria developed by a local multidisciplinary expert group. The criteria were discussed with primary health care teams. How well they were achieved was assessed. SETTING: Twenty-eight general practices in one health authority area. METHODS: Data collection included observation of baby clinics, interviews with health visitors and general practitioners (GPs), questionnaires to parents, collation of child health surveillance reviews recorded in personal child health records and immunization rates. RESULTS: The criteria for assessing preschool child health surveillance were thought to be acceptable and achievable by primary health care teams. Fifteen of the 22 criteria used to assess baby clinics were met by over 90 of practices. Almost all practices completed child health surveillance reviews within a standard time and achieved 90 coverage for primary immunizations. At many practices, less than 90 of parents felt welcome at the baby clinic, usually had enough time to talk to their health visitor or had the purpose or results of the 6 to 8 week child health surveillance review explained to them. GPs were less likely than health visitors to discuss health promotion at child health surveillance reviews (chi(2) 11.52, P = 0.0007). Few practices had a call-up and recall system for all reviews. CONCLUSION: The framework that we developed for assessing preschool child health surveillance was acceptable and achievable by primary health care teams.     

上海市长宁区学龄前儿童非故意伤害监测结果分析

探讨长宁区学龄前儿童非故意伤害的流行特征及其主要影响因素,为制定切实可行的儿童伤害预防策略提供参考.方法 以长宁区6所幼儿园小班和中班790名幼儿为研究对象,随访监测儿童1 a内非故意伤害的发生情况并分析其流行病学特征.结果 790名学龄前儿童1 a间共发生非故意伤害23人次,年发生率2.91%,其中男童发生率为2.38%(10/421),女童发生率为3.52% (13/369),差异无统计学意义(x2=0.916,P=0.338).非故意伤害类型以跌落/坠落为主(占52.2%),52.2%的伤害发生在家中或幼儿园,所有伤害均为轻微伤害.Logistic回归分析显示,与儿童非故意伤害有关的因素有年龄、性格、近1 a非故意伤害史、是否对家庭环境进行安全性评估和孩子健康状况(P值均<0.05).结论 长宁区学龄前儿童非故意伤害发生率虽处于较低水平,但应继续针对儿童非故意伤害相关因素采取综合性安全防范措施,重点加强对家庭环境进行安全性评估,以及关注近1 a有非故意伤害史的儿童.     

Developing a computer-assisted health knowledge quiz for preschool children

ABSTRACT: The project evaluated the reliability of a computer-assisted health education knowledge quiz, a multiple-choice picture identification assessment tool for nutrition and health-related knowledge in preschool age children. Pearson's product moment correlation coefficients were computed to assess overall and componential stability between test/retest scores of 51 children (mean age 3.6 years) enrolled in a Head Start preschool center. Cronbach alpha coefficients were calculated to determine the internal consistency of the subscales. Overall reliability for the computer-assisted quiz was high at .82 (p<. 01). For individual subscales, test/retest correlations were highest for Nutrition, Safety, and Environment (r = .56 to .81) and lower but still significant for Dental, Smoking, and Fitness (r = 37 to .48). Results suggest a computer-assisted knowledge quiz can provide a reliable tool to assess health education knowledge in young children. In addition, the computer-assisted test format is highly acceptable to preschool children and enables researchers to administer a more extensive test to young children with brief attention spans in a manner that engages their full cooperation and effort. In this respect it offers several advantages over traditional paper-and-pencil formats.     

Management of malnutrition in preschool children: the role of primary health care services

Although the prevalence of malnutrition in developing countries is decreasing, it is still a major problem for many children under five. As socio-economic conditions are the main determinants, a final solution for this problem can only be envisaged in the long run. Still, short-term strategies need to be defined in order to relieve the sufferings of individual children and their families. Understanding the problem and consequently formulating intervention programs at the local level remains a complex and difficult issue. The first reason being that the process of malnutrition expresses itself in different forms and with variable consequences. A second reason making malnutrition a complex problem is that the primary causes -- the interaction between insufficient food supply and the frequent recurrence of infectious diseases -- are determined by a multitude of factors of different natures. This complexity -- of its expressions, effects, and causality -- makes it difficult to get a global vision and understanding of the problem, which clearly impedes the definition of rational and integrated intervention strategies. Nevertheless, a better understanding of the pathophysiology of malnutrition and of the factors that influence the growth process in preschool age, will help to better direct actions. To this effect, a conceptual model will be built, based on recent insight in the process of malnutrition within this age group. From this model, two lines of action for increasing the chances of preschool children to express their initial growth potential, become apparent. A first series of activities could tackle the process that, via wasting and recurrence of infections, leads to an increased mortality risk. As timely intervention reduces the risk of depletion of energy reserves, these activities would also have an indirect impact on physical development. Elaborating strategies for secondary prevention and for treating severe cases belongs to the specific competence of the health sector. In the second line of action, the aim is to intervene before reserves are depleted. Here, primary prevention and health promotion are choice activities. This frame of reference will be used for analysing existing health programs for preschool children and how they propose to improve the management of malnutrition. This analysis will show that primary health care services can play a much more important role than usually attributed to them. Identifying these gaps and elaborating alternatives is the purpose of this article.     

Parental expectations for young children: Day care versus preschool

The purpose of this exploratory study was to examine parental expectations for the curriculum content of preschool and day care programs. Subjects were 111 mothers and fathers of three and four year old children enrolled in either a day care or preschool program. Results revealed no significant differences between preschool versus day care parents in terms of expectations for the curriculum content. Analyses indicated that fathers had higher expectations and more favorable attitudes towards instruction in academic and athletic areas than mothers, while both mothers and fathers had higher expectations in academic, artistic, and compliance areas for girls compared to boys. Implications for early childhood programs are discussed.     

Health surveillance of health care workers suffering from neurological, psychiatric or behavioural disorders

INTRODUCTION: Health care workers (HCWs) suffering from psychiatric or neurological disorders, alcohol or drug addiction, may pose a risk for the health and safety of patients. The occupational health specialist charged of medical surveillance of hospital workers (the so-called "Competent Physician") often needs to recognize functional impairment in HCWs. CASE REPORT: Cases of impairment in HCWs are reported, and management criteria are discussed, in order to define effective strategies to deal with the problem. DISCUSSION: Alcoholism and other drug addictions are the most common causes of impairment, followed by emotional impairment, neurological and other physical disabilities. The primary responsibility of protecting the public, should be achieved while at the same time maintaining HCWs at work whenever possible. CONCLUSION: Critical key-points are identified, and suggestions for management of functionally impaired HCWs are given.     

An integrated comprehensive occupational surveillance system for health care workers

BACKGROUND: Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented. METHODS: Human resources job and work location data were used to define the DUHS population at risk. Outcomes and exposure data from existing occupational health and safety programs, health promotion programs, and employee health insurance claims, were linked with human resources data and de-identified to create the Duke Health and Safety Surveillance System (DHSSS). RESULTS: The surveillance system is described and four examples are presented demonstrating how the system has successfully been used to study consequences of work-related stress, hearing conservation program evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids (BBF). CONCLUSIONS: Utilization of existing data, often collected for other purposes, can be successfully integrated and used for occupational health surveillance monitoring of HCWs. Use of the DHSSS for etiologic studies, benchmarking, and intervention program evaluation are discussed.     

Post-acute care for children with special health care needs

Background

Almost all studies of post-acute care (PAC) focus on older persons, frequently those suffering from chronic health problems. Some research is available on PAC for the pediatric population in general. However, very few studies focus on PAC services for children with special health care needs (SHCN).

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

Asthmatic/wheezing phenotypes in preschool children: Influential factors,health care and urban-rural differences

Background

Different wheezing and asthmatic phenotypes turned out to indicate differences in etiology, risk factors and health care. We examined influential factors and urban-rural differences for different phenotypes.

在幼儿教育专业学生中开展口腔保健健康教育的效果评价

目的:了解健康教育对幼儿教育专业学生口腔保健相关知识、态度的影响。方法:以371名幼儿教育专业学生为研究对象,于健康教育前后,对学生进行口腔保健相关知识和态度方面的不记名问卷调查。结果:教育后学生口腔保健的基本知识平均得分由教育前的12.1分提高到17.8分(满分19分),两者相比差异有显著性。教育后对口腔保健及其相关问题的正向态度率均明显高于教育前。电化教育、文字教育和讲座是学生最希望获得口腔保健知识的方式。结论:在幼儿教育专业学生中开展有关口腔保健的健康教育,不仅必要而且可行和有效,对增加学生口腔保健的基本知识、树立与口腔保健有关的正确态度都有积极的影响,为他们今后在托幼机构的工作中,对学龄前儿童开展口腔健康教育奠定了一定的基础。