产科门诊信息管理系统医院本地发掘和在区域妇幼保健网络中的应用

目的建立科学、实用、适应医院产科门诊和地区区域内妇幼保健管理工作的信息系统，实现医院对孕产妇监督、动态跟踪管理，评估和医疗干预，同时满足区域内妇幼保健信息网络系统的高效、实用、稳定、安全和互联互通。方法基于net Framework 2．0框架进行建设，WEB层与应用层采用松耦合的方式进行协作，对数据库的操作采用CMP或JDO技术，同时以3T—NET网络为传输平台，实现Tbit级的区域横向传输，形成以业务为导向和驱动，具有可快速构建和运行，实用兼容、有灵活可扩展性，满足大型集成要求等特点的信息应用软件。结论经过统筹规划实现本地的信息化管理和异地的资源共享，因地制宜地融合医疗服务、妇幼保健、公共卫生、科研教育等分支领域，达到高效便捷地服务于政府、社会和居民的要求。     

Creating a GIS application for local health care planning in Saudi Arabia

The purpose of this paper is to show how Geographical Information Systems can be used to support health planners on a micro-scale. The first part of this paper discusses the issue that affect local health care planning which include monitoring of catchment area and facilities management. The second part defines GIS and its possible uses in the health care field. The relevant GIS functions have also been explained. The third part of this paper discusses the created GIS application, which is made for a local health centre in Makkah City, Saudi Arabia. In this application, three sets of GIS models have been produced. These are catchment area, patient profile and patient distribution and patient flows models. The created GIS models are produced to help local health planners in their health care decision output.     

健康医疗大数据标签体系构建方法研究

在界定健康医疗大数据标签相关概念的基础上,以国家全民健康保障信息平台为应用场景,分析了健康医疗大数据用户的类别及其信息需求,提出了健康医疗大数据标签体系的分类框架、标签维度和标签的设计方法,以及标签命名和取值的标准化原则,搭建了健康医疗大数据标签管理系统的基本架构,研究结果能够为该领域数据标签体系构建提供适宜的方法学指...     

南宁市江南区流动儿童的保健状况

目的了解南宁市江南区流动人口儿童的卫生保健状况,找出存在的问题,为改善流动人口中的儿童保健提供科学依据。方法 2009年1月—2011年12月来广西医科大学第三附属医院儿保门诊健康检查的满3周岁的儿童,采用整群抽样的方法抽出所有满3周岁的流动儿童835人,按照1∶1相匹配的原则,采用随机抽样抽取满3周岁该市儿童835例,通过儿童保健信息平台,查询两组人群儿童系统管理情况,分析体格发育及营养性疾病的患病情况。结果流动儿童的系统管理率为48.1%,该市儿童的系统管理率为92.0%,两者差异有统计学意义(P0.01);流动儿童的体重低下、发育迟缓发生率高于该市儿童,两者比较差异有统计学意义(P0.05);流动儿童的营养性贫血、佝偻病发生率高于该市儿童,两者比较差异有统计学意义(P0.01,P0.05)。结论流动儿童保健状况较差,在流动人口中应大力开展健康教育,强化儿童保健的重要性,改革现有的保健管理模式,让流动儿童享受均等的卫生保健服务,是改善流动儿童保健的重要措施。     

西部贫困农村地区健康信息传播对婴幼儿母亲科学喂养认知的促进

目的 明晰西部贫困农村地区健康信息传播模式对婴幼儿母亲母乳喂养认知的影响,为提高该类地区妇女的婴幼儿喂养认知,从而改善婴幼儿的健康状况,提供科学建议。 方法 分别于2014年、2019年在我国西部贫困农村地区,选取24月龄及以下婴幼儿及其母亲为研究对象,通过问卷调查收集其人口学特征、健康信息传播模式、科学喂养认知等资料。运用回归分析健康信息传播模式对婴幼儿母亲的科学喂养认知的影响。 结果 共纳入1 284对（2014年）、1 049对（2019年）母婴。2019年婴幼儿母亲早开奶知晓率（72.64%）、纯母乳喂养知晓率（31.36%）均分别显著高于2014年（65.73%,25.30%）（均 P < 0.05）。在信息传播模式中,70.54%的婴幼儿母亲主要通过基层医务工作者获取喂养信息。回归分析显示,基层医务工作者结合信息传播材料传递母乳喂养信息( OR = 2.23, 95% CI 1.03～4.85)促进了婴幼儿母亲的早开奶认知;基层医务工作者传播母乳喂养信息( OR = 1.57, 95% CI 1.04～2.38)、基层医务工作者与亲友协同传播母乳喂养信息的交互作用( OR = 2.39, 95% CI 1.48～3.87)促进了婴幼儿母亲纯母乳喂养认知。 结论 以基层医务工作者为核心的母乳喂养信息传播模式促进了西部贫困农村地区婴幼儿母亲早开奶、纯母乳喂养的认知。     

Epidemiological studies of Fukushima residents exposed to ionising radiation from the Fukushima Daiichi Nuclear Power Plant prefecture--a preliminary review of current plans

It is now more than six months since the beginning of the accident on 11 March 2011 at the Fukushima Daiichi Nuclear Power Plant in Japan. The Japanese government and local health authorities have started to collect the information necessary to estimate radiation doses received by those living in the area around the plant, drafted plans for the health care of residents, and started to implement some of them. This paper reviews and discusses the studies necessary for risk evaluation of cancer and non-cancer diseases, including those already planned, mainly from the view point of evaluating health risk using epidemiological approaches. In the long run, it is important to establish a cohort with a control group. Even if the cumulative doses are estimated to be so low that it is difficult to evaluate the risk of cancer and non-cancer diseases, it is necessary to conduct such a study to reassure residents. The health care programme of the Fukushima Prefecture government, including health check-ups of residents, will help to assess indirect effects of radiation exposure, including psychological problems. The success of any studies of radiation epidemiology depends on the collection of accurate information on radiation doses received by the study subjects. However, some of the dosimetry surveys were not conducted in a timely manner. (It should be recognised, though, that such a problem might have been inevitable, considering the chaotic condition after the nuclear accident.) Accurate estimation of the radiation dose received by each resident is not only important for scientific risk evaluation but also to inform each resident about his or her potential risk. Otherwise, residents will bear an undue psychological burden from uncertainties regarding their radiation exposure and its health consequences. One of other important tasks in Fukushima is the improvement of the quality of the regional cancer registry in this prefecture. It is also important to start thyroid cancer screening in a year or two since the expected minimum latent period among those exposed in early childhood is about 4 years. Recently, local health authorities decided to start a thyroid screening programme for those aged 18 years or younger. Any scientific efforts in Fukushima, which need to gain the trust of study subjects about the objectivity of research, may suffer from the fact that residents in Fukushima Prefecture have begun to suspect that the Japanese government and local authorities are keeping important information from them. It seems necessary to make more effort to reflect the opinions of residents when planning health care programmes and to gain the understanding of the public for the programme. In summary, there are many problems that make the evaluation of cancer and non-cancer disease risk in Fukushima difficult. The help of international colleagues will be invaluable for overcoming those problems. In this paper, these efforts are briefly summarised and some comments are made.     

Integrated delivery systems in California--success and failure determining factors for the first 10 years and impetus for Germany

Since the coming into effect of the Health Care Modernization Act (Gesundheitsmodernisierungsgesetz) the conditions for integrated health care delivery are favourable in Germany. However, comprehensive approaches are a long time in coming. In contrast, integrated health care delivery as an integral part of the spreading of managed care entered a further stage of development, which enables health care decision makers to draw conclusions regarding the further development of integrated health care delivery in Germany. Based on case studies integrated delivery systems in the San Francisco Bay Area have been analyzed with the objective to evaluate pitfalls and successful strategies for integrated health care delivery. The major pitfalls refer to an insufficient local focus, a lack of actual integration and the application of per capita reimbursement (which is a key subject on the political agenda in Germany as well) within integrated delivery systems. On the contrary, successful strategies include achieving a dynamic tension between centralized and decentralized coordination, internal and external relationship management, well organised human resource management including a well-defined corporate policy and a comprehensive implementation of information technology. Based on US experiences with integrated delivery systems implications for the design of integrated health care delivery in Germany are discussed.     

Basics of Bavarian health assessment reporting

Management information systems which support a demand-oriented, integrative and comprehensive decision-making in health care policy are of pre-eminent importance for the health care system. Present health care legislation in Bavaria underlines the importance of health reporting as a tool for periodical assessment of the situation and starting-point for decision-making in health care. Demands made on the Bavarian health report stem from both European and national levels and also from the regional structure within the state. It is intended that the health reporting should reach the local level. Single reports cannot cover all relevant aspects. Therefore, health reporting in Bavaria has a modular structure. There is a need for integrated, flexibly useful information. Following an evidence-based approach, health information may be subject to critical assessment. This approach enables decision makers to assess the grade of certainty of recommendations. Health reporting in Bavaria aims at following the people through time. The intelligent use of new media will have to play a key role.     

Preparing for networking information systems in health care organizations

Because the health care administrator faces unprecedented demands concerning information, well-designed and carefully selected information systems have become a critical factor in the viability and survival of health care institutions. Local area network systems are having a significant impact in this regard. Among their advantages are flexibility, dependability, low cost, and modularity. Health care facilities, have found networking to be a simple, cost-effective solution to collecting, processing, and distributing large volumes of data. The keys to a successful implementation recommended in this article should assist health care professionals once they have made the hard decision to use a local area network to process their day-to-day transactions.     

Models for evolving community health information networks

Community stakeholders, from hospital systems to independent physicians, from self-insured employers to managed health plans, from government agencies to consumers, require access to health information across the continuum of care. As the information highways for organizations and communities, health information networks and community health information networks have become the vehicles to address this growing health information imperative. Research identified more than 500 health information networks in all 50 states and most metropolitan markets. Health information networks vary widely in their definition, strategy, and operational status. Despite tumultuous change with both successes and failures, health information networks are indeed affecting health care delivery within enterprises and local communities, across regions, and on a national scale.     

Household health surveys in developing countries: could more use be made of them in planning?

Existing health information systems in Eastern Africa are basedon findings in patients visiting hospitals and clinics and onroutine administrative data. They do not reflect the healthsituation and the health care of the underserved, and do not,therefore, generate the information required for planning andprogramming health care for all. Household health surveys arepotentially very useful in filling important information gaps,but past surveys have been poorly adapted to existing healthcare systems; they have been expensive and difficult to replicate,and findings seem to have been rarely used in the planning process.After a brief presentation of current routine reporting, a fewplanning-oriented surveys conducted in Third World countriesare critically reviewed and presented from a planning perspective.It is concluded that household health surveys can be usefulcomponents of health information systems and could be used moreextensively. However, it is important to involve local healthplanners/managers in developing the survey design and the implementationplan, to keep costs at a replicable level and to estimate andreport survey utility and costs.     

Assessing the applicability of GIS in a health and social care setting: planning services for informal carers in East Sussex,England

Informal carers save the state's health and social care services billions of pounds each year. The stresses associated with caring have given rise to a number of short-term care services to provide respite to carers. The Carers (Recognition & Services) Act of 1995 identified formally for the first time, the important role that unpaid carers provide across the community in Britain. The planning of combined health and social care services such as short-term care is a less developed application of geographical information systems (GIS) and this paper examines awareness and application issues associated with the potential use of GIS to manage short-term care service planning for informal carers in East Sussex. The assessment of GIS awareness was carried out by using a semi-structured questionnaire approach and interviewing key local managers and planners across a number of agencies. GIS data was gathered from the agencies and developed within a GIS to build up a set of spatial databases of available services, location of users and additional geo-demographic and topographic information. The output from this system development was presented in turn at workshops with agencies associated with short-term care planning as well as users to help assess their perspectives on the potential use and value of GIS. A renewed emphasis on a planned approach to health care coupled with integrated/ joint working with social care creates a need for new approaches to planning. The feedback from planners and users, suggested that a number of key data elements attached to data-sharing may prove to be simultaneously progressive yet problematic, especially in the areas of ethics, confidentiality and informed consent. A critical response to the suitability of GIS as a tool to aid joint health and social care approaches is incorporated within a final summary.     

Defining and measuring quality outcomes in long-term care

The US health care industry increasingly agrees that sharing information about quality of care is necessary to stimulate providers' efforts to improve the quality of health care. The availability of mandated, uniform clinical data in all nursing homes and home health agencies has facilitated the rapid adoption of public reporting of comparative quality data. This paper examines the conceptual and technical challenges underlying the application of information about long-term care provider quality to judge and compare the quality of care provided by nursing homes and home health agencies. In general, the impetus to apply the emerging set of quality "tools" based on mandated clinical assessments may have outstripped the evidence for their valid application in selecting top providers or for rewarding their superior performance.     

Genomics--the perfect information-seeking research problem

The intersection of the genetics era and information age poses unique and daunting challenges for health consumers who may not have the health literacy to keep pace. While rapid advances in genetics research promise enhanced care, the inherent complexities and individualistic nature of genetic information have resulted in a challenging information environment. The technical possibilities for acquiring genomic information are increasing at an exponential pace, as are the scientific advances relating to it. Furthermore, societal reactions to genomics, and possible privacy and discrimination issues, may constitute significant constraints. The health care infrastructure also has its limits, given the severe shortage of qualified cancer genetic counselors and general practitioners who are unprepared to address genetics, creating a demand for creative approaches to service delivery. The combination of individual salience, low health literacy, the consumer movement, and important policy problems, then makes genomics the perfect information seeking research problem.     

Taking care of the sick and scared: a local response in pandemic preparedness

Virtually all health care operations, including public health, are undertaken only at a local or regional level. Large-scale infectious disease emergencies, such as SARS or pandemic influenza, will be recognized and managed at a local level. The creation of the Public Health Agency of Canada (PHAC) was an important step in strengthening public health capacity. However, we need adequate operational capacity in local public health departments to have a strong public health system. Local public health takes an integral role in the preparation for and management of infectious disease emergencies. Local public health departments and regional public health infrastructures must be positioned to both maintain core functions and to lead and support health sector response to emergencies. The local establishment of a flexible and sustainable emergency management system must address the need to: integrate health care and first responders; provide all-hazards tools for managing a crisis at the frontline; rank service priorities and provide surge resources; and provide accurate information on a timely basis. Only the leaders within the local or regional health care facilities and organizations can develop workable plans to deliver health care. PHAC must ensure and support the local public health infrastructure and local emergency preparedness. Without this support, there will be consequences for local response to major public health emergencies.     

高校医疗保健机构运行中面临的新问题

本文介绍了近年来高校医疗保健机构在功能定位、运行机制上面临的新问题,提出应根据国家对高校卫生工作要求和学校实际,树立科学、发展、客观的高校卫生工作定位观,重点做好预防保健和医疗工作,确保师生健康;协调处理好教育行政部门、卫生部门、属地化管理等各方面关系,切实解决高校医疗保健机构管理中的突出问题,以促进高校卫生工作的健康发展。     

Increasing Public Awareness of Quality Health Information on the Internet

Abstract

Recent surveys indicate that the number of people looking for health information online has skyrocketed. Consumers have access to an abundance of information via the Web, not all of it quality, authoritative information. Bad information can be worse than no information. The Medical College of Wisconsin Libraries partnered with a local public library to offer classes to the public on finding quality health information on the Web. Within three months after each class, a follow-up survey was sent to participants to determine if they had accessed health information online since taking the class, if taking the class had helped them to find information, and if they had used any of the information in making a health care decision or in interacting with their health care provider. Results show that awareness of quality health related Web sites helped consumers to find information that they in turn used in managing their health care decisions.     

Use of societal criteria in evaluation of medical technology assessment research proposals in the netherlands: Development and testing of a checklist

Rising health care costs, and the recognition that medical technology is a significant contributor to these costs, have provided the stimulus to develop medical technology assessment programmes in the Netherlands. The most important programme in this field is the Investigational Medicine Programme of the Dutch Sick Funds Council So far, priority setting for evaluation of medical technologies in this programme has mostly been based on the scientific merits of individual research proposals. This research was undertaken to encourage priority setting in health care research concerning both new and existing medical technology based on societal criteria as well. A literature study was performed to identify relevant items for the development of a checklist. The checklist was tested using a random selection of eight research proposals granted in the context of the Investigational Medicine Programme. Results of the reassessment showed that, despite the inclusion of a specific question in the application form focusing on societal aspects of an intervention, this issue is hardly dealt with. In those cases where information is given by investigators, its quality is relatively poor. In an attempt to improve this situation and as a result of our work, the Investigational Medicine Committee has restructured its application form. This article concludes with suggestions to improve the methodology of priority setting in health care research.     

Community-oriented primary care: critical assessment and implications for resident education

BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based on principles derived from epidemiology, primary care, preventive medicine, and health promotion that has been shown to have positive health benefits for communities in the United States and worldwide. METHODS: MEDLINE was searched using the key phrase "community-oriented primary care." Other sources of information were books and other documents. RESULTS AND CONCLUSIONS: Because of lack of predictable reimbursement for COPC services and difficulties encountered incorporating COPC in medical and residency curricula, widespread application of COPC has not occurred. Recent trends in public health initiatives, managed health care, and information technology provide an environment ripe for application of COPC in medical practice. Also, recent recommendations made by the Strategic Planning Working Group of the Academic Family Medicine Organizations and the Association of Family Practice Residency Directors regarding specific community competencies for residency training have direct bearing on COPC and family medicine educators. These trends and recommendations, properly configured, will produce a medical training and practice environment conducive to COPC.