Geographic Variation in Public Health Spending: Correlates and Consequences

Objectives. To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation.
Data Sources and Setting. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources.
Study Design. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and 2005. Multivariate regression models for panel data were used to estimate associations between spending, institutional characteristics, health resources, and population characteristics.
Principal Findings. The top 20 percent of communities had public health agency spending levels >13 times higher than communities in the lowest quintile, and most of this variation persisted after adjusting for differences in demographics and service mix. Local boards of health and decentralized state-local administrative structures were associated with higher spending levels and lower risks of spending reductions. Local public health agency spending was inversely associated with local-area medical spending.
Conclusions. The mechanisms that determine funding flows to local agencies may place some communities at a disadvantage in securing resources for public health activities.     

我国政府购买公共卫生服务的实践和特点

目的总结我国政府购买公共卫生服务的实践经验,为其进一步完善和推广提供经验支持。方法采用文献综述法,从电子和公开出版物两个来源获取相关文献,根据研究类型和研究主题筛选纳入相关文献。结果服务提供者类型包括公立和私立的医疗机构,其运行机制由筹资、服务项目选择、监督和评价以及支付等环节组成,对公共卫生服务的可及性和质量产生了积极作用。但是对公共卫生服务效率和公平的影响还不确定。结论我国政府购买公共卫生服务改革推广对改善居民公共卫生服务的利用起到了推动作用。     

浙江省中小学校卫生状况调查

目的了解学校卫生工作中存在的主要问题，提高学校应对突发事件的能力。方法采用分层随机抽样方法，抽取浙江省中小学校32所，进行学校公共卫生状况的现场调查，包括学校主要卫生设施、卫生机构与人员、学校健康教育以及学校卫生管理等内容.结果各级各类学校间教学和卫生设施的差距悬殊，各项指标的变异系数为34．2％-116．2％，90．6％的学校设有学校卫生工作领导小组，71．9％的学校有突发公共卫生事件相关应急措施，农村中小学在卫生设施和食品卫生管理方面落后于城镇小学。结论学校存在发生突发公共卫生事件的隐患，特别应注重农村学校的卫生工作。     

Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey

ObjectiveTo estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration.ConclusionsChronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.     

《突发公共卫生事件的应对及管理》在公共卫生硕士教育的实践

目的 了解《突发公共卫生事件的应对及管理》课程在公共卫生硕士教育中的实践情况和课程满意度的影响因素。方法 编制调查问卷,对四川大学选修过该课程的公共卫生硕士进行网络调查,分析该课程的实践情况,并构建结构方程模型,定量分析影响课程满意度的因素。结果 (1)96.6%的调查对象认为该课程有助于扩大知识量,93.7%的调查对象认为助于职业,95.0%的调查对象认为该课程提升了应对突发公共卫生事件的能力,98.3%的调查对象愿意更加深入的学习该课程;(2)课程满意度影响因素主要为感知质量和学生期望(P<0.01)。结论 (1)有必要在公共卫生硕士培养中开设《突发公共卫生事件的应对及管理》课程;(2)增加该课程的感知质量和学生期望有助于增加课程满意度。     

福建省2004年各类学校突发公卫事件监测结果

目的了解各类学校突发卫生事件的报告及时性与现场处置情况,为有效预防、及时控制各类学校突发卫生事件提供决策依据。方法分析2004年国家突发公共卫生事件报告管理信息系统与福建省文件传输协议(FTP)监测系统的各类突发公共卫生事件。结果各地突发公共卫生事件报告工作不够平衡,有些地市报告工作不够理想;FTP方式是目前的主要报告途径,占各类报告途径的78.02%(71/91);传染性疾病类是各类学校突发公卫事件的主要类型,占89.01%(81/91);春秋两季是学校各类突发公卫事件的好发季节。结论应加强对各级各类学校保健部门督查,提高突发公共卫生事件的报告及时性。     

将健康融入医改政策促进公共卫生服务均等化--以武汉市为例

随着“十二五”期间新医改的不断深化,公共卫生服务工作将迎来一次良好的契机。以医改为契机,将健康融入各项政策中,创新思维,创新机制,创新工作方式,全面促进和提高全市公共卫生服务工作质量,早日实现基本公共卫生服务均等化。     

Public Health Renaissance and the Role of Schools of Public Health

In these turbulent times of political, social and economic changesin Europe public health is again coming into focus. Schoolsof public health, for long the basis for education of publichealth leaders will also in the future play a key role in promotingthe ‘new’ public health agenda. Based on ecologicalawareness and public involvement in health their teaching, researchand policy development should make them be seen as Centres ofRelevance and not only as Centres of Excellence, thus gearingtheir activities to the needs of new generations of practitionerswho can be both activists and advocates for health. If trainingand research are made relevant for practice and community service,then schools will be in the centre of public health insteadof in the periphery of medicine. Elements of a strategy to achievethese objectives are discussed.     

Patterns and Correlates of Public Health Informatics Capacity Among Local Health Departments: An Empirical Typology

Objective: Little is known about the nationwide patterns in the use of public health informatics systems by local health departments (LHDs) and whether LHDs tend to possess informatics capacity across a broad range of information functionalities or for a narrower range. This study examined patterns and correlates of the presence of public health informatics functionalities within LHDs through the creation of a typology of LHD informatics capacities.Methods: Data were available for 459 LHDs from the 2013 National Association of County and City Health Officials Profile survey. An empirical typology was created through cluster analysis of six public health informatics functionalities: immunization registry, electronic disease registry, electronic lab reporting, electronic health records, health information exchange, and electronic syndromic surveillance system. Three-categories of usage emerged (Low, Mid, High). LHD financial, workforce, organization, governance, and leadership characteristics, and types of services provided were explored across categories.Results: Low-informatics capacity LHDs had lower levels of use of each informatics functionality than high-informatics capacity LHDs. Mid-informatics capacity LHDs had usage levels equivalent to high-capacity LHDs for the three most common functionalities and equivalent to low-capacity LHDs for the three least common functionalities. Informatics capacity was positively associated with service provision, especially for population-focused services.Conclusion: Informatics capacity is clustered within LHDs. Increasing LHD informatics capacity may require LHDs with low levels of informatics capacity to expand capacity across a range of functionalities, taking into account their narrower service portfolio. LHDs with mid-level informatics capacity may need specialized support in enhancing capacity for less common technologies.     

基层基本公共卫生服务项目管理工作探讨

基本公共卫生服务项目的推行,对促进基本公共卫生服务均等化的实现具有重要意义。基层单位作为公共卫生服务的主体,其服务能力直接影响卫生服务项目的实现,因此基本公共卫生服务管理工作需要落实到基层。基本公共卫生相关服务项目管理工作顺利开展,不仅能够提升基层公共卫生单位管理质量,而且能够有效为基层相关卫生服务单位获得良好社会及管理效益。但是现阶段在实际的基层基本卫生服务项目管理工作中,相关管理工作仍然存在部分问题。为进一步提升基层基本公共卫生服务项目管理水平,该文旨在分析基本公共卫生服务项目的现状,并提出解决问题的方法,通过从项目管理工作需要面向基层单位以及合理利用各种资源和平台的方式,最终达到提高基层单位项目工作管理质量,以及服务项目取得良好的管理效果和社会效益的目的 。     

论公共卫生与可持续发展

通过阐述公共卫生与可持续发展的关系及对公共卫生现状及政府投入,传染病防制,食品卫生,工业卫生与职业病和放射卫生等问题的揭示,提出了可持续发展应解决好的几个问题;（1）切实转变政府职能;（2）认真做好预防为主;（3）建立政事分开,高效,统一的公共卫生监督管理新体制;（4）开展重大疾病和慢性非传染性疾病的综合防治;（5）进一步加强卫生法制建设。这对于提高国民健康素质和促进社会经济的稳定,协调与持续发展具有重要意义。     

区域基本公共卫生服务评价方法研究

目的：探索适合县级及以上公共卫生机构使用的区域基本公共卫生服务评价方法。方法分别采用加权综合评分法、加权综合指数法、加权逼近理想解排序法（Topsis）和加权秩和比法（RSR）对2012年浙江省11个市的基本公共卫生服务数据进行评价,采用Kendall协调系数W检验对评价结果进行一致性检验。一致性良好的前提下分别采用均值法、加权平均组合评价法和系统聚类分析对4种单一综合评价结果进行组合评价。结果各综合评价方法的单一评价结果不同,前2位排序均为杭州、宁波,一致性检验结果显示4组评价结果具有良好的一致性。均值法和加权平均组合评价法的组合评价值顺位均为杭州、宁波、绍兴、嘉兴、湖州、台州、金华、舟山、丽水、温州和衢州。系统聚类分析将11个市分为4类较为合适：优秀（杭州、宁波）,良好（湖州、嘉兴、绍兴）,中等（舟山、金华、台州）,较差（温州、衢州、丽水）,类间差异有统计学意义（P＜0.01）。结论4种综合评价方法均适用于县级及以上公共卫生机构进行本区域基本公共卫生服务评价,实际应用时宜采用多种综合评价方法。     

A short history of the Multidisciplinary Public Health Forum

The Multidisciplinary Public Health Forum (MPHF) was a 'network of networks' that was formed through grass roots public conferences held during the mid 1990s. It championed the development of a trained, developed and accredited multidisciplinary public health workforce in the UK. This paper draws on documentary evidence and from a series of semi-formal interviews held with individuals who were involved in the development and work of the Forum, to explore why the Forum was influential, the key milestones of the journey and the lessons that we might learn for the continued development of the public health function.     

新疆卫生监督机构卫生监督人员现况调查

目的了解新疆卫生监督机构卫生监督人员现状。方法对新疆各级卫生监督机构人员编制、数量、学历和年龄构成进行调查分析。结果全疆卫生监督机构编制性质不统一。卫生监督人员配置不足。人员学历集中于大专、中专及以下学历，年龄较年轻化，南、北、东疆三大区域卫生监督员学历、年龄构成存在差异。结论建议出台统一政策，制定科学、合理的编制方案，明确卫生监督机构性质、人员编制。严把人员聘用关，提高卫生监督员学历层次。     

对基本医疗服务和特需医疗服务界定的探讨

健康是人类生存和发展的基本要素,享有卫生保健是每一个公民的权利。为了保证医疗服务的公平性,在推行“特需医疗服务”政策时,必须首先对基本医疗服务和特需医疗服务加以界定。指出,基本医疗服务和特需医疗服务的界定,不能背离医学宗旨,应正确理解卫生事业的性质。在运作中要加强管理,根据当地卫生资源配置情况,使特需医疗服务限定在一定时间和空间中进行。     

The Faculty of Public Health in Sofia: activities and experiences in setting New Public Health as a national priority

The article outlines the development and recent national and international activities of the Faculty of Public Health, Medical University - Sofia (FPH, MU - Sofia). It has a leading position in public health education and research in Bulgaria and plays a key role in the introduction of the New Public Health approach to Bulgarian health system and policy. A general aim of the FPH is to build up a well-trained capacity of public health specialists and thus strengthen human recourses in the public health sphere in the country. A major objective of the FPH is to create a new generation of healthcare managers ready for the challenges of the dynamic European market of health services. During its 5-year history, the FPH has been an extremely active player on the regional and international public health stage as well as on a national level. The main priority of the FPH for the future is to guarantee public health education in harmony within the south eastern Europe (SEE) region as well as with European standards. It also strives to provide methodological support to health politicians and decision makers in Bulgaria in order to establish a socially orientated, equitable, effective and high-quality healthcare system.     

公共卫生大数据应用

本文从公共卫生的数据需求出发,分析了公共卫生大数据特征,提出了公共卫生大数据应用架构。并通过对传染病预警预报大数据应用和基于互联网大数据舆情监测预警应用的案例分析,阐述了大数据对公共卫生的应用愿景与应用模式,并以政府主导和社会参与为技术路径,提出了应用策略与关键技术。