世界健康调查-中国调查数据分析方法

目的 对世界健康调查中的调查数据进行分析，以获得卫生系统总体绩效的合理评估。方法 用抽样权重作为调整值，采用Taylor级数线性化技术估计总体参数及相应的方差。结果 对于健康状况指标和卫生系统反应性指标的排序，几个抽样点通过普通统计方法和调查数据分析方法所获得的结果间存在明显差异。采用来自于调查数据分析方法的结果去建立对抽样地区的综合绩效评估。结论 多阶段抽样设计使得抽样调查的分析变得复杂．调查数据分析方法可以计算总体参数的点估计和方差估计的近似值，这种方法减少了由于背离独立同分布(independent and identical distribution，IID)假设所产生的偏倚。     

Non-response in a survey of cardiovascular risk factors in the Dutch population: determinants and resulting biases

BACKGROUND: The aim of the research was to study the determinants of participation in a health examination survey (HES) which was carried out in a population that previously participated in a health interview survey (HIS) of Statistics Netherlands, and to estimate the effect of non-participation on both the prevalence of the main HES outcomes (risk factors for cardiovascular disease) and on relationships between variables. METHODS: Logistic regression was used to study the determinants of participation in the HES (n=3699) by those who had previously participated in the HIS (n=12,786). Linear models were used to predict the main outcomes in non-participants of the HES. Item non-response was handled by multiple imputation. RESULTS: HES participants had a higher socio-economic status and comprised more 'worried well', while the rural population were less likely to participate in the HES. Most predicted values of outcomes in HES non-participants differed from those in HES participants, but much of this was due to differences in the age and gender composition of both groups. Taking age and gender differences into account, most predicted values of outcomes in the entire HIS population were within the 95% confidence intervals of the HES values, with the exception of body height in men and high-density lipoprotein cholesterol, fasting glucose and body weight in women. These differences are most likely to be due to the higher socio-economic status of HES participants. Relationships between HIS variables did not change significantly when using HES participants alone compared with all HIS participants. CONCLUSIONS: Despite a high rate of non-participation, some bias, mostly small, was seen in the prevalence rates of the main outcome variables. Bias in the relationships between variables was negligible.     

Response and Non-response to a Quality-of-Life Question on Sexual Life: A Case Study of the Simple mean Imputation Method

We investigated the non-response rates to the question “I am satisfied with my sex life” in the Functional Assessment of Cancer Therapy – General questionnaire in Chinese (n = 769), Malay (n = 41) and Indian (n = 33) patients in Singapore, a multi-ethnic society whose residents are said to have a conservative sexual attitude. Non-response rates to the question were 44%, 22% and 24% in the three groups respectively. The rates were much higher than that reported previously in a US study (7%) and used in the associated simulation study of the simple mean imputation method. We further examined the Chinese respondents in detail. The odds of non-response and the scores among the responders were associated with several demographic and clinical characteristics. Using the checklist proposed by Fayers et al. [Stat Med 1998; 17: 679–696] to assess the data patterns, we found that the application of the simple mean imputation is questionable. We employed an alternative (multiple) imputation procedure that took into account covariates that predicted the odds of non-response and the observed response scores. We compared the analytic results based on different approaches to handling missing values, and found that analysis based on the simple mean imputation gave results similar to that based on multiply imputed data even in this quite extreme example.     

健康危险因素与个体健康间的结构方程模型

目的探索健康危险因素与个体健康间的潜在关系,以及各潜变量对测量指标的影响。方法利用健康风险评估调查问卷调查西安市某三级甲等医院健康体检人群。构建健康危险因素与个体健康间的结构方程模型,解释不同因子间的相互作用及其对总体健康的效应权重。结果健康行为与健康意识之间呈显著正相关。健康行为对躯体健康的直接效用为0.85,健康意识不仅直接作用躯体健康,而且通过对心理健康的影响对躯体健康产生间接效应,总效应达0.78。结论健康行为、健康意识均是可控的健康危险因素,对躯体健康、心理健康产生一定影响。通过改变这些可控因素可以提高人们整体健康水平。     

Deployment of a mixed-mode data collection strategy does not reduce nonresponse bias in a general population health survey

Objective

To assess nonresponse bias in a mixed-mode general population health survey.

Data Sources

Secondary analysis of linked survey sample frame and administrative data, including demographic and health-related information.

Study Design

The survey was administered by mail with telephone follow-up to nonrespondents after two mailings. To determine whether an additional mail contact or mode switch reduced nonresponse bias, we compared all respondents (N = 3,437) to respondents from each mailing and telephone respondents to the sample frame (N = 6,716).

Principal Findings

Switching modes did not minimize the under-representation of younger people, nonwhites, those with congestive heart failure, high users of office-based services, and low-utilizers of the emergency room but did reduce the over-representation of older adults.

Conclusions

Multiple contact and mixed-mode surveys may increase response rates, but they do not necessarily reduce nonresponse bias.     

2009年省市县三级健康教育机构业务工作现状调查

目的 了解2009年全国健康教育机构业务工作情况.方法 各省(直辖市、自治区)、市、区和县级健康教育机构以函报方式逐级填报本级业务工作情况,调查内容包括对基层提供技术支持、健康教育服务提供、媒体合作和传播材料制作等.结果 2009年全国省、市、区县三级健康教育专业机构共培训下级专业机构1.5万次,培训人员80余万人次;共开展公众健康咨询3.8万次,健康知识讲座4.7万次,播放音像资料时间28.7万小时,更换宣传栏5.4万次;与各级报社合办栏目1557个、活动报道1.8万次,与各级广播电台合办栏目871个、合办节目1714个,活动报道1.1万次,主办网站520个;共设计制作平面传播材料4.3亿份、音像制品97.3万份,发送手机短信1.5亿条,实物0.2亿个.结论 2009年统计报表工作质量和效率较往年明显提高,全面掌握了各级健康教育机构业务工作情况.     

我国居民与收入相关的健康不平等实证研究

本文利用中国健康与营养调查（CHNS）2006年的调查数据，从定量的角度对我国居民与收入相关的健康不平等进行了分析。本文利用有序Probit模型获得了自评健康数据背后的实际健康得分，在此基础上计算健康集中指数衡量我国居民与收入相关的健康不平等程度。结果表明，我国居民的健康不平等问题较为严重，健康不平等问题在城乡之间和不同经济发展水平地区之间存在着较大的差别。     

Gender differences in negative mood states in secondary school students: health survey in Catalonia (Spain)

Objective

To determine the prevalence of negative mood states in adolescents according to gender, to analyze variability among schools, and to evaluate the associated factors.

Methods

A cross-sectional study with a cluster design was carried out. We administered the High-school students health survey to a sample of 9,340 students (aged 14-16 years) in the third and fourth year of Compulsory Secondary Education in Catalonia, Spain, during the 2005-6 academic year. The main outcome measure was evidence of a negative mood state. A multilevel logistic regression model stratified by gender was used to identify the factors associated with negative mood states and to determine variability among distinct schools.

Results

Approximately 19% of adolescents reported evidence of a negative mood state, with a higher prevalence in girls (25%). The most significant factors associated with negative mood states were “use of tranquilizers” and “having eating disorders” in girls and “not exercising” and “poor self-perception of health status” in boys. In both genders, variability was found among schools in the prevalence of negative mood states (girls: variance = 0.078; p <0.001; boys: variance = 0.079; p = 0.012).

Conclusions

The prevalence of negative mood states in adolescent boys and girls was high. Differences were observed between genders in the factors related to these health states. The variability observed in the prevalence of negative mood states among distinct schools could not be explained by the study variables. Our results emphasize the association between the use of tranquilizers and negative mood states.     

Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey

This paper provides evidence on (1) refugees’ subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European ‘refugee crisis.’ It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees’ self-rated health falls below the resident population’s, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees’ access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.     

岱山县海岛渔农村居民高血压现状及危险因素流行病学调查

目的：了解海岛渔农村居民高血压患病情况和相关危险因素,为制定高血压防治策略提供科学依据。方法：采用多阶段整群随机抽样的方法,抽取岱山县18岁以上渔农村居民1149人,进行高血压患病情况调查,并对高血压患病的影响因素进行单因素和多因素非条件logistic回归分析。结果：海岛渔农村18岁以上居民高血压患病率为21．58％,标化率14．43％;其中男性患病率20．56％,标化率13．23％;女性患病率22．38％,标化率15．52％,男女性差异无统计学意义（X2=0．55,P〉0．05）。高血压患病率有随着年龄的增大而上升的趋势;高血压知晓率、治疗率和控制率分别为60．48％、43．95％和25．81％。多因素非条件logistic回归分析显示年龄、高血压家族史、高甘油三酯、高总胆固醇、糖尿病和超重或肥胖为高血压危险因素。结论：海岛渔农村居民的高血压患病率低于全国基本患病率,但知晓率、治疗率和控制率仍较低。要加强社区综合干预工作,有效控制高血压及心脑血管疾病的发生发展。     

Contextual factors and immigrants' health status: double jeopardy

Poor health among immigrants may be accounted for not only by socio-economic factors affecting individuals but also by the environment in which they live. We investigated the association of contextual factors with disparities in self-rated health between native and immigrant groups. The findings indicated that, compared with native-born Belgians, immigrant groups from Turkey and Morocco were more likely to have poorer self-rated health. When contextual factors and individual socio-economic status were allowed for, all immigrant groups had a health status that was similar to or even better than that of native-born Belgians. Immigrants face a double jeopardy at both the individual and the contextual level.     

炼油企业职工健康相关因子负性发生率及其影响因素的试点研究

目的通过对11类健康相关因子的负性发生率及其影响因素的试点研究，综合评估炼油企业职工的健康需求。方法2003年3月，采用整群抽样的方法，对江苏省大型炼油企业陵光集团的职工进行问卷调查，将所有结果进行统计分析。结果炼油企业职工健康相关因子负性发生率高的因素有：环境条件(50．24％)、生活满意度(37．44％)、身体疼痛(30．97％)、生活方式(27．42％)、慢性疾病(25．19％)。与该5种健康相关因子关系密切的个人因素有：性别、吸烟与否、锻炼情况、饮食习惯及年龄。与之关系密切的家庭、社会因素有：经济情况、婚姻状况、工作环境、工作稳定性、本岗位工作时间。结论在企业普遍重视治理传统职业危害因素的今天，影响炼油企业职工健康的因素呈现多样化趋势，不良的行为与生活方式、心理感受及环境条件对健康的影响作用应逐渐受到更多的关注。     

上海市静安区外来务工人员健康知识水平调查

目的了解外来务工人员健康知识水平及其影响因素。方法分层随机抽取上海市静安区外来务工人员1037人,采用面对面询问式问卷调查,调查内容包括一般情况、基本健康知识。结果4种行业务工人员基本情况,性别分布：建筑行业和工厂企业务工人员以男性为主,其他行业性别分布较均衡;年龄分布：服务性行业以20岁～组为主,工厂企业以30岁～组为主,建筑行业和集贸市场则以40岁～组为主;文化程度：建筑行业和集贸市场的务工人员的文化程度最低;经济收入：以服务性行业务工人员最低。不同行业外来务工人员健康知识知晓情况不同,建筑行业对艾滋病、建设健康城市行动的知晓率较高,工厂企业对食品安全、高血压病人饮食知晓率较高。外来务工人员健康知识水平高分组为612人,低分组为425人。在单因素和多因素分析中,已婚者的健康知识水平高于未婚者,文化程度和经济收入越高,健康知识水平越高,且均有统计学意义的因素（P〈0.05）。结论外来务工人员健康知识有待于进一步提高,需继续加强健康教育。     

重庆市武隆县医疗机构安全注射现况调查

目的：了解重庆市武隆县医疗机构安全注射现况，为采取干预措施提供依据。方法：用统一设计的调查表对注射服务机构和人员进行调查。结果：52．2％（12／23）的医疗机构玻璃注射器消毒不合格、31．4％（11／35）的医疗机构注射操作不正确、63．6％（21／33）的医疗机构直接丢弃用过的一次性注射器。存在以上至少1种不安全注射行为的医疗机构有77．1％（27／35）。结论：青霉素皮肤过敏试验共用针管的不正确操作、医务工作者销毁注射器被刺伤、一次性注射器卫生质量管理空白是目前主要的不安全因素。培训医务人员的正确注射行为、重视一次性注射器的卫生质量管理和用后的安全处理是提高安全注射水平的重要措施。     

温州市10社区居民高血压病现状及危险因素的流行病学调查

目的了解温州市35岁以上居民高血压病患病现状及相关危险因素,为制定高血压病防治策略提供科学依据。方法采用多阶段整群随机抽样的方法,抽取年龄在35周岁以上居民13 507人,随机抽样的调查方法进行问卷调查、体格检查和实验室检测。结果温州市35周岁以上居民高血压病患病率为40.28%,高血压病患病率男性高于女性(P=0.00),高血压病患病率有随年龄增高而上升的趋势;高血压病知晓率、服药率、控制率、治疗者血压控制率分别为51.25%,28.32%、10.53%、22.10%。多因素非条件logistic回归显示高血压病的危险因素为超重肥胖、文化程度低、糖尿病、口味重、经常饮酒等。结论高血压病已成为影响35岁以上居民身体健康的重要公共卫生问题,要加强社区综合干预工作,有效防控高血压病以及心脑血管疾病的发生发展。