安全社区伤害干预项目的基线调查方案

伤害的社区干预是世界卫生组织所支持的安全社区项目，社区伤害基线调查是干预工作的前提。根据世界卫生组织的社区调查方案，不同的干预项目可以因地制宜选择某一种社区伤害基线调查方法，达到社区诊断和评价干预效果的目的。中华预防医学会伤害预防与控制分会特推荐此方案，供在使用中补充完善。[编者按]     

上海虹口区2004—2007年伤害病例监测分析

伤害已经成为21世纪上海一个重要的公共卫生问题。开展伤害监测和干预已成为疾病预防控制工作的重要内容之一，建立完善的伤害监测体系是伤害防制工作基础，而社区伤害监测则是整个伤害监测体系中重要的一环，可以弥补二级和三级医院中急诊的监测不全。通过分析虹口区历年社区伤害监测的数据，初步揭示近期本地社区伤害发生的流行特征，探讨社区伤害防制的策略，为进一步完善社区伤害监测体系以及进行社区伤害干预提供相关依据。     

上海市康健社区2006年居民伤害流行病学特征分析

全面科学地分析居民伤害流行特征和评价伤害造成的疾病负担，是制定伤害预防和干预措施的基础，同时也是评价安全社区创建工作及伤害预防干预措施效果的主要依据。上海市康健社区自2096年起开始创建安全社区工作，为掌握社区伤害基线情况，笔者于2007年7～8月，对社区居民伤害情况进行了抽样入户调查，客观描述康健社区伤害的流行情况及其变化特点，为更好地开展安全社区建设工作，提供科学参考依据。     

深圳市社区儿童伤害监测干预模式的研究

目的建立并实施＂社区儿童伤害监测干预模式＂,降低儿童伤害发生率,改善儿童生存质量。方法选择伤害发生率比较高的深圳市龙岗区横岗镇作为社区儿童伤害监测干预点,干预前后分别进行伤害发生情况的问卷调查。结果建立了＂社区儿童伤害监测干预模式＂,伤害发生率由8.36%下降至6.40%,差异有统计学意义。与干预前比较,机械伤、中毒、意外跌落差异均有统计学意义。结论 ＂社区儿童伤害监测干预模式＂能有效地控制儿童伤害发生,为深圳市社区儿童伤害预防提供了新的方法。     

社区卫生服务中心在创建“安全社区”中的作用

城市社区卫生服务中心作为社区跨界组织在创建“安全社区”中承担意外和非意外伤害的监测职能,通过建立健全伤害监测机制,加强网络建设和基础资料收集,规范伤害报告流程,最终提高伤害报告的准确率和及时率,从而为伤害预防和制订干预措施提供基础依据。     

周桥社区学龄前儿童意外伤害危险因素分析

目的 了解长宁区周桥社区学龄前儿童意外伤害危险因素，为制定干预措施提供依据。方法 调查本社区6所幼儿园学龄前儿童889名及其家长的安全知识、2004年儿童意外伤害发生情况。结果 该社区学龄前儿童意外伤害发生率为35．22％，人年均意外伤害1．99次。发生意外伤害的有关因素包括儿童性别、早产史、父母文化程度、家庭收入和儿童自身性格、生活能力、大人陪伴时间等。结论 该社区学龄前儿童意外伤害比较严重与多种因素有关，必须引起有关部门和家长的重视，切实加强防范。     

上海市花木社区幼儿居家安全家长认知调查

【目的】 了解花木社区1~3岁幼儿家长居家安全相关知识、信念、行为的现状,为实施干预提供科学依据。 【方法】 采用系统抽样法,抽取花木社区1、2、3周岁的幼儿303名,以问卷方式了解其近一年伤害发生情况及幼儿家长居家安全认知水平。 【结果】 幼儿伤害发生率为10.58%,2周岁组幼儿伤害发生率最高,伤害类型以跌倒和刺伤为主;幼儿家长对居家安全认知不足。 【结论】 1周岁幼儿是居家伤害干预重点对象,减少幼儿居家伤害的发生,应在儿童保健门诊工作中加强幼儿家长的教育和指导。     

上海市某社区学龄前儿童伤害与相关因素调查研究

目的了解上海市某社区学龄前儿童伤害发生情况及家长幼儿伤害相关知识、信念和行为(KAP)情况,探索基于社区的学龄前儿童伤害干预对策。方法随机整群抽取某社区幼儿园3~6岁儿童家长936名,采用问卷调查学龄前儿童的伤害发生情况及家长对幼儿伤害预防的知识、态度和行为情况。采用t检验比较发生过伤害和未发生过伤害的学龄前儿童家长KAP得分差异。结果学龄前儿童伤害发生率为25.2%,男女之间差异无统计学意义(P=0.308)。最常见的伤害类型为跌倒/坠落伤(12.82%)和碰撞/挤压伤(7.59%),主要发生在家里和居住区(16.56%)。家长的知识、态度和行为得分均低于85分,儿童发生伤害的家长行为得分比儿童不发生伤害的家长行为得分低,差异有统计学意义(P=0.002)。结论以社区为基础的干预可以整合多部门资源,共同改善伤害高发因素。干预既要关注发生率较高的伤害类型,同时也要关注家长监护行为中比较突出的不安全行为,包括药品、电源等危险物品的安置和防溺水方面,从而减少学龄前儿童伤害发生率。     

小学生交通伤害干预定性访谈分析

了解相关人员对基于社区的小学生交通伤害预防与干预的看法和建议,为探索适用于我国基于社区的小学生交通伤害干预策略与方法提供参考.方法 采用个人深入访谈和小组访谈的方法,访谈对象包括行政管理人员、卫生研究人员、卫生技术人员、学校教师、交通部门管理人员共14名.访谈内容包括小学生交通伤害方面存在的问题,以及对基于社区的干预模式的看法和建议.结果 访谈中提及频次较高的小学生交通伤害方面存在的问题包括家长交通安全意识缺乏和违规行为、交通执法不严、小区内非机动车超速乱穿行、道路硬件设施缺乏以及12岁以下小学生骑共享单车.访谈专家一致认为开展基于社区的小学生交通伤害干预十分必要.以社区为基础的干预可以通过统筹协调、合理分配区域内丰富的可利用资源,提供覆盖教育干预、环境干预、执法干预等综合性干预措施.强调社区参与,尤其注重家庭在小学生交通伤害干预中的重要作用,并将干预触角延伸到校外的时段和场所.结论 基于社区的小学生交通伤害干预能够充分满足小学生交通伤害多层面的干预需求.建议开展干预时,充分考虑社区个性化的干预需求和资源配置,根据干预人群心理发展特点和兴趣点选择干预内容和形式.     

南宁城市社区居民伤害干预效果的评价

目的评价南宁城市社区居民伤害预防干预效果,为城市居民社区伤害的干预研究提供科学的依据。方法根据世界卫生组织（world health organization,WHO）推荐的社区调查方案,采用多阶段随机抽样的方法在广西南宁市抽取被调查社区,并通过问卷调查的方法来获得干预前后的资料。干预过程主要采取了以健康教育为主的综合干预措施。结果干预后伤害发生率由28.34%降至14.06%,下降50.39%,干预前后发生率差异有统计学意义（2=32.04,P〈0.001）;多发性伤害发生率则由3.74%降至0.00%,干预前后发生率差异有统计学意义（2=19.28,P〈0.001）;伤害知识知晓率、正确认知比例分别由干预前的55.27%、71.60%上升至干预后的86.76%、89.52%,危险行为发生率也由干预前的57.79%降至干预后的33.12%,三者差异均有统计学意义（均有P〈0.05）。结论以社区为基础的伤害干预,能提高社区居民伤害安全知识水平,有利于培养正确的态度和建立健康的行为,从而有效的降低伤害的发生率,是预防伤害的有效途径。     

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.     

Culturally competent safety interventions for children in Old Order Anabaptist communities

This commentary describes the challenges of child safety interventions in Old Order Amish and Mennonite communities in North America. It proposes nine culturally sensitive interventions appropriate for these separatist communities.     

The Resilience of the Health Care Safety Net, 1996–2001

Objective .  To determine how the capacity and viability of local health care safety nets changed over the last six years and to draw lessons from these changes.
Data Source .  The first three rounds (May 1996 to March 2001) of Community Tracking Study site visits to 12 communities.
Study Design .  Researchers visited the study communities every two years to interview leaders of local health care systems about changes in the organization, delivery, and financing of health care and the impact of these changes on people. For this analysis, we collected data on safety net capacity and viability through interviews with public and not-for-profit hospitals, community health centers, health departments, government officials, consumer advocates, academics, and others. We asked about the effects of market and policy changes on the safety net and how the safety net responded, as well as the impact of these changes on care for the low-income uninsured.
Principal Findings .  The safety net in three-quarters of the communities was stable or improved by the end of the study period, leading to improved access to primary and preventive care for the low-income uninsured. Policy responses to pressures such as the Balanced Budget Act and Medicaid managed care, along with effective safety net strategies and supportive conditions, helped reinforce the safety net. However, the safety net in three sites deteriorated and access to specialty services remained inadequate across the 12 sites.
Conclusions.  Despite pessimistic predictions and some notable exceptions, the health care safety net grew stronger over the past six years. Given considerable community variation, however, this analysis indicates that policymakers can apply a number of lessons from strong and improving safety nets to strengthen those that are weaker, particularly as the current economy poses new challenges.     

Health and safety hazards associated with subways: A review

Subway systems are key components in mass transportation networks worldwide, providing rapid and affordable transportation to urban communities in 58 different countries. The benefits afforded by subway transit are numerous and mainly derived from the reduction in automobile use, thereby limiting environmental and health hazards associated with exhaust-air emissions. Additionally, by limiting congestion and providing vital transportation links within a city, subways also improve the overall quality of life of urban communities. However, to best maximize the positive impact on the urban environment, subway systems need to provide a safe and healthy environment for both passengers and subway transit workers. Periodically, safety concerns are raised, most recently in relation to the vulnerability of subways to terrorist attacks. To examine this issue more carefully, we conducted a structured review of the literature to identify and characterize potential health and safety hazards associated with subways. A secondary goal was to identify various risk management strategies designed to minimize the risk of these hazards. This information may be helpful to urban communities, urban planners, public health specialists, and others interested in subway safety.     

医院与社区信息协同共享模式网络安全解决方案

为降低医院与社区信息协同共享服务模式中存在的安全风险,本文从网络层面提出安全解决方案。利用隔离网络安全互联、链路加密及安全数据隔离三方面的关键技术,构建医院与社区网络互联拓扑架构,以保障医院与社区信息协同共享模式网络安全。     

Public health and the potential benefits of Crime Prevention Through Environmental Design

Studies have consistently found that safety and security are major public concerns; however, crime is rarely considered as an outcome in public health. The recent shift by planning policy towards promoting compact, 'walkable' communities close to public transport aims to redress many of the problems associated with urban sprawl. However, communities that do not feel safe are less likely to be active citizens. This paper argues that Crime Prevention Through Environmental Design has potential benefits for public health in the provision of local crime risk assessments and in delivering safer environments, which can support active living, walkable communities and public health.     

Effect of pesticide exposure on acetylcholinesterase activity in subsistence farmers from Campeche, Mexico

The authors surveyed agricultural production methods and pesticide use among subsistence farmers (campesinos) in 4 rural communities of Campeche, Mexico. Self-reports of symptoms of poisoning resulting from occupational pesticide exposure were elicited by questionnaire (N = 121), and acetylcholinesterase (AChE) activity during insecticide use was evaluated from blood samples (N = 127). In individuals from 2 of the 4 communities, AChE activity was significantly lower (p < 0.05) than the mean of activity determined for individuals in a reference group. Results of this study show that erythrocyte AChE inhibition provides a good biomarker of exposure to organophosphate pesticides in field studies with human populations. Carbamates, particularly carbofuran, seem to be more associated with exuberant and diversified symptomatology of pesticide exposure than organophosphates. Studies in field communities where both carbamates and organophosphates are suspected to exist should include blood AChE determinations, symptomatology surveys, and socioeconomic questionnaires. The authors recommend that the Mexican National Health Ministry authorities specify additional provisions regarding the use of protective equipment and the adoption of other safety practices during field work, increase information campaigns about the risks of pesticide use and the value of safety practices, and increase programs of medical monitoring and assistance for rural communities dealing with pesticides.     

Setting the Agenda for Reproductive and Maternal Health in the Era of COVID-19: Lessons from a Cruel and Radical Teacher

Maternal and Child Health Journal - COVID-19 exposes major gaps in the MCH safety net and illuminates the disproportionate consequences borne by people living in low resource communities where...     

患者安全文化建设实践研究

基于艾德希恩三层次文化理论,通过培养医务人员患者安全意识,促进患者安全行动,构建多元素患者安全文化,并以患者安全文化建设为基础,进一步拓展患者安全文化外延,向患者家属、家庭、基层医疗机构、社区、社会延伸,广泛传播患者安全文化。该项目降低了不良事件发生率,提升了医护人员职业认同感,形成了一系列患者安全文化成果转化。通过患者安全文化建设和传播,对推动全民健康覆盖率,建设健康中国具有重要意义。     

Ride Safe: A Child Passenger Safety Program for American Indian/Alaska Native Children

Background In American Indian/Alaska Native (AI/AN) communities, child safety seat (CSS) use rates are much lower than in non-native communities. To reduce this disparity, Indian Health Service (IHS) staff developed, pilot-tested, and implemented Ride Safe, which provided education, training, and child safety seats for children aged 3–5 participating in Tribal Head Start Centers. Methods Focus groups, key informant interviews, and technical review guided program development and implementation. Progress reports and child safety seat use observations, conducted at the beginning and end of three program years (Fall 2003 to Spring 2006), assessed program reach and impact. To examine CSS use, we used three multiple logistic regressions, including a conservative intent to treat analysis. Results Ride Safe reached approximately 3,500 children and their families at 14 sites in six states, providing over 1,700 parents/family members with educational activities, 2,916 child safety seats, and child passenger safety (CPS) technician certification training for 78 Tribal staff. Children were 2.5 times (OR = 2.55, p < .01) as likely to be observed in child safety seats comparing Rounds 1 and 2 data, with the most conservative model showing that the odds of being observed restrained were 74% higher (OR = 1.74, p = <.01) after implementation of the program. Conclusions The Ride Safe Program effectively increased child safety seat use in AI/AN communities, however, observed use rates ranging from 30% to 71% remain well below the 2006 all US rate of 93%. Results from CSS educational and distribution/installation programs such as Ride Safe should be considered in light of the need to increase distribution programs and enhance enforcement activities in AI/AN communities, thereby reducing the disparity in AI/AN motor vehicle injuries and death.