The geography of self-injury: spatial patterns in attempted and completed suicide

This study uses hospital discharge data, death certificates and medical examiner data for New Jersey for 1999-2001 to investigate whether fatal and non-fatal self-injury exhibit similar geographic patterns. Findings show that the demographic characteristics of individuals committing fatal and non-fatal self-injury are quite different. Furthermore, attempted and completed suicides have a somewhat different geographical pattern. Municipality-level determinants of suicide and non-fatal self-injury were estimated in two separate models. While measures of isolation such as low population density and high proportions of households with only one member were predictive of completed suicides, non-fatal self-injury was related to unemployment and median age. Both types of self-injury were more common in municipalities which lost population between 1990 and 2000, and where divorce rates were high. Population-based suicide prevention efforts should be aided by the knowledge that although there are some similarities in the spatial pattern of completed and attempted suicides, there are some important differences in significant determinants.     

Public and private prenatal care providers in urban Mexico: how does their quality compare?

OBJECTIVE: To evaluate variations in prenatal care quality by public and private clinical settings and by household wealth. DESIGN: The study uses 2003 data detailing retrospective reports of 12 prenatal care procedures received that correspond to clinical guidelines. The 12 procedures are summed up, and prenatal care quality is described as the average procedures received by clinical setting, provider qualifications, and household wealth. SETTING: Low-income communities in 17 states in urban Mexico. PARTICIPANTS: A total of 1253 women of reproductive age who received prenatal care within 1 year of the survey. MAIN OUTCOME MEASURE: The mean of the 12 prenatal care procedures received, reported as unadjusted and adjusted for individual, household, and community characteristics. RESULTS: Women received significantly more procedures in public clinical settings [80.7, 95% confidence interval (CI) = 79.3-82.1; P < or = 0.05] compared with private (60.2, 95% CI = 57.8-62.7; P < or = 0.05). Within private clinical settings, an increase in household wealth is associated with an increase in procedures received. Care from medical doctors is associated with significantly more procedures (78.8, 95% CI = 77.5-80.1; P < or = 0.05) compared with non-medical doctors (50.3, 95% CI = 46.7-53.9; P < or = 0.05). These differences are independent of individual, household, and community characteristics that affect health-seeking behavior. CONCLUSIONS: Significant differences in prenatal care quality exist across clinical settings, provider qualifications, and household wealth in urban Mexico. Strategies to improve quality include quality reporting, training, accreditation, regulation, and franchising.     

北京市农村基层卫生人员健康管理知识知晓情况和培训需求调查

目的了解北京市农村基层卫生人员健康管理相关知识的知晓情况和培训需求,为今后健康管理服务教育和培训提供参考。方法2012年,采用多阶段随机抽样方法选取北京市大兴、房山、密云、平谷和怀柔郊区县部分乡镇医疗机构,以该机构所属的600名卫生人员为调查对象,对其进行问卷调查,了解其健康管理知识知晓率（烟草控制、控制体重、限酒指导、体力运动指导等）、慢病风险评估工具选择及其概念知晓率、高血压、糖尿病正常值掌握正确率和培训需求情况,并分析其在不同地区的差别。描述采用频数和率等描述统计学方法,比较采用x2检验。结果调查对象对烟草控制、控制体重、限酒指导、体力运动指导等知识知晓率较高,平均知晓率分别为94．1％（513／545）、95．3％（522／548）、94．0％（515／548）和85．9％（470／547）,而慢病风险评估工具选择及其概念知晓率较低,仪为55．1％（295／535）和59．8％（329／550）;对高血压、糖尿病正常值掌握正确率分别为85．4％（475／556）和92。4％（514／556）,但对于该病主要危险因素回答准确率却仅为23．6％（131／556）和21．2％（118／556）;调查对象对糖尿病和高血压管理方法的培训需求较高,回答“急需”的比例分别为57．4％（308／537）和56．7％（305／538）。结论北京市农村基层卫生人员对健康管理相关知识了解和掌握情况还有待于进一步提高,建议应加强健康管理人员培训,进一步提高农村基层卫生人员健康管理知识和水平。     

Rural/urban mortality differences in England and Wales and the effect of deprivation adjustment

Perceptions that rural populations are inevitably healthier and live longer than urban populations are increasingly being challenged. But very few publications have investigated the extent to which these putative differences can be explained by variation in area composition. Existing publications have tended to use conventional deprivation measures, often thought to mask rural deprivation by favourable averages. Further, they have typically been based on large and variably-sized geographical units, or confined to studies of a single region or cause of death. This study examines differences in mortality between rural and urban areas in the entire population of England and Wales for 2002-2004. It uses the most up-to-date small geographical units of similar size and homogeneity of population together with the recently-introduced Rural and Urban Area Classification, and adjusts for five different deprivation measures (including modern composite indices). The causes of death investigated were all-cause mortality, cancer, lung cancer, respiratory disease, circulatory disease, suicide and accidents. Particular points of focus for the study were the potential for interaction between deprivation and rurality, and the importance of choice of deprivation measure in quantifying the relationships between mortality, rurality and deprivation. Choice of deprivation measure was not found to alter the substantive conclusions of any analysis, and little evidence for differential effects of deprivation in rural and urban areas was uncovered. Differences between rural and urban areas in all-cause, circulatory disease and cancer mortality could largely be accounted for by adjusting for deprivation. For these causes of death, therefore, rural populations were not found to be inherently healthier than their urban counterparts. However, substantial residual differences between rural and urban areas were found in comparisons of mortality from lung cancer and respiratory disease, mortality being lower in rural areas. Stronger relationships between rurality and mortality were found in 'village and dispersed' settlements.     

Regional differences in HIV prevalence and individual attitudes among service providers in China

We examined the relationships between a region's HIV prevalence and HIV-related knowledge, perceived risk of HIV infection, perceived institutional support for HIV care, and avoidance attitude toward persons living with HIV (PLH) among service providers in China. Data were collected from 40 county-level hospitals in two provinces, including 1760 service providers. Multi-sample standardization and decomposition analysis was performed for HIV knowledge, perceived risk, institutional support, and avoidance attitude toward PLH. After adjusting for potential confounders, service providers from the province with higher HIV prevalence perceived a higher risk of contracting HIV at work, recognized more institutional support for HIV care, and reported a lower level of avoidance attitude toward PLH compared to those from the province with lower HIV prevalence. After confounding factors were standardized across provinces, occupational exposure experience was determined to be the strongest influence on the discrepancy of avoidance attitudes in the two provinces. Regional contextual factors could shape individual providers' attitudes and beliefs and impact the quality of care. Stigma reduction interventions need to be culturally tailored and region-specific.     

Young adults' healthcare utilisation and healthcare needs: Perceptions and experiences of healthcare providers

BackgroundHealth care in many countries entails long waiting times. Avoidable healthcare visits by young adults have been identified as one probable cause.ObjectiveThe aim of this study was to explore healthcare providers'' experiences and opinions about young adults'' healthcare utilisation in the first line of care.MethodThis study used latent qualitative conventional content analysis with focus groups. Four healthcare units participated: two primary healthcare centres and two emergency departments. This study included 36 participants, with 4–7 participants in each group, and a total of 21 registered nurses and 15 doctors. All interviews followed an interview guide.ResultsData were divided into eight categories, which all contained the implicit theme of distribution of responsibility between the healthcare provider and the healthcare user. Young adult healthcare consumers were considered to be highly influenced by external resources, often greatly concerned with small/vague symptoms they had difficulty explaining and unable to wait with. The healthcare provider''s role was much perceived as being part of a healthcare structure—a large organisation with multiple units—and having to meet different priorities while also considering ethical dilemmas, though feeling supported by experience.ConclusionHealthcare personnel view young adults as transferring too much of the responsibility of staying healthy to the healthcare system. The results of this study show that the discussion of young adults unnecessarily seeking health care includes an underlying discussion of scarcity of resources.Patient or Public ContributionThe conduct of this study is based on interviews with young adult patients about their experiences of seeking healthcare.     

A six-year epidemiological surveillance study in Split-Dalmatia County,Croatia: urban versus rural differences in human campylobacteriosis incidence

Data from population-based laboratory surveillance were used to examine the epidemiological pattern of campylobacteriosis in a sentinel site, Split-Dalmatia County (SDC),Croatia, from 2007 to 2012, and to evaluate the association between disease incidence and demographic, geographical, climatic, agricultural, and microbiological factors. A total of 2658 laboratory-confirmed Campylobacter infections were recorded. Overall mean incidence was 96/100,000, ranging from 61/100,000 in rural to 131/100,000 in urban areas; rates were highest in the age group 0–4 years. Overall mean and age- and sex-specific incidences were significantly higher in urban versus rural areas (p < 0.01). The number of infections peaked in early summer, and was correlated with higher average monthly temperature (r = 0.58) and lower humidity (r = ? 0.27), but not with precipitation. Incidence was not associated with agricultural activities. A distinct campylobacteriosis pattern with consistently higher urban versus rural incidence was observed, which may help formulate further preventive measures.     

城乡基层卫生服务机构预防保健功能比较分析

目的：比较我国城乡基层卫生机构预防保健服务功能开展现状,提出缩小城乡预防保健功能差距的建议。资料和方法：分析全国第四次卫生服务总调查数据。结果：城市社区卫生服务中心、农村乡镇卫生院预防保健服务功能整体差距,随着项目优先次序的下降而逐渐扩大。其中,计划免疫农村乡镇卫生院高于城市社区卫生服务中心;慢病管理随着项目重要性提高,差距反而逐渐增大;健康教育二级项目城乡差距最大。建议：为缩小城乡预防保健差距,应采取多项农村支持政策。     

New South Wales trends in mortality differentials between small rural and urban communities over a 25-year period, 1970-1994

OBJECTIVE: To identify trends in premature mortality differences between urban and small rural communities in NSW over a 25-years period. DESIGN: A longitudinal population-based study. ABS population and death data by local government area, sex and age for the period 1970 to 1994, were used to derive mortality measures for urban and small rural communities in NSW. Setting: NSW local government areas categorised by the Rural and Remote Metropolitan Area Classification system as 'capital city' (the Sydney Statistical Division) and 'other rural area' and 'other remote area'. SUBJECTS: All persons aged 0-74 years resident in the aforementioned NSW local government areas between 1970 and 1994 inclusive. MAIN OUTCOME MEASURE: Whether premature mortality differentials have widened, narrowed or remained the same over the study period and the magnitude of any identified changes. RESULT: There was a decrease in premature mortality rates for men and women in both urban and small rural communities. However, the decline was less in small rural communities, with the differential between small rural and urban areas increasing 2-3% every 5 years. CONCLUSIONS: Differences in age structure, proportion of indigenous and migrant populations between small rural communities and urban NSW can not fully account for the increasing differential. Other possible explanatory factors include socioeconomic status and different exposures and practices in rural areas.     

重庆市城乡医疗保障一体化的实践探索

由于中国医疗保障改革中的决策失误,造成了群体之间、城乡之间制度的分割,破坏了医疗保障制度的系统性和统一性.2007年底重庆市开始尝试城乡医疗保障统筹的实践探索,文章分析总结了重庆市实践探索中所取得的成绩和存在的问题,为制度的完善提供了重要的参考依据.     

对统筹城乡卫生资源有关问题的思考

公平合理配置卫生资源是卫生改革与发展的重要目标之一。统筹城乡卫生资源，要充分考虑各方面的因素，积极稳妥地进行。一要按照职能任务，确立配置标准；二要全面认识问题，承认合理差距；三要把握配置重点，城乡整体发展；四要随着政策完善，逐步缩小差距。     

The changing profile of the urban uninsured: Exploring implications of rise in the number of moderate-income uninsureds

Access to care is a major problem in urban America that increasingly affects new segments of the population. Although the demographic profile of the uninsured has changed, recording large increases in numbers of moderate-income uninsured persons, it has not been accompanied by changes in health care safety net programs or increased availability of private insurance products tailored to these groups. Any such changes, however, need to be based on a good understanding of the similarities and differences between low-income and moderate-income uninsured. Based on a telephone survey of the uninsured in three northern New Jersey counties, this study presents a systematic comparison of low-income (below 150% of federal poverty level) and moderate-income (150% to 350% federal poverty level) uninsured on attitudes to health care, perceptions regarding access to care, health status, and health care utilization. We discuss the implications of this comparison for expanding health care access and design of safety net programs and institutions. Dr. Pandey is Assistant Professor of Public Policy and Administration at Rutgers University, Camden, New Jersey, and holds a secondary appointment in the School of Public Health of the University of Medicine and Dentistry of New Jersey     

Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes

Objectives: To examine racial/ethnic differences in healthcare use among patients classified as having controlled and uncontrolled diabetes.

Design: Data from the Carolinas HealthCare System electronic data warehouse were used. Glycemic control was defined as glycosylated hemoglobin (HbA1c)?<?8% (64?mmol/mol) in 2012 (n?=?9996). Patients with HbA1c?≥?8% (64?mmol/mol) in 2012 were classified as uncontrolled (n?=?2576). Race and ethnicity were jointly classified as non-Hispanic Black, non-Hispanic White or Other. Separate mixed effects negative binomial models estimated the independent effect of race/ethnicity on the number of emergency department (ED) visits, hospitalizations and physician office visits in 2013, in each patient group, adjusting for significant confounding variables.

Results: Rates of diabetes-related ED visits were two to three times higher for non-Hispanic Blacks compared to non-Hispanic Whites (uncontrolled rate ratio [RR]: 3.41 95% CI: 1.41–8.22; controlled RR: 2.95; 95% CI: 1.78–4.91). Similar differences were observed for all-cause ED visits (uncontrolled RR: 1.83, 95% CI: 1.50–2.24; controlled RR: 2.45, 95% CI: 2.17–2.77). Non-Hispanic Blacks with controlled and uncontrolled diabetes also had lower rates of all-cause physician office visits when compared to non-Hispanic Whites (uncontrolled RR: 0.84, 95% CI: 0.77–0.91; controlled RR: 0.81, 95% CI: 0.78–0.84).

Conclusion: Notable racial/ethnic disparities exist in the use of emergency services and physician offices for diabetes care. Strategies such as patient education and care delivery changes that address healthcare access issues in racial/ethnic minorities should be considered to offer better diabetes management and address diabetes disparities.     

四川省城乡居民就医行为现状及其影响因素分析

目的了解四川省城乡居民就医行为的现状及其影响因素。方法基于2018年四川省卫生服务调查数据描述四川省城乡居民两周内患病就诊及就诊机构选择的基本特征,采用多水平logistic回归分析居民两周内患病是否就诊以及就诊机构选择的影响因素。结果居民两周患病率为41.7%,其中选择就诊的比例为46.4%;影响居民患病后是否就诊以及就诊机构选择的因素主要是居民是否患有慢性病、自感患病伤的严重程度、病伤的持续天数和患者受教育程度(均P<0.05);基本医疗保险类型是就诊机构选择的重要影响因素(P<0.05);居民选择就诊机构并无城乡差异,但少数民族地区的居民选择基层医疗机构就诊的可能性是非少数民族地区居民的2.627倍(P<0.001)。结论四川省居民两周患病后就诊的比例较低,应进一步完善不同类型基本医疗保险制度,提高基层医疗机构服务水平并加强健康教育,合理规范居民就医行为。     

四川省城乡孕妇叶酸服用现状及城乡差异分析

目的了解四川省城乡孕妇叶酸服用情况,发现叶酸普及工作中的城乡差别及各自工作的重点、难点,为进一步完善全省出生缺陷一级预防工作提供参考依据。方法随机抽取四川省6个市(成都、内江、乐山、南充、眉山、自贡),由上述地区的妇幼保健院和计划生育机构分别对城市和农村的孕期妇女进行调查。结果发放调查问卷1 200份(城乡各600份),回收有效问卷1 179份,回收率98.25%。1 179名孕妇中,曾服用过叶酸1 015名(86.09%),孕前即开始服用者仅316人(31.14%)。从服用的依从性来看,坚持每天服用叶酸920人(78.05%),城市略高于农村(P0.05)。是否计划内怀孕、是否知道叶酸的作用和医生是否推荐对城乡孕妇能否正确服用叶酸均有影响(P0.05);年龄、家庭人均月收入对城市孕妇服用叶酸有显著性影响(P0.05);是否知道叶酸的发放地点对农村孕妇服用叶酸有显著性影响(P0.05)。结论四川省城乡孕妇叶酸服用率仍有待提高,根据城乡差异的特点有针对性加大宣传实施力度,在扩大覆盖面的同时,加强正确服用叶酸知识的宣传。     

四川省城乡居民就医路径及医疗机构选择的影响因素研究

目的 通过纵向随访数据分析四川省城乡居民的就医路径特征和就医机构选择的影响因素。方法 从四川省第五次卫生服务调查的样本区(县)中抽取1个城市点和1个农村点,监测居民3个月的卫生服务利用行为,定性描述居民就医路径特征,采用重复测量资料的多水平Logistic模型分析就诊医疗机构选择的影响因素。结果 患病后,城市点以遵医嘱治疗为主,农村点则以就诊为主;就诊时,城市以县(市、区)级医疗机构为主,农村以基层医疗机构为主;影响就诊医疗机构选择的因素有就业状况、是否患有慢性疾病。结论 四川省城乡居民就医路径特征不同,城市居民就诊机构的流向存在不合理分布。应加强城市点分级诊疗制度的推行,规范城市居民就医行为。     

对医疗保障城乡统筹的建议和思考

医疗保障城乡统筹是新医改工作的一项重点和明确任务,也是完善基本医疗保障制度建设的必然要求。文章借鉴发达国家医疗保障制度城乡统筹的经验,分析当前城乡统筹探索实践中存在的误区,对实现医疗保障城乡统筹提出建议和思考。     

The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico

This study investigates the effectiveness of centralized and decentralized health care providers in rural Mexico. It compares provider performance since both centralized and decentralized providers co-exist in rural areas of the country. The data are drawn from the 2003 household survey of Oportunidades, a comprehensive study of rural families from seven states in Mexico. The analyses compare out-of-pocket health care expenditures and utilization of preventive care among rural households with access to either centralized or decentralized health care providers. This study benefits from differences in timing of health care decentralization and from a quasi-random distribution of providers. Results show that overall centralized providers perform better. Households served by this organization report less regressive out-of-pocket health care expenditures (32% lower), and observe higher utilization of preventive services (3.6% more). Decentralized providers that were devolved to state governments in the early 1980s observe a slightly better performance than providers that were decentralized in the mid-1990s. These findings are robust to decentralization timing, heterogeneity in per capita government health expenditures, state and health infrastructure effects, and other confounders.