国际全科医生制度发展历程:影响因素分析及政策启示

全科医生制度建设的国际经验可以为中国全科医生制度的建立和发展提供借鉴。本文首先梳理了国民健康服务体制、社会医疗保险体制、商业医疗保险体制等部分典型国家的全科医生制度发展历程,重点分析了全科医生制度建设的影响因素。结果发现,建立和发展全科医生制度的主要影响因素有:经济社会因素、卫生保健体制对卫生体系的控制力、医师对卫生体系的控制力、全科医学服务的激励机制、全科医学的发展程度等。最后,结合近年我国全科医生制度建设的实际提出几点政策启示,一要以满足我国公众健康需求为目标,构建中国特色全科医生制度;二要普及全科医学服务核心价值,为建立全科医生制度提供公众民意基础;三要建立健全促进全科医生制度发展的激励机制,提高全科医生地位;四要积极推动全科与专科医学的专业分工,促进全科医学发展。     

儿童营养改善措施的国际经验及启示

营养是生长发育最重要的物质基础,儿童处于旺盛的生长发育阶段,必须不断从外界摄取足够的热能和各种营养素,否则将可能导致一系列营养问题的发生[1]。儿童营养状况直接关系着其自身的健康水平,影响成年时疾病发生的危险性。并且,儿童营养问题会对教育、生产率等产生负面作用,影响经济增长[2]。     

全球健康治理发展历程及启示

根据世界卫生组织的《21世纪健康治理》项目报告,梳理和阐述了全球健康治理发展史上的3次浪潮和我国健康治理发展历程,总结归纳出对我国健康治理的启示：构建医防融合、全专结合的整合型医疗卫生服务模式;从医疗转向健康,构建全方位全周期健康服务理念;健康融万策,高标准增进人民健康福祉。通过对健康治理体系、模式、制度的优化,实现我国健康治理能力现代化。     

国际儿童环境健康政策对我国相关工作的启示

儿童环境健康问题敏感独特,我国较少有专门涉及儿童环境健康的政策法规.本文通过分析以WHO为首的国际机构在儿童环境健康领域的发展历程和主要开展的工作,综述美国、加拿大、欧盟及日本等发达国家在儿童环境健康管理方面的模式和经验,结合我国儿童环境健康政策存在的问题,从顶层设计、制度建设、监测评估、科学研究及宣传教育5个方面提出...     

发展中国家儿童营养政策的经验和教训

在我国进行儿童营养干预和制定儿童营养政策的时候要充分借鉴其他国家的经验。在对一些发展中国家儿童营养政策回顾的基础上,通过经验和教训两方面的案例探索成功实施儿童营养政策的共同点。在儿童营养政策的领导和组织方面,要有坚定的政治承诺,并与其他公共政策紧密结合;在制度和机制设计方面,要保证可持续筹资、社区充分参与,并有针对母亲和儿童的食品补贴政策;在政策实施上,要保证其有效执行和发挥母亲在政策中的关键作用。     

营养历程:对未来临床营养与代谢的展望

营养支持开始于30年前,实践证明只通过静脉补充营养,婴儿也能生长发育.30年来营养领域进展很快,包括脂肪乳剂的产生和改进、对维生素和微营养素的需求及其代谢的认识、对临床营养中生长因子的潜能及氨基酸代谢认识的提高.除了热量测定和双能源X线吸收测定法(DEXA)之外,还包括经外周的中心静脉导管(PICC)和经内镜胃造瘘术(PEG)在内的新的营养供应方式,不仅使营养支持和营养评估更加安全有效,也给我们临床工作提供了更多选择.     

中国儿童的营养现状及其膳食营养指导

近年来,与儿童健康密切相关的儿童营养问题在世界各国皆受到重视。中国3亿多儿童的营养状况,一直受到各级政府的关注。随着经济的迅速增长,人民生活不断改善,我国儿童营养及生长发育水平也迅速提高,城乡儿童体格发育都较10年前有了明显改善,基本没有中重度营养不良,常见的营养缺乏病大幅度下降或消失。总的趋势是城市比农村好,体重发育比身高好,城市男童的身高没有女童好,     

我国食物与营养政策的发展简介

食物与营养是人类生存的基本条件，是反映一个国家经济水平和人民生活质量的重要指标。中国作为一个用占世界8％的耕地养活占世界22％的人口的食物生产和消费大国，其食物安全和国民营养改善，始终是我国的重大问题。食物与营养发展问题能否很好地得到解决，不但事关人民身体健康、安居乐业，而且关乎国家长治久安和中华民族的繁荣昌盛。     

儿童锌营养与体格发育智力发展关系的研究

本文报告了447名3～12岁儿童发锌含量的正常值(百分位数法,ppm);3～4岁缉为50～200;5～6岁70～250;7～8岁80～250;9～12岁110～250。膳食营养调查结果表明儿童锌营养不足,仅及标准的60％。研究结果显示,缺锌对学龄前儿童的体格发育、对学龄儿童的智力发展都有较大影响。     

美国健康战略发展历程及其对我国的启示

美国是世界上最早实施健康战略的国家之一,其健康战略方案具有重要的借鉴意义.作者介绍了美国政府先后制定的4个健康战略,描述了不同阶段健康战略的目标、重点关注领域及主要健康指标,并分析其演变规律和主要特点,为我国"健康中国2020"战略的制定和实施提供借鉴.     

The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children

Objective

The objective of this study is to assess population-level trends in children's dietary intake and weight status before and after the implementation of a provincial school nutrition policy in the province of Nova Scotia, Canada.

Method

Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population-level study with grade 5 students in 2003 (n = 5215) and 2011 (5508), prior to and following implementation of the policy. We applied random effects regression methods to assess the effect of the policy on dietary and health outcomes.

Results

In 2011, students reported consuming more milk products, while there was no difference in mean consumption of vegetables and fruits in adjusted models. Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption. Despite significant temporal decreases in dietary energy intake and increases in diet quality, prevalence rates of overweight and obesity continued to increase.

Conclusion

This population-level intervention research suggests a positive influence of school nutrition policies on diet quality, energy intake and healthy beverage consumption, and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity.     

The development, implementation, monitoring and evaluation of a food and nutrition policy within a local health plan

Local food and health policies were initiated in the UK in the early 1980s, and this paper traces developments in Leicestershire, England. The first policy was launched in 1987, which promoted the nutrition education messages of that time (less fat, more fibre and less sugar), primarily within the National Health Service. As a result of the publication of the Health of the Nation Green Paper in 1991, a local health plan was developed for Leicestershire, in which nutrition formed an integral part. Wider perspectives on nutrition have evolved reflecting the multidisciplinary approach to developing the Food and Nutrition Policy. In addition, updating of the nutrition messages in the local Food and Nutrition Policy has occurred to reflect the shift in emphasis towards nutritional adequacy and balance. The scope for implementation is now much wider, involving several key settings in the community, and there is an increased emphasis on monitoring and evaluation.     

Historical background and development of applied nutrition and community nutrition in Korea

This paper overviews the historical background and development of applied nutrition and community nutrition in Korea. The nutrition studies in the early years focused on animal experiments, human metabolism, and food analysis and therefore were limited to classrooms and research laboratories in universities without spreading into the lives of people. Korean specialists trained through the UN International Course of Applied Nutrition initiated the Applied Nutrition Program (ANP) in Korea in the 1960s. The ANP in Korea was effectively implemented until 1986 with support from UNICEF, FAO, and WHO as a national project to improve the nutrition and health of rural residents. With economic development and urbanization in Korea, the rural-focusing ANP was re-born to a more extended version with the name of "Community Nutrition" targeting the nutrition and health of the entire Korean population. Scholarly associations including the Korean Society of Community Nutrition established in 1995 have significantly contributed to the development of Community Nutrition in Korea and are expected to continue to work for a better connection between nutrition and health promotion.     

The 2000 Dietary Guidelines for Americans: foundation of US nutrition policy

The Dietary Guidelines for Americans form the foundation of US federal nutrition policy. The Food Guide Pyramid, the most widely distributed and best‐recognised nutrition education tool ever produced in the US, is based partially on the Dietary Guidelines. In addition, every federal nutrition programme in the United States uses the Dietary Guidelines as part of their nutrition standards. Federal law requires that the guidelines be reviewed every five years. The Dietary Guidelines Advisory Committee was charged with answering the question, ‘what should Americans eat to be healthy?’ After rigorously reviewing the scientific, peer‐reviewed literature the committee recommended a new set of guidelines for the year 2000. The guidelines are intended for healthy children (ages 2 years and older) and generally healthy adults of any age. The guidelines were expanded from seven in 1995 to ten in 2000. The 2000 Dietary Guidelines for Americans are; (1) aim for a healthy weight; (2) be physically active each day; (3) let the pyramid guide your food choices; (4) eat a variety of grains daily, especially whole grains; (5) eat a variety of fruits and vegetables daily; (6) keep foods safe to eat; (7) choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (8) choose beverages and foods that moderate your intake of sugars; (9) choose and prepare foods with less salt; and (10) if you drink alcoholic beverages, do so in moderation.     

小儿外科围手术期营养支持

小儿围手术期因消化道畸形及手术麻醉创伤,造成机体对营养物质的合成和利用发生障碍,需要营养支持.合理的营养支持有利于减轻或预防围手术期营养不良,使患儿早日恢复正常的营养代谢,从而减少和减轻术后并发症和降低病死率.     

小儿外科围手术期营养支持

小儿围手术期因消化道畸形及手术麻醉创伤,造成机体对营养物质的合成和利用发生障碍,需要营养支持。合理的营养支持有利于减轻或预防围手术期营养不良,使患儿早日恢复正常的营养代谢,从而减少和减轻术后并发症和降低病死率。     

1998年度食物营养监测总报告与政策建议

依据1998年营养监测数据,分析了目前我国儿童营养状况,城市及农村居民食物消费与膳食营养状况,并提出了当前几个主要营养问题及相关的对策建议：儿童营养改善是我国社会经济发展的结果,改善儿童营养的对策应以农村为重点,强化辅食添加,将合理辅食的添加提高到与母乳喂养同等重要地位加以推行;迅速推动大豆消费及生产加工合成为改善营养的最优先措施;贫困人群的营养关系到扶贫工作的成效,是必须也是可能解决的。     

The future of public health nutrition: a critical policy analysis of Eat Well Australia

Objective: To better understand how public health nutrition has been represented during the past decade in Australia this paper critically analyses Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000 – 2010 and its accompanying National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. Method: The paper uses an interpretive approach, drawing on Bacchi's method of problem representation, to examine the strategies being offered within the policy. It uses this framework to uncover how public health nutrition has been represented and examines if the representation provided considers all aspects of the issue. The paper also considers how contextual factors affected policy development through examination of publicly available documents. Results: The problem is represented as being both an individual one and one due to social, structural and economic circumstances. There is a large focus on collaboration, research and capacity building. The context of the policy's development has affected the solutions contained within. Conclusion: The policy's proposed actions reflect the policy‐making environment in which it was conceived. A manifestation of this was unclear division of roles and responsibilities, lack of dedicated resources and inadequate focus on the social determinants of health. Implications: As the policy's timeframe is drawing to its end, critical reflection on how the problem of nutrition has been represented over the previous decade provides greater insight and awareness to direct future public health nutrition work.