上海市某街道楼宇白领人群健康状况及差异分析

  目的  研究白领人群整体健康状况及影响其健康状况的主要因素。  方法  在上海市北外滩辖区内随机选定8座楼宇开展问卷调查,共发放问卷1 040份,回收有效问卷993份。通过对调查结果的整理,本文检验了不同人口特征对于白领人群3种健康状况的影响,包括慢性病患病状况、焦虑状况以及自评健康。  结果  白领人群患有慢性疾病的占总体13.71%;有焦虑症状的占总体33.55%;自评健康结果以“一般”居多,为48.43%,“比较好”次之,为32.73%。随年龄增长白领人群慢性病患病率越高(P < 0.05),从事“商业、服务业人员”以及“专业技术员”的白领人群慢性患病率高于其他职业类型人群; 教育水平越高白领人群心理健康状态越趋近于良好(P < 0.05),社会医疗保险覆盖人群心理健康状况也优于未覆盖人群(P < 0.05);女性白领人群自评健康状况优于男性(P < 0.05),教育水平越高自评健康结果也趋近于更好(P < 0.05),已婚白领人群自评健康结果优于未婚人群(P < 0.05),社会医疗保险覆盖人群自评健康结果也优于未覆盖人群(P < 0.05)。  结论  白领人群健康状况因职业性质特殊具有特异性,年龄、性别、职业内容、教育水平、婚姻状况、社会医疗保险是影响白领人群健康状况的重要因素,应建立白领人群适合的特殊基层医疗体系,从而改善白领人群生理、心理的整体健康水平。      

南通市学龄前儿童心理行为问题及其影响因素的研究

目的 调查和分析南通市学龄前儿童心理行为问题及其影响因素,并比较不同等级幼儿园儿童在心理行为发育方面有无差异.方法 采用Achenbach儿童行为量表(Child Behavior Cheek List,CBCL)中国标准化版对南通市随机抽取四所不同等级幼儿园1 102例4～7岁学龄前儿童进行调查研究.结果 南通市学龄前儿童心理行为问题的分布情况为:优良26.95%,正常63.88%,不正常9.17%,与国内外报道的学龄前儿童行为问题检出率(5%～20%)基本一致[1-2].各幼儿园学龄前儿童行为问题检出率分别为:省示范3.47%,一类1.87%,二类16.10%,三类23,81%,省示范、一类、二类幼儿园的儿童行为问题检出率明显低于三类幼儿园,不同等级幼儿园中,学龄前儿童的心理行为问题差异有显著性(P＜0.05).多因素分析认为影响儿童心理行为问题发生的主要因素为:幼儿园、家庭是否重视儿童心理教育,父母文化程度,家庭情况,是否参加早教等.结论 学龄前儿童行为问题的发生是多因素交互作用的结果.各类幼儿园尤其是三类幼儿园的家长和老师要重视学龄前儿童的心理教育,通过各种途径减少儿童心理行为问题的发生.     

Delivery of child health services in Indigenous communities: implications for the federal government's emergency intervention in the Northern Territory

OBJECTIVES: To describe delivery of child health services in Australian Aboriginal communities, and to identify gaps in services required to improve the health of Aboriginal children. DESIGN: Cross-sectional baseline audit for a quality improvement intervention. SETTING AND PARTICIPANTS: 297 children aged at least 3 months and under 5 years in 11 Aboriginal communities in the Northern Territory, Far West New South Wales and Western Australia in 2006. MAIN OUTCOME MEASURES: Adherence to guideline-scheduled services including clinical examinations, brief interventions or advice on health-related behaviour and risks, and enquiry regarding social conditions; and recorded follow-up of identified problems. RESULTS: Documentation of delivery of specific clinical examinations (26%-80%) was relatively good, but was poorer for brief interventions or advice on health-related behaviour and risks (5%-36%) and enquiry regarding social conditions (3%-11%). Compared with children in Far West NSW and WA, those attending NT centres were significantly more likely to have a record of growth faltering, underweight, chronic ear disease, anaemia, or chronic respiratory disease (P < 0.005). Only 11%-13% of children with identified social problems had an assessment report on file. An action plan was documented for 22% of children with growth faltering and 13% with chronic ear disease; 43% of children with chronic respiratory disease and 31% with developmental delay had an assessment report on file. CONCLUSION: Existing systems are not providing for adequate follow-up of identified medical and social problems for children living in remote Aboriginal communities; development of systems for immediate and longer-term sustainable responses to these problems should be a priority. Without effective systems for follow-up, screening children for disease and adverse social circumstances will result in little or no benefit.     

Correlates of certification in family medicine in the billing patterns of Ontario general practitioners.

There is conflicting evidence as to whether physicians who are certified in family medicine practise differently from their noncertified colleagues and what those differences are. We examined the extent to which certification in family medicine is associated with differences in the practice patterns of primary care physicians as reflected in their billing patterns. Billing data for 1986 were obtained from the Ontario Health Insurance Plan for 269 certified physicians and 375 noncertified physicians who had graduated from Ontario medical schools between 1972 and 1983 and who practised as general practitioners or family physicians in Ontario. As a group, certificants provided fewer services per patient and billed less per patient seen per month. They were more likely than noncertificants to include counselling, psychotherapy, prenatal and obstetric care, nonemergency hospital visits, surgical services and visits to chronic care facilities in their service mix and to bill in more service categories. Certificants billed more for prenatal and obstetric care, intermediate assessments, chronic care and nonemergency hospital visits and less for psychotherapy and after-hours services than noncertificants. Many of the differences detected suggest a practice style consistent with the objectives for training and certification in family medicine. However, whether the differences observed in our study and in previous studies are related more to self-selection of physicians for certification or to the types of educational experiences cannot be directly assessed.     

The characteristics,management, and aftercare of patients with suicide attempts who attended the emergency department of a general hospital in northern Taiwan

BackgroundSuicide is a serious public health problem worldwide. The emergency department (ED) is often the first place of contact with medical and mental health care for suicidal patients. This study aimed to determine the characteristics, management, and aftercare of patients who attempted suicide and then were taken to the ED of a general hospital in Taipei, Taiwan.MethodsOur study was a cross-sectional retrospective study that consecutively recruited patients with suicide attempts attended to the ED of a general hospital from June 2004 to May 2005. The patients' medical information and records pertaining to their emergency visit were subsequently reviewed.ResultsOverall, 481 persons were recruited into our study. The male:female ratio of total surviving attempters was approximately 1:4 and the average age was 33.6 [standard deviation (SD) 12.3] years. The most frequently observed general characteristics from which participants suffered were mental illness (73.1%) and interpersonal problems (76.1%). Nearly all patients (91.7%) received ED on-site psychosocial assessments from social workers (SWs) and psychiatrists in 84.2% and 53.4% of cases, respectively. Less than half of patients (45.1%) were referred to psychiatric outpatient aftercare, and only 26.1% contacted the psychiatric outpatient clinics after discharge from the ED. The stated reasons for psychiatric outpatient referral were associated with interpersonal problems, current psychiatric illness, the ED on-site psychiatrist consultation, and admission to medical, surgical, or psychiatric wards. However, individuals with interpersonal problems, previous psychiatric intervention, and ED on-site psychiatrist consultation were significantly more likely to attend outpatient psychiatric aftercare.ConclusionIndividuals who harmed themselves had a high rate of psychiatric morbidity and interpersonal problems. However, their adherence to psychiatric outpatient aftercare was low. Improved identification of the needs of patients with suicidal tendencies who did not attend outpatient services will have implications for future services provided to this patient population, and will better enable medical personnel to most effectively assist in suicide attempt interventions.     

包头市空巢老年人生存质量心理因子的多因素分析

目的：研究包头市空巢老年人的生存质量状况,深入分析影响心理因素的因子,为制定相应的改善措施提供依据。方法：采用SF-36量表对包头市城区空巢老年人生活质量进行调查。结果：包头市城区空巢老年人心理因子活力、社会功能、情绪角色功能、心理健康的得分分别为65.32±12.63、71.85±22.61、83.48±35.17、69.04±12.70;男性的情绪角色转换和心理健康得分高于女性（P〈0.05）;影响活力的因素有患慢病情况、经济收入、文化程度（P〈0.05）;情绪角色功能、心理健康受患慢病情况、性别、年龄影响（P〈0.05）;社会功能受经济收入和年龄的影响（P〈0.05）。结论：不同性别、年龄、文化程度、经济状况及患慢性病情况对空巢老年人生存质量的心理因子均有影响。     

Going the distance: the influence of practice location on the Ontario Maternal Serum Screening Program

BACKGROUND: The Ontario Maternal Serum Screening (MSS) Program was introduced by the Ontario Ministry of Health as a province-wide pilot project in 1993. The objective of this study was to determine the influence of practice location on Ontario health care providers' use of and opinions regarding MSS, access to follow-up services and recommendations about the program. METHODS: A questionnaire was mailed to a random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in Ontario between November 1994 and March 1995. RESULTS: Among providers who were eligible (those providing antenatal care or attending births) the response rates were 91.4% (778/851), 76.0% (273/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest region (71.4%) and in rural areas (81.9%) stated that they routinely offer MSS to all pregnant women in their practices compared with respondents in other regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in the northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were readily available. Respondents in the northern regions had less favourable opinions of MSS than those in the other regions in terms of its complexity, cost, the time involved in counselling and the high false-positive rate. More respondents in the Central East region (64.6%) and in urban centres (52.9%) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were controlled for in a logistic regression analysis, practice location was not the most important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offer MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that patient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67) or that follow-up services were not readily available (OR 0.33, 95% CI 0.20-0.55) were less likely to offer it. INTERPRETATION: Health care providers in northern and rural Ontario were less likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concerns about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.     

Management of children with cleft lip and palate.

Cleft lip or palate or both is one of the common congenital conditions in Ontario; its incidence is 1.2 to 1.6 per 1000 live births. A review of the records of 358 patients showed that 40%, particularly those with a severe defect, had other medical problems. This condition can affect the children and their families in many ways. In early life many patients undergo surgical repair and have speech, hearing and dental problems; during adolescence they may have cosmetic, orthodontic and emotional problems. Many parents are concerned about the genetic implications of the defect. This variety of problems requires management by several health care disciplines. Many Canadian health sciences centres offer multidisciplinary team management in a cleft palate clinic. The child's primary care physician, with whom the team exchanges information, plays a significant role in helping the child and the family function optimally.     

Correlates of body mass index in the 1990 Ontario Health Survey.

OBJECTIVES: To determine the average body mass index (BMI) and the prevalence of overweight and obesity among people aged 20 to 64 years, to identify sociodemographic, lifestyle and health variables that correlate with overweight and obesity, and, through a comparison of the results with those from an earlier survey, to determine whether prevalence has changed over time. DESIGN: Cross-sectional survey. SETTING: Ontario. PARTICIPANTS: The 1990 Ontario Health Survey surveyed 61,239 people representative of the Ontario population. The authors' analyses were restricted to those aged 20 to 64 years, excluding pregnant women. In the multivariate analyses they included only people with no missing values for any of the variables in the models (n = 26,306). OUTCOME MEASURES: BMI (weight in kilograms divided by height in metres squared) was used to measure healthy weight (BMI between 20 and 25), overweight (BMI greater than 25) and obesity (BMI greater than 27). RESULTS: The prevalence of obesity among men and women was 33.6% and 22.8% respectively (adjusted odds ratio [OR] 1.78, 95% confidence interval [CI] 1.63 to 1.95). There was a positive relation with age (adjusted OR 1.53 [95% CI 1.24 to 1.89] for age 25 to 29 years and 2.78 [95% CI 2.20 to 3.51] for age 50 to 54 years compared with age 20 to 24 years) and an inverse relation with education level (postsecondary education v. primary education: adjusted OR 0.65 [95% CI 0.54 to 0.79]). Analysis of birthplace showed that the prevalence of obesity was lowest among those born in Asia (compared with Canadian born: adjusted OR 0.36 [95% CI 0.27 to 0.47]). The prevalence was higher among former smokers than among those who had never smoked (adjusted OR 1.20 [95% CI 1.18 to 1.22]). People with more health problems and those who rated their health as fair or poor were more likely to be obese. The estimates of the prevalence of obesity were higher than those reported in the 1985 Health Promotion Survey for both sexes in all three age groups examined. CONCLUSIONS: These self-reported data indicate that overweight and obesity remain important health problems in Ontario, and the prevalence appears to be increasing.     

Should children with minor medical problems be sent to hospital? A study of infant care practices within families.

The admission of children to hospital for minor medical problems is frequently influenced by family and social circumstances. This study compared the infant care practices of families of children admitted to hospital for gastroenteritis (n = 76) and families caring for children with gastroenteritis at home (n = 76). Mothers of children who were admitted to hospital were more likely to use medical sources of advice on parenting and less likely to use other non-family sources than home care mothers. They also received less support in the education/entertainment of their children from fathers. There were many similarities between the two groups, including the high level of behaviour problems of the children and the relatively low level of involvement of fathers in child care tasks. Both of these factors serve to increase stress on mothers to the point where they may be unable to cope with a sick child at home.     

云南省农村重性精神疾病患者公共卫生服务利用现状及影响因素

目的 分析云南省农村重性精神疾病患者的公共卫生服务利用现状及影响因素.方法 采用分层整群抽样方法选取云南省农村重性精神疾病患者及其主要照顾者作为调查对象, 采用多因素logistic回归法分析其公共卫生服务利用的影响因素.结果 本次共调查农村重性精神疾病患者284例, 其中男性144人 (50.7%) , 女性140人 (49.3%) .重性精神疾病患者的健康档案建档率、村医随访率、免费体检参与率和健康教育接受率分别为89.8%、84.9%、73.2%和56.7%.女性患者接受免费体检服务的情况优于男性患者 (P<0.05) ;有工作和病情得到控制的患者及其照顾者接受该疾病健康教育的情况优于无工作和病情尚未得到控制的患者及其他们的照顾者 (P<0.05) .结论 应采取措施加强对男性患者的体检工作力度, 加大无工作和病情未得到控制的患者及其照顾者的健康教育工作, 提高农村重性精神疾病患者的公共卫生服务利用率.     

儿科住院患儿存在的健康教育问题及护理对策

目的：探讨儿科住院患儿健康教育存在的问题,分析相关护理对策。方法：选择我院2010年1月-2010年12月儿科住院患儿的家属320例,随机将320例家属分为实验组（n=160）及对照组（n=160）,其中,对照组以2000年6月规范的健康教育内容进行健康教育,实验组在对照组的基础上针对存在的问题采取相应的对策,采用自行设计的医疗护理满意度评估表进行调查分析,比较采取护理对策前后患儿及家属的满意度情况。结果：给予护理对策后,患儿及其家属对疾病知识的掌握程度（96．9％）、对护理人员的满意率（98．8％）、对医疗质量的信任率（98．1％）、对健康教育的满意率（97．5％）,与采取对策前比较均有明显提高,差异有统计学意义（P〈0．05）。结论：对住院患儿进行针对性的健康教育。采取有效的护理对策,可提高患儿及其家属对疾病及保健知识的掌握程度,促进患儿康复,利于儿科健康教育更广泛、更有效地开展。     

Demand-side medical education: educating future physicians for Ontario.

Initiated by Associated Medical Services (AMS), Educating Future Physicians for Ontario is a 5-year collaborative project whose overall goal is to make medical education in Ontario more responsive to that province's evolving health needs. It is supported by AMS, the five universities with medical schools or academic health sciences centres and the Ontario Ministry of Health. The project's five objectives are to (a) define the health needs and expectations of the public as they relate to the training of physicians, (b) prepare the educators of future physicians, (c) assess medical students' competencies, (d) support related curricular innovations and (e) develop ongoing leadership in medical education. There are several distinctive features: a focus on "demand-side" considerations in the design of curricula, collaboration within a geopolitical jurisdiction (Ontario), implementation rather than recommendation, a systematic project-evaluation plan and agreement as to defined project outcomes, in particular the development of institutional mechanisms of curriculum renewal as health needs and expectations evolve.     

基于中医认知疗法探讨慢性乙型病毒性肝炎“话疗”

慢性乙型病毒性肝炎作为一种临床常见的慢性传染病,严重的影响着患者的身心健康,现代研究表明,慢乙肝患者均存在着不同程度上的心理问题。随着＂生物-心理-社会＂医学模式的提出,人们逐渐开始重视心理和社会因素对疾病的发生发展的影响。通过对慢乙肝患者及其家属的＂话疗＂,可以改善患者的心理状态,提高患者的依从性,从而达到更好的治疗效果。     

Understanding the Unique Characteristics of Suicide in China： National Psychological Autopsy Study

Objective To compare the characteristics of suicides in the four main demographic groups： urban males, urban females, rural males and rural females in order to help clarify the demographic pattern of suicides in China. Methods A detailed psychological autopsy survey instrument was independently administered to 895 suicide victims in family members and close associates from 23 geographically representative locations from around the country. Results Pesticide ingestion accounted for 58% （519） of all suicides and 61% （3181519） of deaths were due to unsuccessful medical resuscitation. A substantial proportion （37%） of suicide victims did not have a mental illness. Among the 563 victims with mental illness, only 13% （76/563） received psychiatric treatment. Compared to other demographic groups, young rural females who died from suicide had the highest rate of pesticide ingestion （79%）, the lowest prevalence of mental illness （39%）, and the highest acute stress from precipitating life events just prior to the suicide. Contusion Many suicides in China are impulsive acts of deliberate self-harm following acute interpersonal crises. Prevention of suicides in China must focus on improving awareness of psychological problems, improving mental health services, providing alternative social support networks for managing acute interpersonal conflicts, limiting access to pesticides, and improving the resuscitation skills of primary care providers.     

西安市某综合医院医护人员身心健康状况及影响因素分析

目的 通过本研究寻找影响医护人员身心健康状况的主要因素,探讨如何缓解医护人员压力,更好服务患者的方法.方法 对某医院不同科室、不同性别、年龄、职称及不同受教育程度的医护人员进行问卷调查.结果 调查结果显示：69.56％的医护人员身体健康状况一般,58.69％的医护人员存在着焦虑或抑郁的情况,且女性的比例高于男性.结论 影响医护人员身心健康的因素是多重的,建立健全的社会伦理环境,制定明确、规范的医疗伦理行为规范,普及精神心理伦理知识,关爱医护人员心理健康可以有效缓解医护人员压力.     

创建“粉丝”为基础的家庭医生制服务模式研究

目的探索创建"粉丝"为基础的家庭医生制服务模式,并对其运行效果进行评价。方法白云街道社区卫生服务中心的4个团队中的18名医生与辖区内居民签订了契约式服务,每名医生约签约50户"粉丝"家庭,共签约"粉丝"家庭925户。责任医生为"粉丝"家庭提供基本医疗、健康教育、生活方式及行为方式指导等服务,由此盘活居民健康档案、实施慢性病管理等各项社区卫生工作。结果以"粉丝"为基础的家庭医生制服务模式的运行,使社区各项公共卫生服务、基本医疗服务明显改善,社区居民的满意度明显提高。结论以"粉丝"为基础的家庭医生制服务模式运行效果良好,能够为我国其他地区开展家庭医生制服务试点工作提供参考和借鉴。     

Do-not-resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact?

We studied compliance with do-not-resuscitate (DNR) orders at a university hospital where a DNR protocol has existed since 1979. Documentation of DNR status in patient progress notes and chart orders increased through 1983. During a 12-month period (March 1983 through April 1984), we studied in detail the medical records of 521 patients who had a cardiopulmonary arrest in the hospital. Seventy-five percent (389 of 521) of these patients were designated DNR. Patients who were designated DNR were significantly more likely to be older, to have malignancy or an abnormal mental status, and to be less likely to have acute myocardial infarction, stroke, or chronic obstructive pulmonary disease than patients in whom resuscitation was attempted. Eighty-six percent of families, but only 22% of patients, were involved in the decision to designate a patient DNR. The decision to designate a patient DNR occurred late in the course of a patient's illness, often when the patient was in coma. For 28% of patients, some form of medical care was withdrawn or withheld after they were designated DNR. These data suggest that use of the DNR protocol requires changes if patients are to participate in the decision not to undergo cardiopulmonary resuscitation.