探索建立农村基层卫生管理新模式——基于会宁县乡村卫生服务一体化管理的研究

以会宁县乡村一体化管理为研究对象,研究了会宁县在创新农村卫生管理新模式中探索实施乡村一体化管理的具体措施和取得的成绩,分析并提出了创新农村卫生管理新模式的相关借鉴经验。     

The Keokuk County Rural Health Study

ABSTRACT

The Keokuk County Rural Health Study is a unique, population-based, prospective study of an agricultural community. The study is expected to continue for twenty years. The research includes systematic assessment of respiratory disease, injury, and other health outcomes in relation to agricultural, occupational, and environmental exposures. The aims of the environmental surveys are: (1) to conduct a systematic assessment of rural households in order to characterize the environmental exposures associated with the resi-dences and properties of the study subjects comparing farm, rural non-farm, and town households; and (2) to characterize occupational exposures associated with activities of the study subjects, particular-ly those related to farming and the rural environment. The environ-mental surveys consist of a combination of personal interviews, walk-through observations, and measurement of a selected number of environmental parameters. The focus of these assessments is on the environment and operations of the household and farm. Four instruments are used to record data: a Home Environmental Ques-tionnaire; a Home/Grounds Environmental Checklist; a Farm Envi-ronmental Questionnaire; and a Farm Environmental Checklist. Pre-liminary results from the first 106 environmental assessments are described, including the first 26 farms. More than half of residences were built before 1950, and they are primarily heated with liquid propane gas, natural gas, or wood. Dangerously high levels of car-bon monoxide were measured in several homes during winter 1995/96. Only 77 of 148 smoke detectors functioned. Farms ranged from 7 to 1,600 acres, with a mean of 324 acres. Eleven raised swine in enclosed systems. The average age of tractors in use was 26 years. Twenty-eight percent of all tractors had cabs, 25% had ROPS, and 39% had PTO shields.     

The Keokuk County Rural Health Study

SUMMARY

The Keokuk County Rural Health Study is a population-based, prospective study of environmental exposures and health status of a large randomly-selected sample of residents from each of three strata in one rural Iowa county. The study focuses on injury rates and respiratory disease; in addition, it monitors health care de-livery; geriatric, reproductive, and mental health; and other health outcomes. Injury and disease prevalence are investigated in relation to occupational, agricultural, and other environmental exposures. This paper describes the sampling method, the protocol, and the demographic profile of adult subjects of the first 400 households en-rolled in the study. Farmers were slightly younger than rural non-farmers and townspeople and more farmers had lived in the county all of their lives. Females were more highly educated than were males, and less than half as many female farmers had lived in the county all their lives than had male farmers. Net household income figures were complex and are shown in a graph in Table 1.     

农村公共卫生事业管理的探讨

1农村公共卫生的现状 1.1政府对农村公共卫生没有足够的重视从经济发展看，卫生健康状况的提高对经济的发展具有促进作用。许多经济学家和卫生经济学家的理论研究中健康被看作是人力资本的一个组成部分，是经济发展的一个推动因素。而实证研究也发现健康状况对经济增长的促进作用。如果一个国家卫生部门的绩效非常差，那么该国的经济增长也将逐渐消失。因此，对公共卫生投入是一种投资，而不仅是消费。     

重庆市城乡卫生统筹条件下县乡村卫生一体化管理研究

党的十七大报告中明确提出：科学发展观的根本方法是统筹兼顾。在需要统筹发展的多种关系中，统筹城乡发展无疑处在十分重要地位，而与广大人民群众生命健康息息相关的农村卫生事业对于城乡统筹发展又起着突出作用。在城乡卫生统筹条件下，开展县乡村卫生一体化管理，对农村卫生事业发展具有重要的理论价值和现实意义。     

H县农村卫生管理体制的历史分析与现实思考

农村卫生事业的发展分为了三个阶段,在三个历史阶段中通过有效的制度安排,H县用占全县GDP3%左右的卫生投入,大体上满足了几乎所有社会成员的基本医疗卫生服务需求,城市与乡村并无太大的差异。医疗卫生管理体制变革的的基本方向逐步朝着商业化、市场化发展,商业化和市场化又给我国基础薄弱的农村卫生事业带来了一系列的现实思考。     

射阳县农村居民高血压健康教育综合干预策略研究

目的评价农村居民高血压健康教育综合干预效果。方法采用多级分层整群随机抽样方法,选取射阳县5个不同方位镇的18岁以上常住居民,于2005年采取规范的健康教育措施,如多种形式的宣传教育等。在实施干预前和3年后,采用问卷调查和体格检查,分别获取被干预对象对于高血压的相关知识、态度和行为的资料。结果高血压影响器官功能、多吃动物内脏有害及新鲜蔬菜营养等9个方面的知识知晓率,干预后（89.6%）明显高于干预前（12.9%）,差别有统计学意义（P〈0.05）;测血压行为、喝牛奶豆浆和常吃五谷杂粮等7个方面行为形成率,干预后（85.8%）明显高于干预前（18.0%）,差别有统计学意义（P〈0.05）;家中卫生书报刊拥有和阅读、希望提供上门测血压和宣传慢性病知识等6个方面的健康需求率,干预后（80.3%）明显高于干预前（31.5%）,差别有统计学意义（P〈0.05）。结论健康教育综合干预活动在提高射阳县农村居民高血压相关知识知晓率、健康行为形成率和降低高血压相关危险因素流行水平方面是有效的。     

农村社区卫生服务机构转型时期现状与管理

目的探索农村地区不同类别医疗机构依法过渡、转型、准入和规范执业现状及监管路径。方法运用法规、规章、规范及《浙江省中小医疗机构依法执业分级监管评分标准》等,对海盐县社区卫生服务机构的执业许可、人员和房屋三大要素进行剖析、诊断。结果全县147家医疗机构的《医疗机构执业许可证》中有116家核准第二名称为社区卫生服务中心（分中心）站,115家与登记号编码类别不相符,占99．14％。房屋达到中心设置要求的有13家全部符合;103家社区卫生服务站中只有16家符合,占其总数的15．53％。全县已取得省级全科医学合格证的70名医生均未注册。结论明确农村地区医疗机构发展方向,理顺社区卫生服务机构与综合医院、卫生院、村卫生室等不同类别医疗机构的关系,严格准入,着力解决转型时期的突出问题,是分类或分级监管的重中之重。