影响南京市社区居民道路交通伤害干预效果的社会人口学分析

目的了解南京市社区居民预防道路交通伤害的知识和行为情况,针对社区居民道路交通伤害健康教育和健康促进干预效果进行评价,为有效开展社区道路交通安全健康教育工作提供参考依据。方法采用随机多级抽样的方法抽取被调查社区,通过问卷调查的方法获得干预前后的资料,并分析年龄、性别、婚姻状况、文化程度及经济状况等因素对居民道路交通伤害干预效果的影响。结果不同年龄、性别、婚姻状况、文化程度和经济状况的居民,知识知晓率干预效果比较理想,行为行成率干预效果存在着一定差异。干预后,男性的行为改变较明显（χ^2=7.67,P〈0.01）;20～30岁人群（χ^2=2.96,P〉0.05）、大学、高中和初中文化程度的人群（χ^2=2.03、3.34、2.04,P〉0.05）、家庭人均年收入在4万元以上人群（χ^2=2.85、12.41、0.44,P〉0.05）的行为干预效果最不理想。结论开展道路交通安全健康教育工作应针对不同人群的特点采取相应的措施。     

Variations in infant mortality rates among municipalities in the state of Ceará, Northeast Brazil: an ecological analysis.

BACKGROUND: Infant mortality rates vary substantially among municipalities in the State of Ceará, from 14 to 193 per 1000 live births. Identification of the determinants of these differences can be of particular importance to infant health policy and programmes in Brazil where local governments play a pivotal role in providing primary health care. METHODS: Ecological study across 140 municipalities in the State of Ceará, Brazil. RESULTS: To determine the interrelationships between potential predictors of infant mortality, we classified 11 variables into proximate determinants (adequate weight gain and exclusively breastfeeding), health services variables (prenatal care up-to-date, participation in growth monitoring, immunization up-to-date, and decentralization of health services), and socioeconomic factors (female literacy rate, household income, adequate water supply, adequate sanitation, and per capita gross municipality product), and included the variables in each group simultaneously in linear regression models. In these analyses, only one of the proximate determinants (exclusively breastfeeding (inversely), R2 = 9.3) and one of the health services variables (prenatal care up-to-date (inversely), R2 = 22.8) remained significantly associated with infant mortality. In contrast, female literacy rate (inversely), household income (directly) and per capita GMP (inversely) were independently associated with the infant mortality rate (for the model including the three variables R2 = 25.2). Finally, we considered simultaneously the variables from each group, and selected a model that explained 41% of the variation in infant mortality rates between municipalities. The paradoxical direct association between household income and infant mortality was present only in models including female illiteracy rate, and suggests that among these municipalities, increases in income unaccompanied by improvements in female education may not substantially reduce infant mortality. The lack of independent associations between inadequate sanitation and infant mortality rates may be due to the uniformly poor level of this indicator across municipalities and provides no evidence against its critical role in child survival. CONCLUSIONS: These results suggest that promotion of exclusive breastfeeding and increased prenatal care utilization, as well as investments in female education would have substantial positive effects in further reducing infant mortality rates in the State of Ceará.     

社区开展高血压分级管理模式与干预效果分析

目的探讨社区开展高血压分级管理，社区干预措施对脑血管病预防效果。方法2002年至2006年，在上海斜土社区随机抽取部分居委为干预组，对社区高血压病患者进行分级管理。另随机抽取部分居委为对照组，比较两组脑卒中发病率、死亡率。结果干预终点，干预组的高血压管理率达89．2％，控制率达91．4％；脑卒中发病率105．7／10万，死亡率26．4/10万。对照组脑卒中发病率为462．5/10万，死亡率72．5/10万。两组标化后脑卒中发病率、死亡率间差异均有统计学意义（P〈0．01）。结论在社区实施高血压分级管理的干预模式，对脑血管病的预防控制有实际意义。     

浙北地区城乡社区健康教育效果评价

目的评价浙北地区城乡社区健康教育效果,探讨城乡社区健康教育的有效方法。方法在浙北地区各选择1个城市社区和1个农村社区实施综合性健康教育干预活动,同时选择条件相似的2个社区作为对照。干预前后,在城市和农村干预、对照社区均随机抽取600人进行问卷调查,比较调查对象健康核心信息知晓率和健康相关行为形成率。结果干预后,农村干预社区居民对核心知识的知晓率明显提高（P〈0.05）;而城市干预社区居民则无明显提高。城市干预社区居民饮酒率下降,测量血压的比例升高（P〈0.05）;农村干预社区居民形成了定期更换牙刷以及刀和菜板生熟分开的行为习惯（P〈0.05）。结论充分发挥社区卫生服务中心的作用,通过责任医师实施综合性干预,是城乡健康教育的一种有效方法。     

Economy, community and mortality in British Columbia, Canada

Stimulated by the growing body of literature relating economic inequalities to inequalities in health, this article explores relationships between various economic attributes of communities and mortality rates among 24 coastal communities in British Columbia, Canada. Average household income, a measure of community wealth, was negatively related and the incidence of low incomes, a measure of poverty, was positively related to age-standardized mortality. Both were more strongly related to female than male mortality. Mean and median household income, the incidence of low incomes and a lack of disposable income, and the proportion of total income dollars derived from government sources were significantly related to mortality rates for younger and middle-aged men but not for elderly men. Mortality rates for younger and middle-aged women were not explicated by these economic attributes of communities: among elderly women only, mortality rates were higher in communities with a lower average household income and in those with a higher incidence of low incomes. Finally, a higher concentration in white-collar industries was related to higher mortality rates for females, even after controlling for other economic attributes of communities. These results do not obviously support a psychosocial argument for an individual-level relationship between income and health that assumes residents perceive their status primarily in relation to other members of the same community, but do provide moderate support for the materialist argument and moderate support for the psychosocial argument that assumes community residents perceive their status in relation to an encompassing reference group. Other viable interpretations of these relationships pertain to ecological characteristics of communities that are related to both economic well-being and population health status; in this instance, concentration in specific economic industries may help to understand the ecological relationships presented here.     

舟山海岛社区高血压综合防治模式探讨

目的 提高海岛居民高血压防治知识的水平,降低人群中高血压的危险因素水平及其发病率和死亡率,促进海岛居民建康,总结一套适合海岛地区行之有效的高血压防治模式。方法采用整群分层随机抽样方法,确定调查范围为2个街道2个社区,对35岁以上常住居民2000人进行高血压综合防治干预。结果经过5年的社区高血压综合干预,社区居民高血压的知晓率、病人坚持服药率、高血压控制率及高血压相关的知晓率有明显提高。结论对海岛社区居民开展高血压综合防治干预是行之有效的．对于减少人群的高血压危险因素水平,提高高血压患者的治疗率和血压控制率,是切实可行的,应进一步深入开展社区居民高血压知识的健康教育和健康促进。     

不同危险因素人群的社区脑卒中干预效果评估

目的评价社区脑卒中干预在不同危险因素人群中的效果。方法1987年在北京和长沙两城市各选择2个不相邻、框架人口约为1万的自然人群,分别作为干预和对照社区,从2个社区35岁以上人群中分别选取2700名既往无脑卒中病史的居民作为队列人群,进行脑卒中危险因素基线调查,两城市共入选干预队列5319人,对照队列5506人。在干预队列,对筛查出的高危对象进行社区干预,对照队列的人群则顺其原有医疗不予干预。干预时间为12年。结果干预队列脑卒中发病的危险比对照队列低22%(HR=0.78,95%CI:0.66～0.92)。无论居民是否有脑卒中的危险因素,干预队列脑卒中发病率都低于对照队列,无论教育水平如何、是否肥胖或超重,脑卒中发病率均有明显降低,但是在男性、吸烟和饮酒者中脑卒中发病率在干预组和对照组比较其差异无统计学意义。干预队列脑卒中死亡率明显低于对照队列(HR=0.27,95%CI:0.17～0.42)。脑卒中死亡率在不同危险因素水平均有明显的降低(P<0.05)。结论经过长期的社区干预,不仅可以降低高危人群脑卒中的发病和死亡危险,无危险因素的社区居民也受益。但是男性、吸烟和饮酒者的干预还亟待加强。     

河北省邯郸市社区居民乙肝防治知识健康教育效果评价

目的了解河北省邯郸市社区居民健康教育前后对乙肝防治知识的知晓率及态度改变情况,评价健康教育的效果。方法在河北省邯郸市选择2个社区,分别作为干预组和对照组,对干预组实施健康教育干预,在干预前后分别开展问卷调查,了解居民乙肝防治知识的知晓情况及态度变化并对干预效果进行评价。结果干预组干预后乙肝疫苗作用、传播途径的知晓率约90%,对乙肝疫苗接种程序、接种对象、携带者概念的知晓率约为60%～70%,对乙肝疫苗种类及我国乙肝携带者人数等问题的知晓率不足40%,对照组大部分问题的知晓率在25%～45%之间,干预组的整体知晓率明显高于对照组(P<0.05)。干预组关于乙肝疫苗预防接种的态度较对照组积极(P<0.05)。结论对社区人群进行乙肝防治知识健康教育,增强了社区人群对乙肝及其疫苗预防的认识。     

苏州工业园区居民高血压相关知识知晓率调查

目的了解苏州工业园区社区居民高血压知识知晓情况及影响因素,为干预提供依据。方法采用多级整群随机抽样方法 ,对苏州工业园区7个社区的13058人进行高血压流行病学调查和体格检查,用非条件logistic回归分析其影响因素。结果该工业园区居民对高血压知识的知晓率为81.19%,城市高于农村,男性高于女性,文化程度和月收入高者知晓率高。主要影响因素有性别、文化程度、城市农村、医疗保险、人均月收入、高血压家族史,OR值分别为0.900、1.547、2.814、1.498、1.157和1.569。结论苏州工业园区社区居民高血压知识知晓率有待提高,尤其是农村社区、文化程度和收入较低的男性无医疗保障人群。     

2008年四个直辖市居民艾滋病相关知识知晓状况及影响因素分析

目的了解我国直辖市居民对艾滋病相关知识知晓情况,为进一步开展全面宣传,制定宣传策略提供线索和依据。方法采用多阶段分层整群随机抽样方法,共调查了8 654人。结果 8 654名调查对象艾滋病传播途径知识知晓率为69.0%（68.0%~70.0%）,调查的全部艾滋病知识知晓率为2.7%（2.4%~3.1%）,调查对象艾滋病传播途径知识与其文化程度、职业、家庭月收入有统计学联系。家庭月收入在1 000元以上的居民艾滋病传播途径知识是1 000元以下居民的1.21倍（OR=1.78,95%CI 1.04~1.41）;文化程度高的居民艾滋病传播途径知识知晓率平均为文盲居民的1.66~4.82倍;其他职业居民艾滋病传播途径知识知晓率平均为农民的0.61~0.79倍。结论本次研究发现直辖市居民艾滋病传播途径知识知晓率均低于《中国遏制与防治艾滋病行动计划（2006-2010年）》的要求,但直辖市居民艾滋病知识来源多样,获取知识途径受到的限制较少,职业、家庭月收入和文化程度对艾滋病知识的影响提示在今后的艾滋病健康教育活动中,应加强职业教育中艾滋病的内容,尤其对于低收入和文化程度较低的群体。     

Clusters of cancer mortality in New Jersey municipalities; with special reference to chemical toxic waste disposal sites and per capita income

The state of New Jersey (NJ), USA, has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for NJ counties. This study presents an analysis of mortality from major cancers for NJ municipalities during 1968-1977, and correlates cancer mortality rates with several potentially relevant variables. Age-adjusted mortality rates for 13 major cancer sites for 194 municipalities of 10 000 or more people in 21 NJ counties were compared with cancer mortality in the US. Municipality rates were correlated with: distribution of chemical toxic waste disposal sites (CTWDS); annual per capita income; the rates of low birth weight, birth defects and infant mortality of NJ municipalities. Clusters of cancer mortality were observed in 23 municipalities in 10 counties in which a total of 98 age-adjusted cancer death rates were at least 50% above the national rate, and each of these municipalities had at least two race-sex-specific cancers in which the observed number of cancer deaths was greater than the expected number of deaths at the p less than 0.0005 level. Of these 98 excessive cancer death rates, 72% involved the gastrointestinal tract. Most of the municipalities are located in the highly industrialized densely populated northeastern part of the State. Correlation analyses showed a consistent and significant (p less than 0.05) negative correlation between income and cancer mortality in 11 of 12 cancers studied. These analyses also showed a significant positive association between 8 of 12 cancers studied and CTWDS in one or more subgroup populations and lesser associations with birth defects, low birth weight and infant mortality.     

Mortality effects of average education in current and earlier municipality of residence among internal migrants, net of their own education

Many researchers have shown an association between a person's health or mortality and the socio-economic resources in the community, net of the person's own resources. The focus has typically been on the current community of residence or one where the person lived a few years earlier. Only a few authors have tried to establish whether there is an additional effect of earlier community exposures, and they have not made a distinction between migrants and non-migrants, which there are good reasons to do. The results from these earlier investigations have been rather mixed. In the present study, a discrete-time hazard model for mortality between ages of 60–89 over the period 1991–2002 was estimated from register data that included the entire Norwegian population. For each person, and for each of these years, municipalities of residence during the previous 20 years were known. There was also information on each person's educational level. For the relevant years and each of the 433 municipalities, measures of average education in the population were constructed by aggregating over the individual data. The analysis was focused on the subgroup who had moved across a municipality border only once during the previous 20 years, among whom there were 29,843 deaths during 839,113 person-years of follow-up. The population sizes of the municipalities were included as control variables. Among those who had moved within the last 10 years, the current socio-economic context was not important for mortality. The earlier context had an effect, but this was restricted to men. Those who had lived longer in the current municipality of residence were influenced only by the average education in that municipality. The findings support the idea that neighbourhood socio-economic effects need some time to build up, and that they do not dissipate soon after the person has moved to a new environment.     

Mortality from Breast Carcinoma Among US Women: The Role and Implications of Socio-Economics, Heterogeneous Insurance, Screening Mammography, and Geography

Despite rapid advances in medicine and beneficial lifestyle changes, the incidence and mortality rate of gynecologic carcinoma remains high worldwide. This paper presents the econometric model findings of the major drivers of breast cancer mortality among US women. The results have implications for public health policy formulation on disease incidence and the drivers of mortality risks. The research methodology is a fixed-effects GLS regression model of breast cancer mortality in US females age 25 and above, using 1990–1997 time-series data pooled across 50 US states and DC. The covariates are age, years schooled, family income, 'screening' mammography, insurance coverage types, race, and US census region. The regressions have strong explanatory powers. Finding education and income to be significantly and positively correlated with mortality supports the 'life in the fast lanes' hypothesis of Phelps. The policy of raising a woman's education at a given income appears more beneficial than raising her income at a given education level. The relatively higher mortality rate for Blacks suggests implementing culturally appropriate set of disease prevention and health promotion programs and policies. Mortality differs across insurance types with Medicaid the worst suggesting need for program reform. Mortality is greater for women ages 25–44 years, females 40–49 years who have had screening mammography, smokers, and residents of some US states. These findings suggest imposing more effective tobacco use control policies (e.g., imposing a special tobacco tax on adult smokers), creating a more tractable screening mammography surveillance system, and designing region-specific programs to cut breast cancer mortality risks.     

Income distribution and mortality: implications from a comparison of individual-level analysis and multilevel analysis with Swedish data

BACKGROUND: This follow-up study analyses whether there is an association between income distribution in Swedish municipalities and risk of death from all causes in the total Swedish population aged 40-64 years and compares the results obtained with analyses performed on individual-level analysis and multilevel analysis. METHODS: Individual-level data on social and economic circumstances were obtained from various official records and were linked to the national cause-of-death register. Analyses were made with two methods, an individual-level regression and a multilevel regression. The study population comprised all people 40-64 years of age in the 1990 Swedish census, altogether 2.57 million people in 284 municipalities. RESULTS: The main results showed that in the individual-level regression the income distribution showed a positive and significant association (risk ratio = 1.29; 95% CI = 1.24-1.34) with higher mortality for those living in municipalities with higher income inequality. This association was not found in the multilevel regression analysis (RR = 1.03; 95%CI = 0.94-1.13). CONCLUSION: There seems to be no association between income distribution and mortality in Sweden when considering the possibility of clustering in municipalities. Further studies on the relationship between income inequality and health should aim at elucidate processes within area-level units.     

Socioeconomic Predictors of Diabetes Mortality in Japan: An Ecological Study Using Municipality-specific Data

ObjectivesThe aim of this study was to examine the geographic distribution of diabetes mortality in Japan and identify socioeconomic factors affecting differences in municipality-specific diabetes mortality.MethodsDiabetes mortality data by year and municipality from 2013 to 2017 were extracted from Japanese Vital Statistics, and the socioeconomic characteristics of municipalities were obtained from government statistics. We calculated the standardized mortality ratio (SMR) of diabetes for each municipality using the empirical Bayes method and represented geographic differences in SMRs in a map of Japan. Multiple linear regression was conducted to identify the socioeconomic factors affecting differences in SMR. Statistically significant socioeconomic factors were further assessed by calculating the relative risk of mortality of quintiles of municipalities classified according to the degree of each socioeconomic factor using Poisson regression analysis.ResultsThe geographic distribution of diabetes mortality differed by gender. Of the municipality-specific socioeconomic factors, high rates of single-person households and unemployment and a high number of hospital beds were associated with a high SMR for men. High rates of fatherless households and blue-collar workers were associated with a high SMR for women, while high taxable income per-capita income and total population were associated with low SMR for women. Quintile analysis revealed a complex relationship between taxable income and mortality for women. The mortality risk of quintiles with the highest and lowest taxable per-capita income was significantly lower than that of the middle-income quintile.ConclusionsSocioeconomic factors of municipalities in Japan were found to affect geographic differences in diabetes mortality.     

Randomized intervention trial on preventive home visits to older people: baseline and follow-up characteristics of participants and non-participants

AIMS: In controlled intervention studies, a selective non-response or refusal to participate at baseline may bias measurable effects of the intervention. The aim of this study was to compare mortality and nursing home admission among older persons who accepted (participants) and older person who declined (non-participants) to join a controlled feasibility trial, and to describe and evaluate defined subgroups of non-participants. METHODS: Prospective controlled three-year intervention study (1999-2001) in 34 Danish municipalities with five-year follow-up. Randomization and intervention (education of municipality employees) was done at municipality level. In total 5,788 home-dwelling 75- and 80-year-olds living in these municipalities were invited to participate in the study. Written consent was obtained from 4,060 persons (participation rate 71%). RESULTS: During five-year follow-up non-participants had a higher mortality rate (survival analysis risk ratio RR = 1.5, 95% CI = 1.3-1.7, p<0.0001) and a higher rate of nursing home admissions (RR = 1.7, 95% CI = 1.3-2.1, p<0.0001) compared with participants. Subgroups of non-participants describing themselves as "too ill" and persons "not reached" had a significantly higher mortality rate and risk of admission to nursing home than participants, whereas the subgroups of non-participants describing themselves as "too healthy" and having "another reason for refusal" did not differ from the participants. There was no difference in mortality rates between non-participants living in intervention municipalities compared with non-participants living in control municipalities. CONCLUSIONS: Mortality and nursing home admissions were higher among non-participants. Selection participation bias was of no clinical importance since subgroups of non-participants eligible for the intervention did not differ from the participants.     

Estimating the burden of illness in an Ontario community with untreated drinking water and sewage disposal problems

The Hamilton-Wentworth regional health department was asked by one of its municipalities to determine whether the present water supply and sewage disposal methods used in a community without piped water and regional sewage disposal posed a threat to the health of its residents. Three approaches were used: assessments by public health inspectors of all households; bacteriological and chemical analyses of water samples; and completion of a specially designed questionnaire by residents in the target community and a control community. 89% of the 227 residences in the target community were found to have a drinking water supply that, according to the Ministry of Environment guidelines, was unsafe and/or unsatisfactory. According to on-site inspections, 32% of households had sewage disposal problems. Responses to the questionnaire revealed that the target community residents reported more symptoms associated with enteric infections due to the water supply. Two of these symptoms, diarrhea and stomach cramps, had a relative risk of 2.2 when compared to the control community (p less than 0.05). The study was successfully used by the municipality to argue for provincial funding of piped water.     

Reducing Hospital Readmissions Through a Skilled Nursing Facility Discharge Intervention: A Pragmatic Trial

ObjectiveTo determine if implementation of Project Re-Engineered Discharge (RED), designed for hospitals but adapted for skilled nursing facilities (SNFs), reduces hospital readmissions after SNF discharge to the community in residents admitted to the SNF following an index hospitalization.DesignA pragmatic trial.Setting and participantsSNFs in southeastern Massachusetts, and residents discharged to the community.MethodsWe compared SNFs that deployed an adapted RED intervention to a matched control group from the same region. The primary outcome was hospital readmission within 30 days after SNF discharge, among residents who had been admitted to the SNF following an index hospitalization and then discharged home. January 2016 through March 2017 was the baseline period; April 2017 through June 2018 was the follow-up period (after implementation of the intervention). We used a difference-in-differences analysis to compare the intervention SNFs to the control group, using generalized estimating equation regression and controlling for facility characteristics.ResultsAfter implementation of RED, readmission rates were lower across all 4 measures in the intervention group; control facilities’ readmission rates remained stable or increased. The relative decrease was 0.9% for the primary outcome of hospital readmission within 30 days after SNF discharge and 1.7% for readmission within 30 days of the index hospitalization discharge date (P ≤ .001 for both comparisons).Conclusions and ImplicationsWe found that a systematic discharge process developed for the hospital can be adapted to the SNF environment and can reduce readmissions back to the hospital, perhaps through improved self-management skills and better engagement with community services. This work is particularly timely because of Medicare's new Value-Based Purchasing Program, in which nursing homes can receive incentive payments if their hospital readmission rates are low relative to their peers. To verify its scalability and broad potential, RED should be validated across a broader diversity of SNFs nationally.     

北京市中关村社区老年骨质疏松高危人群健康教育效果评估

目的了解北京市中关村社区老年人群骨质疏松高危因素的情况,评价对该人群进行相关健康教育干预的效果。方法选择中关村社区为干预社区,对骨质疏松症高危人群进行综合健康教育干预,选择学院路社区为对照社区。干预前后,对调查对象进行问卷调查,以评价干预效果。结果干预社区干预前后分别调查134人和126人,对照社区干预前后分别调查146人和140人,两组调查对象在年龄、性别、医保形式上的差异均无统计学意义（P〉0.05）。干预前,两组调查对象的骨质疏松知识均较局限,干预后,干预组对12条骨质疏松知识点的知晓率均有明显提高（P〈0.05）,且明显高于对照组（P〈0.05）。干预前,两组调查对象的居住环境都存在“楼道内有障碍物”、“房间内无夜灯”和“地面不平、堆杂物、较滑”等问题,干预后,干预组居住环境的安全问题明显减少。结论开展骨质疏松高危人群健康教育具有重要意义,对提高相关知识知晓率、改变危害健康行为、养成良好生活方式具有促进作用。     

Improving motivation and goal setting for return to work in a population on sick leave: a controlled study

AIM: Limited knowledge precludes evidence-based interventions targeting return to work among employees on sick leave. The objective of this study was to examine the vocational effect of an intervention focused on motivation, goal setting, and planning of return to work. DESIGN AND METHODS: A total of 2,795 people, across 6 municipalities, on sick leave for at least 21 days received a questionnaire; 1,256 with a self-assessed poor prognosis for fast return to work were eligible for the study. An examination by a specialist in social medicine, followed by additional counselling by a social worker, was offered to 510 residents in two municipalities and accepted by 264 (52%). The goal was to enhance motivation, goal setting, and planning of return to work. Residents in the remaining municipalities (n=746) received the standard case management offered by the municipalities; 845 (67%) persons completed a follow-up questionnaire gathering data on general health and employment status. The duration of the sick leave was analysed by Cox regression, and the chance of being gainfully employed was analysed by logistic regression analysis, both adjusted for several covariates. RESULTS: The intervention neither shortened sick leave periods nor increased the likelihood of gainful employment after one year (OR 0.76; 95% CI 0.45-1.28). CONCLUSIONS: A low-cost counselling programme addressing motivation, goal setting, and planning of return to work did not improve vocational outcomes or reduce the duration of sick leave.