上海市社区计划生育综合服务站工作人员紧急避孕知晓程度调查

目的:了解上海市社区计划生育综合服务站工作人员紧急避孕意识和服务水平,探讨社区紧急避孕规范化服务。方法:2010年1月～2010年12月对上海市闵行区和徐汇区25个街道计划生育服务站的275名服务人员进行问卷调查(紧急避孕相关知识及可接受性情况),同时进行紧急避孕专业培训。结果:社区计划生育服务人员均知道有紧急避孕,但在工作中应用比例为38.5%,73.8%调查对象知道紧急避孕的具体方法,能够正确回答紧急避孕使用常见问题的比例有33.87%。社区计划生育服务人员能够区别紧急避孕与常规的避孕方法,而对紧急避孕的局限性、副作用和失败后的处理方法认识还不足。通过紧急避孕专业培训,78.65%服务人员能够正确回答紧急避孕常见问题,同时纠正了原有的一些认识误区,提高了紧急避孕的知晓度和服务意识。结论:社区人口与计划生育服务人员应定期接受紧急避孕知识及技术培训,及时更新知识,提高服务水平。     

How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners

Background: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms.

Objectives: This study compares health status indicators during the HC period before reforms (2003–2007) and the FP period after reforms (2008–2012) in Turkey.

Methods: This study encompasses time series data consisting of the results of a 10-year assessment (2003–2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis.

Results: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period.

Conclusion: Primary care services should be reorganized and integrated with public health services.     

Social origins,early hardship and obesity: A strong association in women,but not in men?

This study investigates the relation between early life conditions and adult obesity in France, using a rich data set collected through the 2003 nationally representative Life History Survey. No salient factor emerged in men, while in women, after controlling for current socio-demographic characteristics, a relation was found between obesity and the following factors: father's occupation (OR = 3.2 for women whose father was a clerical worker, versus those whose father was in a higher-level occupation); experience of economic hardship in childhood (OR = 2.0), and; high parity (OR = 2.1 for parities of more than 3 versus parity of 1). Neither early family history nor mother's working status surfaced as significant factors. Those findings highlight a definite gender pattern, with a strong association between early disadvantage and obesity in women, but not in men. Potential mechanisms are discussed, particularly the “habitus”, the “thrifty phenotype” and the “feast–famine” hypotheses, and possible interactions with childbearing and motherhood. An integration of social and biological perspectives is needed to reach a better understanding of the processes involved, and to achieve progress in primary and secondary prevention.     

甘肃省重点人群家庭医生服务签约现状及影响因素研究

目的 通过调查甘肃省重点人群家庭医生服务签约现状,探讨影响重点人群签约行为的因素。方法 采用分层抽样的方法,于2017年9-12月,对甘肃省10个县市区重点人群家庭医生签约服务的实施现状进行问卷调查。结果 甘肃省重点人群家庭医生服务的知晓率低,签约率存在地区间的差异（χ2=30.78,P<0.01）;81.3%的人群签约了基础服务包,17.7%的人群不知道签约的家庭医生是谁,31.0%的人群不了解签约后可享受的优惠措施;重点人群认知家庭医生服务的首选方式是通过就诊时医务人员的介绍（46.8%）;签约行为与地区、是否患有慢性病、家庭医生服务知晓情况、服务收费、诊疗水平、交流时间、服务内容、服务效果满意情况有关（P<0.01）。结论 促进重点人群签约工作可通过加大宣传、增加服务内容、提高居民的满意度与获得感来实现。     

Retrospective Analysis of Emotional Burden and the Need for Support of Patients and Their Informal Caregivers after Palliative Radiation Treatment for Brain Metastases

Cancer burdens not only the patients themselves but also their personal environment. A few studies have already focused on the mental health and personal needs of caregivers of patients. The purpose of this retrospective analysis was to further assess the emotional burden and unmet needs for support of caregivers in a population of brain metastasis patients. In the time period 2013–2020, we identified 42 informal caregivers of their respective patients after palliative radiation treatment for brain metastases. The caregivers completed two standardized questionnaires about different treatment aspects, their emotional burden, and unmet needs for support. Involvement of psycho-oncology and palliative care was examined in a chart review. The majority of the caregivers (71.4%, n = 30) suffered from high emotional burden during cancer treatment of their relatives and showed unmet needs for emotional and psychosocial support, mostly referring to information needs and the involvement in the patient’s treatment decisions. Other unmet needs referred to handling personal needs and fears of dealing with the sick cancer patient in terms of practical care tasks and appropriate communication. Palliative care was involved in 30 cases and psycho-oncology in 12 cases. There is a high need for emotional and psychosocial support in informal caregivers of cancer patients. There might still be room for an improvement of psychosocial and psycho-oncological support. Care planning should cater to the emotional burden and unmet needs of informal caregivers as well. Further prospective studies in larger samples should be performed in order to confirm this analysis.     

患者入院家庭健康教育处方对农村地区冠心病患者焦虑、抑郁情绪的影响

目的：探讨患者入院家庭健康教育处方对农村地区冠心病患者焦虑、抑郁情绪的影响。方法：选取2010年1月-2013年1月入院当天经焦虑自评量表（SAS）和抑郁自评表（SDS）进行心理测评,存在焦虑、抑郁症状的114例冠心病患者作为研究对象,其中2010年1月-2012年4月实施健康处方前的57例患者作为对照组;2012年5月-2013年1月开展患者入院家庭健康处方的57例患者作为观察组。对照组给予常规心理护理与健康指导,观察组在对照组的基础上增加入院家庭健康教育处方,两组患者出院时重新测评SAS、SDS并比较。结果：出院时,观察组的SAS、SDS得分较对照组明显降低,差异均有统计学意义（P〈0.05）。结论：患者入院家庭健康教育处方可以改善农村地区冠心病患者的焦虑、抑郁情绪,促进身心康复。     

2015—2018年西安市百日咳流行特征分析

目的 分析西安市2015—2018年百日咳流行病学特征,为预防和控制百日咳传播提供参考。方法 采用描述流行病学方法,对中国疾病预防控制信息系统中2015—2018年期间西安市百日咳报告病例和此期间西安市百日咳哨点监测病例的数据进行统计学分析。结果 西安市2015—2018年共报告百日咳确诊病例1 635例,发病率分别为3.97/10万、4.11/10万、4.85/10万和5.28/10万,发病有逐年上升趋势（χ2趋势 = 21.719,P＜0.001）;高发季为3—8月（2015—2018年分别占该年度总发病数的75.73%、66.76%、78.97%和80.27%）;以3～6月龄发病比例最高（2015—2018年分别占该年度总发病数的50.58%、48.60%、48.36%和41.22%）;未全程接种疫苗患儿所占比例最大（2015—2018年分别为36.26%、23.74%、42.76%和33.73%）,未到接种年龄就发病所占比例有逐年升高趋势（χ2趋势 = 10.302,P = 0.001）,无免疫史患儿比例呈逐年降低趋势（χ2趋势 = 36.088,P＜0.001）;3种实验室检测方法中荧光PCR的检出率最高（40.12%）;传播模式除了散发病例,出现了家庭聚集现象,且所有流行病学相关病例均被漏诊或误诊。结论 西安市近年来百日咳发病率有明显上升趋势,＜6月龄婴儿为主要发病人群,百日咳的日常监测仍有待加强,且其家庭聚集式传播现象值得关注。     

我国城乡基层“2 + X”家庭医生团队现状与预测研究

目的 预测“十四五”期间我国城乡人口和基层医疗卫生机构“2 + X”家庭医生团队数量,探究我国城乡家庭医生服务覆盖情况,为家庭医生健康发展提供科学依据。方法 依据2013—2019年相关数据,采用GM(1,1)灰色预测模型预测2020—2025年我国城乡人口数和“2 + X”家庭医生团队数量和相关卫技人员数。观察每 2000 服务人口标准下,2018—2025年我国城乡“2 + X”家庭医生团队服务人数和服务覆盖率。结果 2020—2025年我国城镇人口数逐年增长,到2025年增至98 831万人;城市基层医疗卫生机构全科医生数、注册护士数、家庭医生团队数量逐年增长,到2025年分别增至171 712人、848 324人、171 712个;全科医生与护士比逐年上升,到2025年升至1∶4.94;2018—2025年我国城市“2 + X”家庭医生团队服务人口覆盖率逐年上升,到2025年升至35%。2020—2025年我国乡村人口数逐年下降,到2025年降至48 053万人;乡镇基层医疗卫生机构全科医生数、注册护士数、家庭医生团队数量逐年增长,到2025年分别增至447 672人、854 976人、447 672个;全科医生与护士比逐年下降,到2025年降至1:1.91;2018—2025年我国乡村“2 + X”家庭医生团队服务人口覆盖率逐年上升,理论上2022年实现全面覆盖。结论 2018—2025年我国城乡“2 + X”家庭医生团队数量逐年增加,但城市家庭医生缺口较大,应加强全科医学人才培养,增强家庭医生职业吸引力,缩小城乡全科医生薪资差距,优化家庭医生服务覆盖均衡性。     

脑卒中患者主要居家照顾者负荷及影响因素的研究

目的了解脑卒中主要居家照顾者的负荷水平及其影响因素。方法选择上海市社区脑卒中患者180例,调查患者的基本情况和功能独立性水平,调查主要照顾者的人口社会学资料、照顾相关资料、应对资源与负荷。对数据进行单因素分析和多元回归分析。结果主要居家照顾者负荷平均分为48.83±8.05。不同的文化程度、家庭经济情况、慢性病情况、每天照顾时间、照顾任务、陪伴患者时间、照顾意愿、自我效能、健康相关生活质量以及患者功能独立程度不同,主要照顾者的负荷差异有统计学意义(P<0.05)。以负荷总分为应变量,所有因素为自变量进行多元逐步回归,,照顾者健康相关生活质量、脑卒中患者的功能独立程度进入回归方程(P<0.001)。结论居家照顾脑卒中患者给其照顾者带来了较重的负荷。应充分重视提高患者的功能独立性水平,给予照顾者多方面的社会支持,提高其自我效能。     

Impact of Obesogenic Environments on Sugar-Sweetened Beverage Consumption among Preschoolers: Findings from a Cross-Sectional Survey in Beijing

The excessive consumption of sugar-sweetened beverages (SSBs) has been proven to be critical for obesity among preschoolers. This study aimed to describe the SSB consumption rates among preschoolers in the Dongcheng District of Beijing, China, and to explore the association between obesogenic environmental determinants and consumption. We applied a stratified cluster sampling method and recruited 3057 primary caregivers of preschoolers in June 2019 to participate in the survey. The caregivers reported their children’s consumption rates of six categories of SSBs and their exposure rates to SSB-related obesogenic environments. The associations between them were tested using multivariate logistic regression models. The mean (SD) age of the children was 5.6 (0.6) years and nearly half (48.3%) were girls. About 84.5% of the children had consumed SSBs over the past three months, and sugar-sweetened milk beverages had the highest consumption rate. Higher exposure to advertisements for the corresponding SSB categories in children, higher frequency rates of consuming SSBs and of taking children to fast-food restaurants in caregivers, and lower frequency rates of reading the Nutrition Facts Panels by caregivers were associated with higher SSB consumption rates among children (p < 0.05 in all of the SSB categories investigated, except for the Nutrition Facts Panel reading behaviors for the sports and energy beverages). SSB consumption among preschoolers is of concern, and comprehensive policy actions and education are urgently needed.