县级医院改革试点医院就医环境评价及改进策略

目的 基于新医改背景调查陕西省某市县级医院改革试点医院住院患者对就医环境的满意度,为医院医疗环境的改进提供参考建议.方法 随机对250名在某市5所试点医院就诊的患者进行当面式问卷调查,应用EpiData软件对数据进行录入,应用SPSS13.0对数据进行描述性统计、x2检验和回归分析.结果 患者对医院环境的总满意度均分为3.69分,影响患者满意度的最主要因素是病房人数,其次是收入水平和文化程度.结论 随着新医改的实施推进,患者对医院环境满意度评价尚可,但仍需改进.     

丰富环境刺激联合水疗对新生儿缺氧缺血性脑病的干预效果

目的观察丰富环境刺激联合水疗对新生儿缺氧缺血性脑病（HIE）的早期干预效果。方法将50例中、重度HIE患儿随机分为刺激组和对照组各25例。2组均给予常规治疗和护理,刺激组在患儿惊厥控制后,给予丰富环境刺激联合水疗的方法。比较2组体质量、神经行为评分（NBNA）及发育商（DQ）。结果2组治疗前体质量和NBNA评分比较,差异无统计学意义,刺激组在日龄15天和28天时体质量和NBNA评分均高于对照组。刺激组在3个月和6个月的DQ值均高于对照组。结论丰富环境刺激联合水疗能够降低HIE患儿的伤残率,促进患儿运动功能和智能发育,有助于改善新生儿HIE的预后,是一种简单、有效、无创、依从性好的早期干预措施。     

Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study

BACKGROUND: Vending machines account for food sales and revenue in schools. We examined 3 strategies for promoting the sale of lower‐calorie food products from vending machines in high schools in the Netherlands. METHODS: A school‐based randomized controlled trial was conducted in 13 experimental schools and 15 control schools. Three strategies were tested within each experimental school: increasing the availability of lower‐calorie products in vending machines, labeling products, and reducing the price of lower‐calorie products. The experimental schools introduced the strategies in 3 consecutive phases, with phase 3 incorporating all 3 strategies. The control schools remained the same. The sales volumes from the vending machines were registered. Products were grouped into (1) extra foods containing empty calories, for example, candies and potato chips, (2) nutrient‐rich basic foods, and (3) beverages. They were also divided into favorable, moderately unfavorable, and unfavorable products. RESULTS: Total sales volumes for experimental and control schools did not differ significantly for the extra and beverage products. Proportionally, the higher availability of lower‐calorie extra products in the experimental schools led to higher sales of moderately unfavorable extra products than in the control schools, and to higher sales of favorable extra products in experimental schools where students have to stay during breaks. Together, availability, labeling, and price reduction raised the proportional sales of favorable beverages. CONCLUSION: Results indicate that when the availability of lower‐calorie foods is increased and is also combined with labeling and reduced prices, students make healthier choices without buying more or fewer products from school vending machines. Changes to school vending machines help to create a healthy school environment.     

Air quality and exercise-related health benefits from reduced car travel in the midwestern United States

Background: Automobile exhaust contains precursors to ozone and fine particulate matter (PM ≤ 2.5 µm in aerodynamic diameter; PM_2.5), posing health risks. Dependency on car commuting also reduces physical fitness opportunities.Objective: In this study we sought to quantify benefits from reducing automobile usage for short urban and suburban trips.Methods: We simulated census-tract level changes in hourly pollutant concentrations from the elimination of automobile round trips ≤ 8 km in 11 metropolitan areas in the upper midwestern United States using the Community Multiscale Air Quality (CMAQ) model. Next, we estimated annual changes in health outcomes and monetary costs expected from pollution changes using the U.S. Environmental Protection Agency Benefits Mapping Analysis Program (BenMAP). In addition, we used the World Health Organization Health Economic Assessment Tool (HEAT) to calculate benefits of increased physical activity if 50% of short trips were made by bicycle.Results: We estimate that, by eliminating these short automobile trips, annual average urban PM_2.5 would decline by 0.1 µg/m³ and that summer ozone (O₃) would increase slightly in cities but decline regionally, resulting in net health bene-fits of $4.94 billion/year [95% confidence interval (CI): $0.2 billion, $13.5 billion), with 25% of PM_2.5 and most O₃ bene-fits to populations outside metropolitan areas. Across the study region of approximately 31.3 million people and 37,000 total square miles, mortality would decline by approximately 1,295 deaths/year (95% CI: 912, 1,636) because of improved air quality and increased exercise. Making 50% of short trips by bicycle would yield savings of approximately $3.8 billion/year from avoided mortality and reduced health care costs (95% CI: $2.7 billion, $5.0 billion]. We estimate that the combined benefits of improved air quality and physical fitness would exceed $8 billion/year.Conclusion: Our findings suggest that significant health and economic benefits are possible if bicycling replaces short car trips. Less dependence on automobiles in urban areas would also improve health in downwind rural settings.     

长沙市家禽市场环境中H5N1亚型禽流感病毒传播风险研究

目的 对长沙市家禽市场职业暴露人群进行禽流感病毒（AIV）H5N1亚型抗体水平和环境AIV核酸检测,并对环境中AIV H5N1亚型的血凝素（HA）基因进行测序分析。方法 抽取长沙市1个区和1个县,各选择2个城区或乡镇家禽市场进行职业暴露人群H5N1抗体和环境AIV核酸检测。利用单放射免疫扩散溶血实验（SRH）对102份家禽市场职业暴露人员血清标本进行H5N1抗体检测,real-time PCR方法检测160份家禽市场环境标本（污水、禽类粪便、羽毛和禽类笼具表面涂抹标本）AIV核酸,对4份污水H5N1亚型AIV核酸阳性标本进行HA基因RT-PCR扩增和TA克隆测序,测序结果利用Lasergene和Mega 5.0软件进行氨基酸比对和进化树构建。结果AIVH5N1抗体监测结果显示,家禽市场职业暴露人群血清H5N1抗体阳性率为25.5%（26/102）,其中乡镇和城区家禽市场职业暴露人群阳性率分别为50.0%（9/18）和25.4%（17/67）,乡镇家禽市场职业暴露人群阳性率高于城区。长沙市家禽市场环境中H5亚型AIV核酸阳性率为31.3%（50/160）,其中乡镇家禽市场阳性率为37.3%（31/83）,高于城区家禽市场24.7%（19/77）;不同标本H5亚型AIV核酸阳性率不同：污水（50.0%,24/48）、羽毛（44.5%,4/9）、禽类粪便（29.8%,14/47）和禽类笼具表面涂抹（14.3%,8/56）;差异均有统计学意义（P＜0.01）。TA克隆测序得到4个AIVH5N1亚型HA基因序列,进化树显示4个AIVH5N1亚型HA基因与中国内地和香港禽来源的AIV分离株为同一分组,属于欧亚分支;4个AIV H5N1亚型HA基因受体结合位点氨基酸序列仍然为禽源（QSG）、HA1和HA2蛋白之间连接肽为多个碱性氨基酸序列（RERRRKK或RERRGKK）,与入源AIV H5N1亚型具有相同的受体结合位点和高致病性的分子特征。结论 长沙市家禽市场环境中存在较多数量的AIVH5N1亚型,是导致职业暴露人群抗体阳性率达25.5%的原因之一;环境中存在的AIVH5N1亚型HA基因表现出来的高致病性分子特征,增加了家禽市场环境中发生AIV传播的风险。     

中国0?4岁儿童残疾发生现状:家庭环境的支持效应分析

目的 探讨家庭环境(家庭经济条件、父母社会经济角色)对低龄儿童罹患残疾的关联效应。方法 从2006年第二次全国残疾人抽样调查原始数据库中截取0~4周岁儿童及其父母的信息形成新样本, 总量为73394个。应用SPSS16.0软件, 率或构成比的比较用X2检验, 多因素分析用binarylogistic回归模型。结果 残疾发生的风险在3岁前随着年龄的增长不断升高(0~4岁Ofl值分别为0.47、0.66、0.90、1.56和1.47), 与描述残疾现患水平的“累积”特性密切相关;男童的残疾发生风险要高于女童(0R=0.82);家庭收入越低子女残疾的发生风险则越高(家庭人均收人≤683元, 0?=1.80;彡7255元, 0fi=0.34);在父母同居的家庭中子女残疾发生风险与父母文化程度显著关联, 如是否识字(父P<0.001, OR=2.18;母P=0.02, 0R=1.82)和是否上过小学(父P=0.05, OR=1.56);父亲就业状况与子女残疾的发生关联不显著, 而与母亲的就业状况则显著关联(P=0.02, OR=1.19)。单因素分析显示, 母亲是否为初婚、再婚均与子女残疾发生显著关联, 而与父亲是否再婚的关联显著, 初婚则不显著。但在多因素分析中, 无论父亲还是母亲的婚姻经历均不再显著。结论 家庭环境是影响低龄儿童残疾的直接因素。     

Effect of an educational intervention on Hungarian adolescents’ awareness,beliefs and attitudes on the prevention of cervical cancer

The alarming national data on the mortality and morbidity rates of cervical cancer as well as the results of a Hungarian survey demonstrating adolescents’ low level of understanding of human papillomavirus (HPV) infection and HPV vaccination encouraged the authors to conduct an educational intervention. The aim of this survey was to explore the impact of a brief, HPV-focused program on adolescents’ knowledge, beliefs and attitudes.     

A photovoice documentation of the role of neighborhood physical and social environments in older adults' physical activity in two metropolitan areas in North America

A substantial body of evidence indicates that regular engagement in moderate-intensity physical activity on most days of the week is sufficient for older adults to achieve positive health outcomes. Although there is a growing body of literature that examines the affect of neighborhood environment on physical activity in older adults, the research tends to overlook social aspects that potentially shape the relationship between physical environment and physical activity. This article presents qualitative themes related to the role of the physical and social environments in influencing physical activity among older adults as identified through the photovoice method with sixty-six older adults in eight neighborhoods in metropolitan Vancouver, British Columbia, Canada and Greater Portland, Oregon, USA. The photovoice data generated seven themes: being safe and feeling secure, getting there, comfort in movement, diversity of destinations, community-based programs, peer support and intergenerational/volunteer activities. Although the majority of these themes have explicit or implicit physical and social aspects, certain themes are primarily based on physical environmental aspects (e.g., safe and feeling secure, comfort in movement), while a few themes are more oriented to social context (e.g., peer support, intergenerational activity/volunteering). The themes are discussed with a focus on how the neighborhood physical and social environmental aspects interplay to foster or hinder older adults in staying active in both everyday activities and intentional physical activities. Policy implications of the findings are discussed.     

Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth,Western Australia

Mental health is a public health priority globally. Public Open Space (POS) may enhance mental health by facilitating contact with nature and the development of supportive relationships. Despite growing interest in the influence of the built environment on mental health, associations between POS attributes and mental health remain relatively unexplored. In particular, few studies have examined the relative effects of the quantity and quality of POS within a neighbourhood on mental health. Guided by a social-ecological framework, this study investigated the relationship between POS attributes (i.e., quantity and quality) and better mental health (i.e., low risk of psychological distress) in residents of new housing developments in the Perth metropolitan area, Western Australia. The extent to which relationships between POS attributes and mental health were confounded by psychosocial factors (e.g., social support, sense of community) and frequent use of POS was also explored. Data were obtained from a cross-sectional survey (n = 911), a POS audit, and Geographical Information Systems, and was analysed using logistic regression. Approximately 80% of survey participants were at low risk of psychological distress. Residents of neighbourhoods with high quality POS had higher odds of low psychosocial distress than residents of neighbourhoods with low quality POS. This appeared to be irrespective of whether or not they used POS. However, the quantity of neighbourhood POS was not associated with low psychological distress. From a mental health perspective, POS quality within a neighbourhood appears to be more important than POS quantity. This finding has policy implications and warrants further investigation.