化疗前宣教对癌症患者身心健康的影响

目的:探讨化疗前健康宣教对癌症患者身心健康的影响。方法:选择680例癌症患者按入院的先后顺序分为干预组和对照组各340例例,干预组进行化疗前宣教,对照组按常规进行护理。比较两组患者开始化疗时、化疗后10 d及20 d的抑郁、焦虑、生活质量等情况。结果:两组患者在年龄、性别比例、文化程度、就业方面比较,差异无统计学意义(P>0.05);开始化疗时、化疗后10 d及20 d两组的抑郁、焦虑、生活质量比较,差异均有统计学意义(P<0.05)。结论:加强化疗前宣教可使患者了解化疗的作用、不良反应,且有效的提高了患者化疗后的生活质量。     

强直性脊柱炎住院患者的健康宣教

目的:探讨健康教育在强直性脊柱炎患者中的护理效果。方法:选择强直性脊柱炎患者共40例,上述患者符合强直性脊柱炎诊断标准。将上述患者随机分为观察组和对照组。对照组实施强直性脊柱炎常规护理,不实施健康教育。观察组患者实施健康教育。干预后采用生活质量核心量表(QOL-C30)对两组患者进行问卷调查。结果:观察组干预后躯体功能、心理功能、社会功能、物质生活与对照组干预后比较,差异有统计学意义(P<0.05)。结论:健康教育有助于提高强直性脊柱炎患者生存质量,护理效果显著,值得借鉴。     

What (or who) causes health inequalities: Theories,evidence and implications?

Health inequalities are the unjust differences in health between groups of people occupying different positions in society. Since the Black Report of 1980 there has been considerable effort to understand what causes them, so as to be able to identify actions to reduce them. This paper revisits and updates the proposed theories, evaluates the evidence in light of subsequent epidemiological research, and underlines the political and policy ramifications.     

健康教育对习惯性流产患者社会支持和抑郁的影响

目的:探讨健康教育对于习惯性流产患者社会支持和抑郁的影响.方法:选择2010年6月～ 2011年6月习惯性流产患者140例,随机分为实验组(健康教育组)70例和对照组70例,对照组实施常规护理,而实验组在对照组的基础上进行健康教育的干预,用社会支持量表(SSQ)和汉密尔顿抑郁量表对两组患者在干预前后进行测量,比较评分结果.结果:实验组社会支持总分与对照组相比明显提高,抑郁总分较对照组明显下降.结论:在临床护理中应注重与患者建立良好的护患关系;对患者进行健康教育对习惯性流产患者抑郁的缓解及社会支持水平的提高是有效的.     

Dealing with moral dilemma raised by adaptive preferences in health technology assessment: The example of growth hormones and bilateral cochlear implants

The aim of this article is to assess dilemma raised by adaptive preferences in the economic evaluation of growth hormone (GH) treatment for non-GH-deficient short children, and of bilateral cochlear implants for deaf children. Early implementation of both technologies and their irreversible consequences increase the potential conflicts faced by the assessors of health-related quality of life (HRQoL) states (on behalf of patients) who could be interviewed (parents, individuals with an experience of the same disability, or representative samples of the general public). Indeed, assessors' preferences may be influenced by their own situation and they are likely to vary according to age and the experience of disability. Three options are put forward which aim to resolve these moral dilemma and help economists make methodological choices that cannot be avoided in order to carry out this assessment. They are grounded on three specific egalitarian theories of social justice. The main contribution of this article is to show that a dialogue between ethics and economics, prior to an assessment, makes it possible to redefine the choice of effectiveness criteria (subjective well-being, capabilities or social outcomes), the choice of perspective (patients or the able-bodied), as well as the scope of assessment (medical and non-medical care).     

How do you measure trust in the health system? A systematic review of the literature

People's trust in the health system plays a role in explaining one's access to and utilization of medical care, adherence to medications, continuity of care, and even self-reported health status. Yet it is not easy to find trust measures and understand what they are measuring. A systematic review of scales and indices identified 45 measures of trust within the health system with an average of 12 questions each, which quantified levels of trust among various relationships across the health system. Existing evidence was narrow in scope, where half examined the relationship between doctors/nurses and patients, and the majority were designed, tested and validated in the United States. We developed a health systems trust content area framework, where we identified that honesty, communication, confidence and competence were captured frequently in these measures, with less focus on concepts such as fidelity, system trust, confidentiality and fairness. Half of the measures employed a qualitative method in the design of these measures and 33% were pilot tested. Reporting of test–retest reliability and inter-rater reliability were less common. This review identifies a need to develop measurements of trust beyond doctor–patient relationships and outside of U.S. contexts, and strengthen the rigor of existing trust measures. Greater development and use of trust measures in the health system could improve monitoring and evaluation efforts, which may in turn result in better health outcomes.     

Exercise,physical activity,and exertion over the business cycle

Shifts in time and income constraints over economic expansions and contractions would be expected to affect individuals' behaviors. We explore the impact of the business cycle on individuals' exercise, time use, and total physical exertion, utilizing information on 112,000 individual records from the 2003–2010 American Time Use Surveys. In doing so, we test a key causal link that has been hypothesized in the relation between unemployment and health, but not heretofore assessed. Using more precise measures of exercise (and other activities) than previous studies, we find that as work-time decreases during a recession, recreational exercise, TV-watching, sleeping, childcare, and housework increase. This, however, does not compensate for the decrease in work-related exertion due to job-loss, and total physical exertion declines. These effects are strongest among low-educated men, which is validating given that employment in the Great Recession has declined most within manufacturing, mining, and construction. We also find evidence of intra-household spillover effects, wherein individuals respond to shifts in spousal employment conditional on their own labor supply. The decrease in total physical activity during recessions is especially problematic for vulnerable populations concentrated in boom-and-bust industries, and may have longer-term effects on obesity and related health outcomes.     

Exploring the health consequences of majority–minority neighborhoods: Minority diversity and birthweight among native-born and foreign-born blacks

We examined the association between neighborhood minority diversity and infant birthweight among non-Hispanic US-born black women and foreign-born black women from Sub-Saharan Africa and the non-Spanish speaking Caribbean using 2002–2006 vital statistics birth record data from the state of New Jersey (n = 73,907). We used a standardized entropy score to measure the degree of minority diversity (i.e., non-white multiethnic racial heterogeneity) for each census tract where women lived. We distinguished between four levels of minority diversity, with the highest level representing majority–minority neighborhoods. We estimated mean birthweight for singleton births over this 5-year period using linear regression with robust standard errors to correct for clustering of mothers within census tracts. We found significant differences in mean birthweight by mother's country of origin such that infants of US-born black mothers weighed significantly less than the infants of African and Caribbean immigrants (3130 g vs. 3299 g and 3212 g; p < 0.001). Adjustments for neighborhood deprivation, residential instability, individual-level sociodemographics, maternal health behaviors and conditions, and gestational age did not reduce these origin differences. Minority diversity had a protective effect on black infant health. Women living in low and moderately diverse tracts as well as those in majority–minority neighborhoods had heavier babies (β = 26.5, 29.8 and 61.2, respectively, p < 0.001) on average than women in the least diverse tracts. The results for majority–minority neighborhoods were robust when we controlled for neighborhood- and individual-level covariates.     

India's “tryst” with universal health coverage: Reflections on ethnography in Indian health policymaking

In 2011, India stood at the crossroads of potentially major health reform. A High Level Expert Group (HLEG) on universal health coverage (UHC), convened by the Indian Planning Commission, proposed major changes in the structure and functioning of the country's health system. This paper presents reflections on the role of ethnography in policy-based social change for health in India, drawing from year-long participation in the aforementioned policy development process. It theorizes that international discourses have been (re)appropriated in the Indian case by recourse to both experience and evidence, resulting in a plurality of concepts that could be prioritized for Indian health reform. This articulation involved HLEG members exerting para-ethnographic labour and paying close attention to context, suggesting that ethnographic sensibilities can reside within the interactive and knowledge production practices among experts oriented toward policy change.