上海市某健康社区居民健康知识与健康行为干预效果

目的 探索健康社区建设工作对提高居民健康知识知晓程度与促进居民健康行为形成水平的效果.方法 采用多阶段抽样方法,使用统一的调查问卷,分别在2009年4月和2011年10月,对上海市某健康社区所辖11个镇/街道的768名居民进行干预前的基线调查和干预后的追踪调查.结果 干预后该健康社区居民对健康知识的知晓率(82.69％)高于干预前(70.63％),干预后的健康行为形成率(74.36％)高于干预前(63.06％),干预前后健康知识知晓率的差异和干预前后健康行为形成率的差异均有统计学意义(P＜0.01).结论 健康社区建设工作可以有效提高居民对健康知识的知晓程度,可以有效促进居民健康行为的形成水平,应持续大力推广健康社区建设工作.     

Sampling methods for the study of pneumococcal carriage: A systematic review

Streptococcus pneumoniae is an important pathogen worldwide. Accurate sampling of S. pneumoniae carriage is central to surveillance studies before and following conjugate vaccination programmes to combat pneumococcal disease. Any bias introduced during sampling will affect downstream recovery and typing. Many variables exist for the method of collection and initial processing, which can make inter-laboratory or international comparisons of data complex. In February 2003, a World Health Organisation working group published a standard method for the detection of pneumococcal carriage for vaccine trials to reduce or eliminate variability. We sought to describe the variables associated with the sampling of S. pneumoniae from collection to storage in the context of the methods recommended by the WHO and those used in pneumococcal carriage studies since its publication. A search of published literature in the online PubMed database was performed on the 1st June 2012, to identify published studies that collected pneumococcal carriage isolates, conducted after the publication of the WHO standard method. After undertaking a systematic analysis of the literature, we show that a number of differences in pneumococcal sampling protocol continue to exist between studies since the WHO publication. The majority of studies sample from the nasopharynx, but the choice of swab and swab transport media is more variable between studies. At present there is insufficient experimental data that supports the optimal sensitivity of any standard method. This may have contributed to incomplete adoption of the primary stages of the WHO detection protocol, alongside pragmatic or logistical issues associated with study design. Consequently studies may not provide a true estimate of pneumococcal carriage. Optimal sampling of carriage could lead to improvements in downstream analysis and the evaluation of pneumococcal vaccine impact and extrapolation to pneumococcal disease control therefore further in depth comparisons would be of value.     

Holism in Osteopathy – Bridging the gap between concept and practice: A grounded theory study

Background and objectivesThis study aimed to explore the meaning of holism to Osteopathic professionals and thus develop a theory to inform the gap between holism as a concept and its implementation in clinical practice.MethodsOsteopathic practitioners were purposively selected resulting in eight participants from eight clinics in different demographic regions of Melbourne, Australia. In depth interviews were conducted and data was analysed using grounded theory methodology.ResultsResults demonstrate that an understanding of holism in osteopathic health care (in education and clinical practice) required an “awareness of relationships”. The emerging theory relates concept and educational framework (i.e. both biomedical and holistic philosophical approaches), with the practice of holism and describes what holism means within the context of an individual treatment.ConclusionImplications are for osteopathic education to provide a balanced emphasis between holistic and biomedical frameworks and theoretical insight into understanding patients presenting with chronic health issues.     

El proceso de institucionalización de la enfermera gestora de casos en España. Análisis comparativo entre los sistemas autonómicos de salud

Care of chronicity is a pressing issue for health systems because of its high prevalence and the organisational challenges that it generates. Different countries solve the complexity of the care of chronicity through case management by the nursing profession, obtaining good results.This paper analyses the status of institutionalisation of the case management nurse in Spain through the design of a reference standard to compare between the autonomous communities in their approach to chronicity. Thus, we sought to monitor the degree of progress of the institutional structure of the policies for the care of chronicity in our country through this healthcare professional. Our results showed that no autonomous community has reached the maximum standard of implementation and that the situation is very heterogeneous, confirming a weak and erratic degree of institutionalisation of the case management nurse in Spain despite the formal recognition of their role in patient care.