濮阳市社区卫生服务网络实施效果评价

目的 对濮阳市社区卫生服务网络的实施效果进行评价，探讨适合经济欠发达地区中小城市的社区卫生服务网络模式。方法 选取濮阳市城乡居民8231人进行问卷调查，分析社区卫生服务网络实施前、后居民社区卫生服务需求率和满意度及慢性非传染性疾病患者的一般情况。结果 社区慢性非传染性疾病患病率为75．4％o。社区卫生服务网络实施前、后居民对社区卫生服务的需求卒、满意度、卫生知识掌握率、不良行为暴露率及高血压患者的行为改善率、正规服药率和血压控制达标率间差别均有显著性意义（P〈0．05）。结论 建立适合本地特点的社区卫生服务网络模式有利于提高社区居民的健康保健知识和促进慢性病的管理。社区健康教育在社区卫生服务工作中占据着重要地位。     

中医临床医师研修需求的分析

对广东、福建、湖南、湖北等地的中医临床工作者随机发放问卷,对中医临床工作者的研修目的、认为最需要提高的方面、最理想的进修方法、跟师形式、学习时间安排等9个方面进行了调查,统计分析。提示我们应该根据中医临床医师的需求,采取院校教育与"师带徒"培养相结合的方式,在全面培训的基础上,侧重加强其基础理论知识的积累和临床应用能力的提高,从而更加有效地发挥继续教育的作用。     

Consumer health information: the role of breast cancer associations

Background. Providing information for patients is currently a growth need for health professionals, medical journals, and consumer associations. Despite several patients or consumers associations being active in Italy, scarce evidence is available on the volume and type of activities carried out. A national survey was carried out to investigate the volume and the nature of phone requests for information addressed to associations belonging to the Italian Forum of EUROPA DONNA, an European movement active in 28 countries, working to raise public awareness of breast cancer. Methods. A structured questionnaire was sent to all EUROPA DONNA breast cancer associations to be filled in by the persons in charge for delivering the telephone information. Results. Of the 87 breast cancer associations contacted, 41 (47%) participated to the survey, completing a total of 2383 questionnaires for 4251 kinds of information. Most of the people who called were women and about 57% were breast cancer patients. A wide range of information were required: 29% on prevention, 22% on practical problems of daily life, 23% on services actually offered by breast cancer associations, 10% on psychological counselling, and finally 14% for advice on primary therapy and follow-up. In more than one-third of phone calls, people were looking for opinion from women who personally experienced a breast cancer. Conclusion. This survey shows that breast cancer associations receive daily requests of information and convey a wide range of information. The findings underline the need to create meaningful partnership between health professionals and patient's associations in the complex field of information and communication.     

高等教育供求关系与卫生人力客观调控

本文对经济高速发展条件下高等教育供求关系进行理论研究。采用比较研究法探讨浙江省到2020年卫生人力的发展目标。采用卫生人力与人口比值法对浙江省卫生人力需求进行仿真预测。以浙江省卫生人力情况为蓝本的研究表明：到2020年每千人口医生数达到发达国家20世纪90年代每千人口医生数的平均水平（2．4）时，才能满足浙江省的实际需要。     

社区合同式健康管理需求调查及影响因素研究

目的了解社区合同式健康管理服务需求及其影响因素。方法以方庄社区芳星园年龄>18岁的居民为研究对象,结合合同式健康管理服务需求及其影响因素的内容进行问卷调查和定性访谈。结果居民对合同式健康管理服务需求最大的是基本医疗服务,其次是预防保健服务。合同式健康管理需求受年龄、对家庭医生认知情况、职业、收入水平及是否患慢性病等多种因素影响,其中年龄、对家庭医生认知情况是影响合同式健康管理服务的主要因素。结论不同人群对合同式健康管理服务有不同层次的需求,社区卫生服务机构应结合市场需求调查相关影响因素,加强对合同式健康管理的宣传,制定合理的服务合同内容,并逐步规范管理。     

城市居民卫生服务状况纵向分析

本文通过3次卫生服务调查的纵向比较,对我国城市居民卫生服务状况进行了总结,并在分析现状的基础上,展望了今后社区卫生服务的发展前景。     

用ELES模型分析城镇居民药品需求弹性

目的:定量研究我国城镇居民药品需求弹性。方法:运用扩展的线性支出系统模型分析2003年我国城镇居民各项消费支出及可支配收入的截面数据,计算边际消费倾向值、需求收入弹性值和需求价格弹性值。结果与结论:药品价格的变化对药品需求影响较小,城镇居民的药品消费属于生活必需品消费。     

设立妇幼专科护理门诊社会需求的调查研究

目的探讨设立妇幼专科护理门诊的可行性.方法对491例门诊就诊对象进行护理门诊社会需求调查,应用EPIinfo 6.0软件包进行相关分析.结果 100%调查对象认为医院应该设立护理门诊以满足就医者的健康咨询.结论有病就医已不再是人们到医院的惟一目的.设立护理门诊可满足就诊者多元化的需求;护理学科的发展现状能够满足护理门诊的需求;护理门诊的设立将强化医疗门诊作用.     

慢性病人社区卫生服务需求影响因素分析

目的探讨深圳市慢性病病人社区卫生服务需求、利用及其影响因素,为慢性病社区综合防治的实施提供科学依据。方法采取分层随机抽样方法,抽取深圳市26个社区1841名15岁以上常住居民,对其进行问卷调查。调查内容包括:人口社会学特征、慢病患病情况、两周患病情况、社区卫生服务实际利用及意愿等。结果深圳市慢性病患病率为20·86%,前10位慢性病是高血压、类风湿性关节炎、视力问题、慢性胃肠炎和消化性溃疡、睡眠困难、椎间盘疾病、偏头痛、龋齿、冠心病、糖尿病。因素分析表明,社区慢病卫生服务受社区康复服务中心设点布局、就诊手续和环节等因素影响。结论提高社区卫生服务的可及性和方便程度,才能促进慢性病人有效利用社区卫生服务。     

Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies

Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty-six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two-factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC-curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC-curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants' Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs' alpha with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler-Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.