泉州市心脑血管疾病患病现状及卫生需求调查研究

目的调查泉州市心脑血管疾病患病现状及卫生需求,为临床防控、健康教育干预等工作提供参考。方法选择泉州市第一医院2012—1013年收治的心脑血管疾病患者736例,于首次就诊时采用自行设计的患病现状和卫生需求调查表及诺丁汉健康调查问卷(NHP)进行调查。根据卫生需求调查结果对患者进行有针对性的健康指导和干预,并于3个月后评估其生活质量。结果 736例患者中心血管疾病、脑血管疾病分别为368例(占50.0%),267例(占36.3%);患者对发病原因、治疗措施及疾病预后的需求较高,分别为98.9%、97.7%、94.7%;就诊3个月后患者精力、疼痛、情感、睡眠、社会活动及身体活动方面评分均低于首次就诊(P0.05)。结论卫生工作者了解心脑血管疾病患病现状及卫生需求并进行有针对性的临床防控、健康教育干预,有利于心脑血管疾病的诊治、保健和康复,提高患者生活质量。     

社区老年耳聋患者听力保健认知现状及健康教育需求调查

目的了解社区老年耳聋患者对听力保健知识的知晓情况、健康教育的需求及希望接受的健康教育方式,为实施针对性的健康教育提供依据。方法采用、自行设计的听力保健知识健康需求问卷对社区150例老年耳聋患者进行问卷调查,了解患者听力保健知识的认知现状和健康教育的需求。结果老年耳聋患者的听力保健基础知识的知晓率均较低,其中对早期发现听力下降的重要性知晓率最高,为82．67％;其次为听力下降的危害,为70．67％;知晓率最低的是常见耳毒性药物,为23．33％。对听力保健健康教育知识的需求最高的是如何早期发现听力异常100．00％、保护老人听力的基本方法100．00％等;对听力保健健康教育方式需求率较高的是一对一教育指导96．67％、社区授课94．67％。结论应开展形式多样的健康教育,提高老年耳聋患者的听力保健知识水平,指导养成健康的听力保健行为,以减轻或延缓听力的进一步下降。     

Review article: efficacy and safety of rabeprazole in treating gastroesophageal reflux disease

Proton pump inhibitors (PPI) are the mainstay of gastroesophageal reflux disease (GERD) treatment. They have a good efficacy and short- and long-term safety profile. Rabeprazole is a second generation PPI with rapid onset of action that quickly relieves symptoms of GERD. Rabeprazole consistently and profoundly inhibits gastric acid secretion. Its metabolism is less dependent on CYP4502C19 system and therefore is the least affected among all PPIs by CYP4502C19 genetic polymorphism. Recent studies have also indicated that rabeprazole on-demand is cost effective in preventing non-erosive reflux disease (NERD) symptom relapse.     

The WHO Tailoring Immunization Programmes (TIP) approach: Review of implementation to date

IntroductionThe WHO Regional Office for Europe developed the Guide to tailoring immunization programmes (TIP), offering countries a process through which to diagnose barriers and motivators to vaccination in susceptible low vaccination coverage and design tailored interventions. A review of TIP implementation was conducted in the European Region.Material and methodsThe review was conducted during June to December 2016 by an external review committee and was based on visits in Bulgaria, Lithuania, Sweden and the United Kingdom that had conducted a TIP project; review of national and regional TIP documents and an online survey of the Member States in the WHO European Region that had not conducted a TIP project. A review committee workshop was held to formulate conclusions and recommendations.ResultsThe review found the most commonly cited strengths of the TIP approach to be the social science research as well as the interdisciplinary approach and community engagement, enhancing the ability of programmes to “listen” and learn, to gain an understanding of community and individual perspectives. National immunization managers in the Region are generally aware that TIP exists and that there is strong demand for the type of research it addresses. Further work is needed to assist countries move towards implementable strategies based on the TIP findings, supported by an emphasis on enhanced local ownership; integrated diagnostic and intervention design; and follow-up meetings, advocacy and incentives for decision-makers to implement and invest in strategies.ConclusionsUnderstanding the perspectives of susceptible and low-coverage populations is crucial to improving immunization programmes. TIP provides a framework that facilitated this in four countries. In the future, the purpose of TIP should go beyond identification of susceptible groups and diagnosis of challenges and ensure a stronger focus on the design of strategies and appropriate and effective interventions to ensure long-term change.     

Meeting women’s demand for contraceptives in Ghana: Does autonomy matter?

This study addressed a basic conceptual gap in research on the relationship between women’s autonomy and contraceptive behavior and included intention to use while measuring the unmet demand for family planning. The study used data from the 2014 Ghana Demographic and Health Survey. The weighted sample included 2,017 sexually active, non-pregnant, fecund women in unions, aged 15–49 years, who wanted to delay conception for at least 2 years. The relation of household decision-making autonomy to current contraceptive use and intention was assessed, adjusting for women’s socio-demographic, partner, and couple characteristics. About half of the women studied had a met demand for contraception, and over a third had no intention to use a contraceptive method in the future. In adjusted multinomial logistic regression models, household decision-making autonomy was not significantly associated with met contraceptive demand for contraceptives, but was associated with their intentions to use contraception (p = .05). Formal education, age, wealth, and region of residence were significantly associated with having a met demand. In Ghana, women’s household decision-making autonomy appears to have modest relation to contraceptive uptake. Programs to improve meeting contraceptive demand should consider contextual factors and place differences in contraceptive uptake.     

Conditional cash transfer policies in maternal health service utilization in Nepal: Analysis of safe delivery incentive program (Aama Surakshya Karyakram) using Kingdon's multiple streams framework

Various factors limit access to and utilization of health services even when provided at subsidized cost. This results in poor utilization of services that contributes to further economic impoverishment and health care disparity. Many countries are experimenting with various approaches to tackle the poor utilization of health care services including demand‐side financing policy. This paper explains the policymaking process during the formulation of safe delivery incentive program, a conditional cash transfer program in Nepal using Kindgon's multiple streams framework. Analysis of earlier policies and programs around safe motherhood concludes that high transportation cost was a major cause for poor utilization of institutional obstetric care, despite being provided at free of cost. Health was recognized as fundamental constitutional right in 2007. This assured societal support and political commitments for protecting health constitutionally. Furthermore, there was commitment from external development partners (EDPs) for investment in maternal health. Together, these problem, policy, and politics opened Kingdon's “windows of opportunity” for formulation of conditional cash transfer policy. This paper presents evolution of Aama Surakshya Karyakram and uses Kingdon's multiple streams framework to explain how problem, policy, and politics streams converged together to allow this program to be introduced in Nepal.     

甘肃省卫生人力资源公平性及预测研究

目的对甘肃省卫生人力资源配置现状及公平性进行分析,对2019—2023年需求数量进行预测,为甘肃省卫生人力资源发展规划提供参考建议。方法运用洛伦兹曲线和基尼系数对甘肃省卫生人力资源配置的公平性进行研究;运用时间序列模型对甘肃省2019—2023年卫生人力资源需求量进行预测。结果 2018年甘肃省所属每千人口卫生技术人员、执业(助理)医师和注册护士分别为5.2名、2.0名和1.9名。按人口配置的基尼系数均小于0.4的临界值;按地理配置的基尼系数均超过0.6,处于高度不公平状态。预测到2023年甘肃省卫生技术人员、执业(助理)医师和注册护士的人数分别为167 471人、40 534人和53 657人。结论甘肃省卫生人力资源配置的人口公平性优于地理公平性;卫生人力资源发展速度缓慢,医护比不合理,全省医疗人力资源不足;甘肃省在未来五年对卫生人力资源的需求量很大,需要进一步重视卫生人力资源的开发,扩大人才队伍建设规模。     

高原某部驻训官兵健康教育需求分析

 目的 了解高原官兵健康教育需求情况,为健康教育方案提供科学依据。方法 采用随机抽样法选择四川省阿坝州红原县某部官兵423名为研究对象进行问卷调查,内容包括高原卫生、高原防护等相关知识的掌握情况,官兵对健康教育的需求和喜好方式,并对结果进行比对分析。结果 所有驻训官兵对健康基本知识较为熟悉,但对高原疾病预防的掌握程度较差;在各项知识的掌握程度上,老兵较熟悉健康基本知识(53.2%)及高原训练伤知识(31.2%),明显高于新兵的47.4%和22.7%。新兵和老兵在健康教育的需求及获得方式上均有所不同。结论 高原官兵对健康教育需求迫切,应有针对性地开展官兵易于接受的健康教育。     

基于EICU患者家属心理需求的护患认知差异分析

目的了解EICU患者家属需求的期望值及护士对EICU患者家属需求的满足现状及认知差异。方法应用急危重患者家属需求量表(CCFNI)对42名EICU患者家属及72名护士进行心理需求调查,内容包括获得支持领域、获取信息领域、病情保证领域、接近患者领域和自身舒适领域。结果护士在信息、接近、舒适及保证因子评分低于患者家属的评分,有显著性差异(P<0.01);家属最重要的需求是保证需求。结论 EICU护士对患者家属一些需求重视不足。及时与患者家属进行沟通,理解和重视患者家属的心理需求,可以减轻EICU患者家属的负性心理,减少医患纠纷。