中国六省及自治区小儿脑性瘫痪患病状况的调查

目的 调查中国1－6岁小儿脑性瘫痪（简称脑瘫）的患病现状。方法 1997年5月－1998年12月在中国江苏等6个省及自治区对1－6岁小儿脑性瘫痪现况进行了整群抽样调查。结果 共调查1－6岁儿童1047327名,诊断脑瘫患儿2009例,患病率为1．92‰,男性的患病率为2．24‰,女性为1．55‰;孕周小于37周的早产儿患病率为35．13‰,足月儿患病率为1．58‰,过期产儿的患病率为2．1‰。结论 本组合资料脑瘫的患病率与世界各国家及地区相比处于较低范围,这可能与中国早产儿发生率低和早产儿存活率低有关;同时脑瘫患病率还与地区、性别、年龄、民族、出生体重及孕周有关。     

Drug expenditure in hospitals: what do German ward physicians know?

AIMS:Ward physicians hold key positions in the course of efforts to reduce drug expenditures in hospitals. This study evaluated the knowledge of German hospital physicians with respect to the daily therapeutic costs of 21 frequently used drugs. METHODS: A questionnaire survey was carried out among 168 ward physicians from university and municipal hospital departments of internal medicine. RESULTS: One hundred and twenty-seven physicians returned a completed questionnaire, a response rate of 75.6%. On average the physicians successfully identified both low cost and expensive drugs. The prices of inexpensive and moderately expensive drugs were generally overestimated whereas those for the expensive and highly expensive drugs were underestimated in 35% and 68% of respondents, respectively. CONCLUSIONS: The results of this survey of German hospital physicians suggest that a more economically efficient use of drugs could be achieved by an improved knowledge of daily therapeutic costs.     

Subject health concepts and health-related quality of life--is there a correlation?

ZusammenfassungFragestellung Patienten in Allgemeinpraxen sowie erwachsene und jugendliche Mitglieder von Sportvereinen wurden zu ihrem subjektiven Gesundheitskonzept, zur gesundheitsbezogenen Lebensqualität und Gesundheitsbewertung von Alltagstätigkeiten befragt.Methoden Insgesamt 221 Personen (Response Rate: 84%) nahmen an der explorativen Studie teil.Ergebnisse Gesundheit wurde oft als höchster Wert im Leben oder normales Funktionieren von Körper und Geist oder vollständiges Wohlbefinden definiert. Neben Sport bewerteten sehr viele Befragte Schlaf und Freizeit als sehr wichtig für ihre Gesundheit. Einzelne Dimensionen der Lebensqualität korrelierten mit einer (negativen oder positiven) gesundheitsbezogenen Bewertung von Alltagstätigkeiten, z.B. der körperliche Status und die gesundheitsbezogenen Bewertung des Fernsehens. Innerhalb der einzelnen Stichproben wurden die Personen danach unterschieden, ob für sie ein bestimmtes Gesundheitskonzept (z.B. Wohlbefinden) von hoher subjektiver Bedeutung war oder nicht. Anschliessende multiple Regressionen zeigten, dass die Gesundheitsbewertung jeweils anderer Tätigkeiten mit der Lebensqualität assoziiert war, dieser Zusammenhang manchmal negativ, manchmal positiv war und insgesamt mehr Varianz in den Regressionsmodellen aufgeklärt wurde.Schlussfolgerungen Widersprüchliche Korrelationen zwischen der Bewertung von Alltagstätigkeiten, Gesundheitskonzept und Lebensqualität stellen einen linearen Zusammenhang von Gesundheitskonzept und Gesundheitshandeln in Frage. Die Förderung der Gesundheit sollte sich stärker noch als bisher am jeweiligen Lebenszusammenhang und individuellen Einstellungen orientieren.

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SummaryObjectives The aim of this study was to explore associations between lay concepts of health, quality of life and the health-related evaluation of daily activities.Methods A total of 221 persons (patients from general practice and adult as well as young members of sporting clubs) participated in the study (response rate: 84%).Results Health was often defined as highest value of life; normal functioning of body and soul and complete well-being. Many persons considered sports, sleeping and leisure time being highly important for their health. The single dimensions of quality of life were associated with some health-related evaluations of daily activities, e. g., bodily functioning and health-related evaluation of television. Dividing the sample into persons who did or did not consider a certain concept of health (e. g., well-being) to be highly important had the following consequences: The quality of life was associated with different evaluations of daily activities in different strata; this association was sometimes negative, sometimes positive in different strata; more variance was explained by dividing the sample into different strata.Conclusions The often contradictory associations between evaluation of everyday activities, lay concepts of health and quality of life should warn us not to think of health concepts and health actions in form of linear relations. Rather, health promotion should be more stronger oriented towards the individual's life conditions and his or her attitude to health.

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RésuméObjectifs Une enquête a été effectuée auprès de patients de cabinets de médecine générale et parmi des membres de clubs sportifs, jeunes et adultes sur le concept subjectif de la santé, la qualité de la vie et l'évaluation d'activités quotidiennes en ce qui concerne la santé.Méthodes Au total, 221 personnes (taux de réponses: 84%) ont pris part à cette étude prospective.Résultats La santé a souvent été définie comme valeur la plus importante dans la vie ou comme fonctionnement normal du corps et de l'esprit ou encore comme bien-être complet. Un grand nombre de personnes interrogées ont estimé qu'à côté du sport, le sommeil et les loisirs étaient très importants pour leur santé. Les dimensions individuelles de la qualité de la vie étaient en corrélation avec une évaluation des activités quotidiennes par rapport à la santé, par ex. l'état corporel et l'évaluation de la télévision par rapport à la santé. A l'intérieur de chaque échantillon on a fait la distinction entre les personnes pour qui un certain concept de santé (par ex. bien-être) avait une grande importance subjective ou non. Les régressions multiples suivantes ont montré que l'évaluation de la santé était associée à la qualité de la vie suivant des activités différentes, ce rapport était parfois négatif, parfois positif et que dans l'ensemble on a décelé plus de variance dans les modèles de régression.Conclusions Des corrélations contradictoires entre l'évaluation d'activités quotidiennes, le concept de santé et la qualité de la vie remettent en question le rapport linéaire entre le concept de santé et l'action de santé. La promotion de la santé devrait s'orienter encore plus fortement que jusqu'alors sur les conditions de vie individuelles et sur les points de vue respectifs.

     

Prevalence and morbidity associated with non-malignant, life-threatening conditions in childhood

OBJECTIVE: To determine the prevalence of non-malignant life-threatening illness in childhood and associated morbidity in the affected child and their family members. DESIGN: Cross-sectional survey. SETTING: Bath Clinical Area (total population 411,800). SUBJECTS: Children aged 0-19 years. RESULTS: One hundred and twenty-three children were identified, giving a prevalence of 1.2/1000 children. Morbidity assessed in 93 children showed 60% in pain or discomfort, 35% unable to walk and 25% with severe cognitive impairment. Mental health problems were found in 54% of mothers and 30% of fathers, and significant emotional and behavioural problems in 24% of healthy siblings. CONCLUSIONS: Non-malignant life-threatening illness is more prevalent than reported in previous studies. Considerable morbidity is experienced by the child and their family. An individual and family approach is required. Key messages (1) The prevalence of non-malignant life-threatening illness is four times greater than previous estimates. (2) This group of conditions have significant implications for all family members. (3) Early comprehensive assessment and access to effective interventions may pre-empt later problems.     

Socio-economic and locational determinants of accessibility and utilization of primary health-care

Differences in levels of utilization vary and are a function of socio-economic and geographical factors. This paper presents the results of a questionnaire study involving twelve GP practices in Northamptonshire, UK, of factors which affect access and utilization in asthmatics and diabetics; these groups were selected to control for differences in utilization behaviour, as a result of different aetiologies. The questionnaire sought data on: residential location of patients, utilization characteristics of primary health-care, personal circumstances and mobility and hindrances to access and utilization. Key themes were identified relating to age, gender, social class, employment, ethnicity and proximity to the GP surgery. The young, elderly and females report higher rates of utilization, as do nonmanual workers and those who are unemployed. However, accessibility and utilization vary greatly in response to mobility and locational characteristics; these variations tend to be masked by data on overall rates of usage. Optimal scaling techniques were used to investigate the interactions between the factors affecting accessibility and utilization, and to characterize patients in terms of their levels of utilization. Results confirmed that current service provision afforded a differential level of service to patients, which does not directly reflect their level of need.     

Management of hepatitis C patients by primary care physicians in the USA: results of a national survey

Hepatitis C is a major health problem worldwide, yet very little research has been performed to assess the knowledge base and practice patterns of primary care physicians (PCPs) regarding hepatitis C. The aim of this study is to determine the knowledge base and practice patterns of a nationwide cohort of PCPs. A survey was developed to assess the knowledge of PCPs regarding risk factors for hepatitis C, management of hepatitis C patients and attitude regarding testing for hepatitis C. The survey was mailed to 4000 PCPs in the USA. A total of 1412 (39%) PCPs completed the survey. The vast majority, > 90%, of PCPs correctly identified the most common risk factors for hepatitis C. However, only 59% indicated they ask all patients about hepatitis C risk factors, 70% reported they test all patients with hepatitis C risk factors and 78% test all patients with elevated liver enzymes for hepatitis C. Most (72%) PCPs would refer an HCV-positive patient with elevated aminotransferase but only 28% would refer an HCV-positive patient with normal aminotransferase to a specialist. One-fourth of the PCPs did not know what treatment to recommend for hepatitis C patients. Our data suggest that hepatitis C patients may be underdiagnosed and under-referred. Specific educational initiatives and practice guidelines for PCPs are needed to optimize the recognition of patients at risk for hepatitis C and to ensure appropriate testing and referral.     

Exposure to Schistosoma mansoni infection in a rural area of Brazil. I: water contact

The study of water contact patterns in rural Brazil presents unique challenges due to widely dispersed settlement patterns, the ubiquity of water contact sites, and the privatization of water resources. This study addresses these challenges by comparing the two most widely used methods of assessing water contact behaviour: direct observation and survey. The results of a 7-day direct observation of water contact were compared with water contact surveys administered 1 week after and then 1 year after the direct observation study. The direct observation study recorded a water contact rate higher than reported by other investigators (3.2 contacts per person per day); however, 75% of these contacts were for females and consisted mainly of domestic activities occurring around the household. A comparison of the frequency of water contact activities between the direct observation and the two surveys revealed several important points. First, no significant differences were found between methods for routine water contact activities (e.g. bathing), indicating that participants were able to accurately self-report some types of water contact activities. Second, significant differences were found in the recording of water contact activities that took place outside the observation area, indicating that direct observation may under-report water contact activities in areas where contact sites are dispersed widely. Third, significant differences between the direct observation and the survey method were more common for males than for females, indicating that the combination of widespread water contact sites and gender-specific division of labour may result in under-reporting of male contacts by direct observation methods. In short, despite the limitations in the recording of duration and body exposure, the survey method may more accurately record the frequency of water contact activities than direct observation methods in areas of widely dispersed water contact sites. Hence, surveys may be more suitable for the unique challenges of water contact in rural areas of Brazil.     

Lay recommendations on how to treat mental disorders

Background Beliefs about the helpfulness of interventions are influencing the individual help-seeking behavior in case of mental illnesses. It is important to identify these beliefs as professional helpers are asked to consider them in their treatment recommendations. Objective Assessing lay proposals for an appropriate treatment of mental illnesses. Methods We conducted a representative opinion survey in Switzerland. Eighteen treatment proposals were presented with respect to a vignette either depicting schizophrenia or depression. Respondents were asked to indicate the proposals considered to be helpful for treatment and those considered to be harmful, respectively. Results‘Psychologist,’‘general practitioner,’‘fresh air,’ and ‘psychiatrist’ were mostly proposed as being helpful. Among several psychiatric treatment approaches ‘psychotherapy’ was favored, while psychopharmacological treatment and electroconvulsive therapy were only proposed by less than one-fourth of the interviewees. Especially psychotropic drugs were considered to be harmful. Treatment by a psychiatrist was regarded as being more helpful for schizophrenic individuals than for depressive persons. For a person experiencing a life crisis, treatment by a psychiatrist and psychological treatment were viewed as being harmful, and non-medical interventions were preferred. However, for persons thought to be mentally ill, psychiatric and psychopharmacological treatments were recommended. Conclusion Mental health professionals are regarded as being helpful although their treatment methods are seen as being less helpful. A clear distinction is made between lay proposals for depression and schizophrenia. However, the perception of whether a condition is considered to be an illness or a life crisis has significantly more influence on lay treatment proposals than the cited diagnosis in the vignette. Accepted: 3 September 2001     

重庆市中老年人群膳食结构分析

目的了解重庆市城乡中老年人群膳食结构和营养状况,为开展营养教育和营养改善工作提供科学依据。方法选用2002年中国居民营养与健康状况调查重庆地区的资料,运用食物频率询问法调查887名40岁及以上居民,对每个调查对象过去1年中的各类食物摄入频率和摄入量进行询问。结果重庆市城乡中老年人群膳食结构的主要特点是:城乡居民在膳食比例上存在着差异,主食以谷类为主,蔬菜、水果、豆制品、奶及奶制品摄入偏低,油脂和盐摄入过量,农村居民尤为严重。结论重庆市中老年人群的膳食结构不太合理,应加强宣传教育提高营养知识水平,改善居民的膳食模式应以调整不平衡膳食结构为主要目的。