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.     

中医院校兴办体育教育专业的社会调查与分析

目的调查社会对中医院校兴办体育教育专业的认识和评价，从社会需要的角度探明体育教育专业建设中存存的问题，提出应对策略.方法以问卷调查法为主要研究方法，辅以文献分析法、电话访谈等其它方法。结果社会需要大量具有扎实的预防保健知识、掌握养生健身方法的人才，但同时也要求其具备从事多个体育项目教学、训练和竞赛组织工作的理论和技能，中医院校兴办体育专业既有优势，也面临许多困难：结论依托中医院校优势学科，优化课程设置、加强实践教学环节、积极组织社会活动以加大宣传，以确保人才培养符合社会需要。     

283家涉外企业职业危害现状及服务需求调查

目的了解我省涉外企业职业卫生现状及服务需求,为建立科学、有效的职业卫生管理机制提供参考依据。方法选择有代表性6个市（县、区）市的283家涉外企业为调查对象。对工作场所有害因素进行检测与工人职业健康检查,进行意向性问卷调查。结果283家涉外企业存在职业危害,接触职业病危害因素18448人。存在职业病危害因素的行业集中在纺织业、制衣业及机械业。职业病危害因素共检测1759个点,合格率60.09%;接触噪声与苯的工人听力下降与白细胞减少异常率增高。部分企业忽视职业卫生工作,对职业病危害因素监测与评价、建立职业卫生档案、职业健康体检、职业卫生管理与职业病防护不到位。结论目前我省涉外企业职业卫生状况不容乐观,应及时采取相应的预防对策与控制措施。     

Help-seeking behaviour in patients with anxiety disorder and depression

OBJECTIVE: The objective of this study was to investigate help-seeking behaviour among persons with anxiety disorder and depression based on self-rating in a Norwegian population (the HUNT study). METHOD: Of the 92 100 inhabitants aged 20-89 years invited, 65 648 (71.3%) took part. Among them 60 869 (66.1%) persons delivered valid ratings on hospital anxiety and depression scale, and had answered the requested help for mental problems question. RESULTS: Among HUNT attenders 13% of those with depression and 25% with anxiety disorders had been help seekers. Help seeking was only non-significantly associated with demographic or other variables. CONCLUSION: Most persons with anxiety disorder and/or depression in the population had not sought help for their mental disorders, but the disparity between use and need of health service must not be overassessed. Improvement of the help-seeking rate for common mental disorder should have high priority in mental health politics.     

A needs index for mental health care in England based on updatable data

Abstract. Background: Mathematical models relating rates of mental health care use to population characteristics such as social deprivation are widely used in both planning and researching mental health services. The models currently in wide use in England are based on data mostly derived from the 10-yearly population censuses. These are perceived to be out of date many years before new census data are available for their replacement. A new set of government deprivation monitoring statistics based mainly on annually updatable data has recently been developed. This study set out to produce a mental illness needs index based on these new data. Methods: A series of regression models were tested using individual domain scores from the DETR Index of Multiple Deprivation and the Office of National Statistics area-type classification as independent variables to predict 1998/9 psychiatric admission rates for broad diagnostic groups for 8251 of the 8414 electoral wards in England as dependent variables. Results: The distribution of admission numbers in wards showed a pattern of over-dispersion with an excessive number of zero values for conventional regression approaches. A two-stage hurdle model was, thus, adopted, predicting first the likelihood that wards would produce any admissions and second the probable number. This produced satisfactory predictive power, with residual variance showing strong geographical patterns associated with administrative areas, probably arising from differential resourcing or idiosyncratic clinical practice. Conclusions: A website providing data on the various indicators has been provided and its uses are indicated.     

Effects of the September 11th attacks on urgent and emergent medical evaluations in a Northern California managed care plan

PURPOSE: To determine whether the terrorist attacks on September 11, 2001, affected the health of persons far from the attacks, we studied rates of urgent and emergency medical evaluations among the 3 million persons enrolled in a managed care plan in Northern California. METHODS: Using a computerized database of all urgent care and emergency department evaluations, we monitored physician diagnoses made during the 6 weeks before and after September 11, 2001, at 16 hospitals in the Kaiser Permanente Medical Care Program. Actual rates of evaluations and diagnoses were compared with expected rates based on similar periods in 1998, 1999, and 2000. RESULTS: There were 4260 fewer urgent and emergent medical evaluations than expected during the 6 weeks beginning September 11, 2001 (-4%; 95% confidence interval [CI]: -3% to -5%; P <0.0001; N = 95,603). Emergency department visits occurred at the expected rate (-1%; 95% CI: -2% to 1%; P = 0.34), but urgent care visits were reduced (-9%; 95% CI: -8% to -11%; P <0.0001). Evaluations were particularly less frequent during the week beginning September 11 (-7%; 95% CI: -4% to -9%; P <0.0001), but a decrease persisted afterwards. Compared with expected rates, injuries (P <0.0001) and ill-defined/symptom-related diagnoses (P <0.0001) were less frequent, while gastrointestinal diagnoses (P = 0.01) were more frequent, during the 6 weeks after the attacks. Total urgent and emergent evaluations were mostly unchanged on September 11; only diagnoses associated with cardiac ischemia were more frequent (+70%; 95% CI: 10% to 163%; P = 0.02). CONCLUSION: Total urgent and emergent medical evaluations in a California managed care plan were reduced during the 6 weeks after the September 11th attacks. These results may help in allocation of resources during national disasters.