Work Place Health Promotion

This article deals with the question of whether and how much workplace health promotion measures have infiltrated the working world and which factors determined the results of health promotion programs for the enterprises. To answer this question we conducted a longitudinal study (measuring times: 1997 and 2003) in 150 enterprises in Hessen and Thueringen of the service sector and metal branch. A standardized questionnaire was used to collect the data. One of the results was that the high level of occupational safety and health (OSH) obtained was greatly appreciated by the enterprises interviewed. Many of the enterprises (82.7%) were able to implement at least one workplace health promotion (WHP) measure, mostly assessments of occupational health risks and behavior-oriented offers. The portion of businesses with a very good to sufficient level of workplace health promotion increased clearly from 16.0% in 1997 to 27.4% in 2003. Half of the enterprises interviewed confirmed the need for information and consultation in questions about occupational safety and health issues and workplace health promotion. They expected support particularly from the institutions for statutory occupational accident insurance, health insurance companies, public institutions for labor protection and safety engineering, as well as from the advisory boards of the trade unions. These institutions definitely need to address the consultation requests from the enterprises, as the lack of information and contact persons was one of the reasons why workplace health promotion measures could not be implemented.This study was commissioned by the Hans Boeckler Foundation and the SMBG and translated by Evelyn Jäck     

Routine Physical Examination and Forgone Health Care among Latino Adolescent Immigrants in the United States

Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents’ not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. ≤ 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. ≤ 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors.     

关于我国公共卫生体系建设现状及对策的思考

公共卫生问题直接关系到群众的身心健康，特别是全球化进程的加快，食品卫生、疾病控制等问题是各国共同面临的问题。作者通过对奥地利卫生管理、体系建设、食品安全等方面的考察，进行分析、思考，对我国卫生体制改革提出了建议。作者认为，深化卫生改革，要进一步加强食品卫生监督执法，要重视和加强职业卫生，要加强医疗救治和医疗机构监督管理，要进一步完善社会医疗保险体系，要加强卫生管理理论的培训。     

System weaknesses as contributing causes of accidents in health care.

OBJECTIVE: Accidents in health care, resulting in injury or death to the patient, are a matter of considerable concern. The aim of this study is to examine whether system weaknesses can contribute to these accidents, and if so, how. DESIGN: Eight consecutive accidents reported to the Health Authority in Sweden were analysed using MTO (Man-Technique-Organization) analysis. SETTING: Emergency care hospitals in Sweden. RESULTS: All cases that involved the system supported the assumption that system weaknesses are a contributing factor to accidents. In this study two types of latent failure could be identified: process control latent failures and interactional latent failures. The time span from activation of process control latent failures to operator error was very short, and the study demonstrates the simple relationship between situational factors and operator errors. Interactional latent failures exert system influence in a more indistinct manner. Latent failures, as seen in this study, act not only by creating opportunities for operator errors but also by hindering error detection in the time window available. Safety barriers, which might have prevented the accidents, could be proposed in seven out of eight cases. CONCLUSION: System weaknesses seem to play an important role in accident evolution. Consequently, certain measures can be suggested in order to improve patient safety: (i) sufficient resources should be allocated for research and development at both medical schools and hospitals in order to establish competence and procedures for systematic analyses of processes; and (ii) authorities handling accident cases should have adequate competence in system analysis.     

Development of the multi-attribute Pediatric Asthma Health Outcome Measure (PAHOM).

OBJECTIVE: To develop a multi-attribute outcome measure for children with asthma that allows for the calculation of quality-adjusted life years in cost-effectiveness studies and can also be used to assign preference weights to asthma-symptom-free days. STUDY DESIGN: A literature review and two interviewer-administered surveys. SETTING: Homes or community centers of participants in Seattle, United States. MAIN MEASURE: Visual analog scale (VAS), standard gamble (SG), and relative risk attitude equation techniques were used to estimate two sets of preference weights for 10 health states. The PAHOM was used to record health states of pediatric asthma patients. RESULTS: A total of 94 subjects provided complete responses without any illogical ratings to VAS questions and 101 provided the same to SG questions. The VAS preference weights of the health states range from a maximum of 1 for perfect health to a minimum of 0.03 for severe asthma symptoms, emotional problems, and activity limitations. Those based on the relative risk attitude equation constructed with both VAS and SG preference weights range from 1 to 0.06. The mean PAHOM scores of pediatric asthma patients based on VAS and converted SG preference weights were 0.70 and 0.83, respectively. CONCLUSIONS: The PAHOM calendar can be used to identify asthma patients' health outcomes, to calculate the preference weights of asthma patients' health states, and to estimate the number of symptom-free days. These factors make the PAHOM a promising instrument for use in effectiveness and cost-effectiveness studies in children with asthma.     

Quality of primary health care in Saudi Arabia: a comprehensive review.

OBJECTIVES: Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. This study presents an overview of quality of primary care in Saudi Arabia, and identifies factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be improved. METHOD: Using a systematic search strategy, data were extracted from the published literature on quality of care in Saudi primary care services, and on barriers to achieving high-quality care. RESULTS: Of the 128 studies initially identified, 31 met the inclusion criteria for the review. Studies identified were diverse in methodology and focus. Components of quality were reviewed in terms of access and effectiveness of both clinical and interpersonal care. Good access and effective care were reported for certain services including: immunization, maternal health care, and control of epidemic diseases. Poor access and effectiveness were reported for chronic disease management programs, prescribing patterns, health education, referral patterns, and some aspects of interpersonal care including those caused by language barriers. Several factors were identified as determining whether high-quality care was delivered. These included management and organizational factors, implementation of evidence-based practice, professional development, use of referrals to secondary care, and organizational culture. CONCLUSION: There is substantial variation in the quality of Saudi primary care services. In order to improve quality, there is a need to improve the management and organization of primary care services. Professional development strategies are also needed to improve the knowledge and skills of staff.     

新型卫生投入政策研究

本文提出了一整套新型卫生投入政策方案，总目标是建立起“四级两块式”卫生投入政策，具体目标模式有：改革卫生投入方式，实行“五级浮动式”医疗价格体制，建立医疗价格政策性补贴，增加公共卫生投入，整合卫生资源。并进行可行性论证。     

收入分配差距对我国卫生保健公平性的影响

本文概述了我国城乡、不同行业和地区之间居民收入差距及其原因，主要从卫生筹资、卫生服务利用两个方面分析了收入差距对卫生保健公平性的影响，并就如何改进卫生服务公平性提出了政策措施。     

社区卫生服务及基本卫生服务主要内容探讨

本文分两部分：第一部分主要介绍了国内外社区卫生服务的发展模式及主要内容；第二部分主要介绍了国外基本卫生服务的界定原则、界定方法及主要内容。     

砷对健康危害的研究进展

地球化学因素造成的局部地区饮水高砷和人为因素造成的砷污染对健康产生的危害是值得关注的问题。本文对国内外近些年来有关砷在机体中的代谢 ,砷对皮肤、循环系统、神经系统、泌尿生殖系统、消化系统、呼吸系统和免疫系统的损害及其机制的研究进行了综述。