Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Selection of Health Care Workers for Screening for Latent Tuberculosis Infection

Introduction: The rate of latent tuberculosis infections (LTBIs) in health care workers (HCWs) is higher than that in non-HCWs. We studied to investigate the prevalence and risk factors of LTBIs and the acceptance rate for treatment of LTBI among HCWs in South Korea, a country with an intermediate tuberculosis (TB) burden. Methodology: LTBI screening was conducted for HCWs at a tertiary and a secondary hospital from April 2017 to August 2017. This was a retrospective study included all HCWs who underwent LTBI examination. HCWs were classified by the degree of risk into four groups, based on two factors: possibility of exposure to TB, and impact on patients at the time of TB onset in the HCWs. The interferon-gamma release assay was used for the diagnosis of LTBI. Results: A total of 1326 HCWs were included;they comprised 801 HCWs from a tertiary hospital and 525 from a secondary hospital. A total of 235 (17.7%) HCWs were diagnosed with LTBIs. According to risk classification, there was no significant difference (P = 0.24). In multivariate analysis, age was the only independent risk factor (P Conclusions: HCWs did not show any significant difference in the rate of LTBI by the degree of risk, and age was the independent risk factor. LTBI screening should be conducted for all HCWs regardless of risk classification.

A model for retention and continuity of care and treatment for opioid dependent injection drug users in the Russian Federation

Health and Development Foundation has worked collaboratively with the Government of the Russian Federation to develop and implement a model program of retention and continuity of care for opioid dependence and HIV infection. The model utilizes the Narcology Detoxification Service, State AIDS Centers, Non Government Organization (NGO) managed narcology treatment and rehabilitation centers, NGO outreach programs and the community. The model program was developed and implemented as a pilot demonstration project to provide essential health services to injection drug users and retain them in care. The interventions developed and implemented comprised HIV Testing and Counseling, HIV/AIDS Narcology Post-Graduate Curriculum, Peer Support Groups (Buffer groups), Narcological Follow-up Phone Monitoring, Women’s Narcological Services and Short Messaging Services for Injection Drug Users. These services and interventions promoted the integration and utilization of HIV/AIDS health services and narcological services to form an evidence-based health service delivery model providing essential services to people who inject drugs and people living with HIV/AIDS in the Russian Federation.

Evaluating health care financing in a highly decentralized Beveridge model

The Finnish health care system is financed in a highly decentralized manner. In the tax-financed Beveridge model each municipality is responseble for financing and organizing health care services for its residents. This paper examined the annual incidence and treatment costs of three cost-intensive DRG-groups, and all DRG-groups together. The objective was to estimate municipal level predictions on the incidence of new illness cases and their associated costs, and to analyze whether there was greater uncertainty in anticipated specialized health care costs in municipalities with smaller populations. The dataset comprised of longitudinal hospital utilization and discharge data from Hospital Discharge Registers. The expected annual variation of illness cases and costs was assessed with respect to 95% confidence intervals estimated for each morbidity group and municipality. The results indicated that the costs of the selected morbidity groups fluctuated in a completely uncontrollable manner in municipalities with small populations. As the median size of Finnish municipalities is less than 6000, the inability to anticipate periodic health care costs constitutes an extensive financial problem and calls for the establishment of larger regional units and funding pools.

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

新时代我国医药卫生领域工程科技发展研究

近年来,我国医药卫生领域工程科技发展迅速,政策推动效果显著,全面增强了疾病防治与健康产业的科技支撑,在多个方面取得了显著成效。但与国际先进水平相比,仍存在基础研究薄弱、精准医疗水平不高、新药技术创新缺乏、重大突发疫情识别和应对能力不足、医疗装备关键核心技术研发存在差距、中医药效果评价方法不完善等问题。基于此,本文深入分析了国际医药卫生领域工程科技发展态势,探讨了我国医药卫生领域工程科技的发展形势与面临的挑战,并提出推动我国医药卫生领域工程科技发展的对策建议。研究建议:强化医药卫生战略与制度建设,打造全生命周期健康服务体系;加速药品创新与成果转化,强化全生命周期管理;改革疾病预防控制体系,建立公共卫生保障管理办法;推动医学技术革新与标准化,构建关键技术平台;强化中医药发展战略,促进科技创新与基层服务提升;优化人才培养与学科交叉,创新资助评价与激励机制,旨在推动我国医药卫生领域工程科技水平迈向新高度,更好地满足人民的健康需求。

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

中医治未病思想及其现代应用探讨

中医治未病思想指导人们的养生保健及治疗,自提出以来一直被广泛应用。具有未病先防、欲病救萌、既病防变、瘥后防复的思想内涵。对人们的身体及心理健康都有很重要的指导意义。在现代社会,治未病思想旨在提高人们的健康观念、倡导新时代健康生活方式。广泛应用于亚健康状态的调节、慢性病的管理等方面,具有重要的现代应用价值。

分级诊疗制度下我国基层医疗卫生服务能力综合评价

[目的]对分级诊疗制度下我国31个省份基层医疗机构服务能力进行综合评价,为各省基层医疗卫生服务能力的整体提升提出有效对策。[方法]采用熵权-TOPSIS法并结合RSR法综合评价2021年我国各省份基层医疗卫生机构服务能力。[结果]熵权-TOPSIS法结果显示,31个省份基层医疗卫生机构总体服务能力综合评价排名前5的省份依次为四川、山东、江苏、广东、河南,排名后5的省份依次为黑龙江、辽宁、青海、天津、宁夏。RSR法分档结果为好、中、差三档,被划分为“好”的是四川、山东、江苏、广东、河南;“差”的是黑龙江、青海、宁夏、西藏;其余省份为“中”档次。方差分析结果显示,F=496.566,(P<0.001),提示分档结果具有统计学意义。[结论]我国基层医疗卫生服务水平总体良好,但各省基层医疗卫生服务水平存在一定差异,总体上呈现东部强、中部次之、西部较弱的分布格局,未来仍需提高各省基层医疗卫生服务能力,缩小区域间差距。

老年慢性阻塞性肺疾病患者应用Swanson关怀理论的健康教育实践研究

目的观察基于Swanson关怀理论的健康教育对老年慢阻肺患者治疗依从性和生活质量的影响。方法回顾性选取2021年6月—2023年6月间在亳州市人民医院接受治疗的老年COPD稳定期患者104例,依据不同干预措施将患者分为对照组和观察组,每组52例。对照组患者行常规健康教育,观察组采用基于Swanson关怀理论的健康教育。观察并比较2组干预前后患者治疗依从性、生活质量和肺功能指标值变化情况。结果干预后,观察组和对照组患者吸入药物治疗依从性量表(TAI)评分均较同组干预前升高,且观察组TAI评分高于对照组(均P<0.05);观察组和对照组患者活动能力、胸闷、精力和日常活动能力评分较同组干预前降低,且观察组上述评分均低于对照组(均P<0.05)。干预后,观察组和对照组患者FVC、FEV 1/FVC较干预前升高,且观察组高于对照组(P<0.05)。结论应用基于Swanson关怀理论的健康教育可显著改善老年慢阻肺患者的治疗依从性,提高患者的生活质量和肺功能。

Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department

Background Community acquired pneumonia （CAP） is one of the most common infectious disease in emergency department.In 2005 the concept of healthcare associated pneumonia （HCAP） was proposed by the ATS/IDSA guidelines.The clinical features and microbiology of HCAP are different from CAP,however,the initial antimicrobial treatment is still controversial.We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guidelineconcordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.Methods We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012.Patients were divided into 2 groups according to their different initial antimicrobial treatment.We compared clinical features,distribution of pathogen,severity,days and spending on intravenous antimicrobial,length and charge of hospitalization and clinical outcomes,and meanwhile analyzed the clinical efficacy as well.Results Of the 125 HCAP patients,55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents.The major pathogens were Klebsiella pneumoniae,methicillin-resistant staphylococcus aureus （MRSA）,Pseudomonas aeruginosa and Escherichia coll The 2 groups were similar at baseline,including old age,comorbidities,Pneumonia Severity Index scores,APACHE scores,and length of intravenous antimicrobial use and hospitalization duration,and in-hospital mortality.Overall efficacy rate occurred in 70.0％ of HCAP agent patients and 50.9％ of CAP agent patients （P=0.029）.Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.Conclusions Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate,as well as antimicrobial charge and total hospital charge,but was not associated with shortening the length of stay,or lowering in-hospital mortality.

北京市妇幼保健机构互联网诊疗服务影响因素的质性研究

目的针对北京市妇幼保健机构互联网诊疗服务存在问题,提出针对性建议,为促进妇幼保健机构“互联网+”医疗服务发展提供参考。方法对来自北京市10家公立妇幼保健机构的58名职能部门管理人员进行半结构化访谈与焦点小组访谈,采用Colaizzi七步法对访谈内容进行分析。结果妇幼保健机构开展互联网诊疗服务受到制度要求、组织管理、患者特征三方面因素影响。结论妇幼保健机构开展互联网诊疗服务需加大政策支持和财政投入,加强医疗服务质量控制,规范互联网诊疗流程,提高医生线上诊疗服务能力,拓展线上服务内容,培养患者线上就医意识等。

药师参与社区慢性病药物治疗管理的实践与研究

目的探寻药师在社区开展慢性病药物治疗管理(MTM)工作方法,提升慢性病MTM水平。方法选取2022年7月至2023年6月参加百色市右江区城东社区卫生服务中心慢性病MTM讲座的48例中老年慢性病患者为研究对象,按随机数表法分为对照组和观察组,每组各24例,对照组采用原有的治疗方式,观察组采用药师参与MTM的方式。经过3个月的随访调查后,比较两组患者在不合理用药相关问题、用药依从性、药物治疗效果评价三个方面的差异。结果观察组总不合理用药率低于对照组,差异有统计学意义(P<0.05)。观察组用药依从率高于对照组,差异有统计学意义(P<0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。结论采用药师干预的MTM有效提高了慢性病患者用药认知水平、安全性和依从性,显著改善慢性病患者的药物治疗效果,为药师如何开展慢性病MTM服务提供参考。

纵向轨道延续性护理对无托槽隐形矫治患者牙周健康及美观度的影响

目的:探讨纵向轨道延续性护理对正畸矫治患者牙周健康及美观度的影响。方法:选择2014年6月-2022年6月在笔者医院口腔科接受正畸矫治的100例患者为研究对象,通过随机数字法将患者分成对照组与观察组,每组50例。对照组患者实施常规护理措施,观察组患者在常规护理基础上联合纵向轨道延续性护理干预。统计比较两组患者牙周健康各项指标及美观度评分。结果:干预后,观察组患者的菌斑指数(Plaqueindex,PLI)、龈沟出血指数(Sulcus bleeding index,SBI)、探诊深度(Probing depth,PD)、牙龈指数(Gingival index,GI)各项牙周健康评分明显低于对照组(P<0.05);与干预前相比,干预后两组患者牙齿美观度自我评价评分及医生评价评分均明显降低,观察组患者牙齿美观度的自我评价与医生评价均明显低于对照组,且差异具有显著统计学意义(P<0.05)。结论:纵向轨道延续性护理干预可督促患者对口腔保健行为进行自我监测,使患者主动参与正畸矫治的护理管理,可有效提高患者牙周健康水平与美观度。

人文关怀联合健康教育在阑尾炎患者手术治疗中的效果分析

分析人文关怀联合健康教育在阑尾炎患者手术治疗中的效果。选取2022年8月—2023年4月贵州省黔东南州从江县人民医院收治的140例接受手术治疗的阑尾炎患者作为研究对象,采用随机法将患者平均分为实验组和观察组两组,每组各70例。实验组患者接受常规护理,观察组患者接受人文关怀联合健康教育,对比两组患者的护理效果、心理状况(抑郁自评量表评分与焦虑自评量表评分)、疼痛评分、生活质量和并发症发生率。结果显示,观察组首次排便时间、手术时间、住院时间、抑郁自评量表评分和焦虑自评量表评分等指标均优于实验组(P<0.05);观察组疼痛评分低于实验组,生活质量评分高于实验组(P<0.05);观察组术后并发症总发生率为4.29%,实验组术后并发症总发生率为18.57%,差异有统计学意义(P<0.05)。研究发现,于阑尾炎患者手术治疗过程中,为其提供人文关怀联合健康教育,能够缓解患者负面情绪,缩短患者住院时间,降低并发症发生率,提高患者生活质量。

健康教育在妊娠糖尿病患者临床护理中的应用效果

目的:研究健康教育在妊娠糖尿病(GDM)患者临床护理中的应用效果。方法:选取2021年2月—2022年2月徐州市中心医院收治的GDM患者84例作为研究对象,按随机数字表法分为对照组和试验组,各42例。对照组实施常规护理,试验组在对照组基础上实施健康教育。比较两组护理效果。结果:干预后,两组空腹血糖、餐后2 h血糖、糖化血红蛋白水平低于干预前,且试验组低于对照组,差异有统计学意义(P<0.05)。干预后,两组按时产检、规律运动、膳食控制、遵医嘱用药、血糖监测评分高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。干预后,两组自护技能、自护责任感、自我概念、健康知识评分高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。试验组不良妊娠结局总发生率低于对照组,差异有统计学意义(P=0.023)。结论:健康教育在GDM患者临床护理中的应用效果显著,可提高患者依从性及自护能力,有效控制血糖水平,改善妊娠结局。

护理行为感知对未足月前置胎盘期待治疗患者心理健康及分娩结局的影响

目的:观察护理行为感知对未足月前置胎盘期待治疗患者心理健康及分娩结局的影响。方法:招募鹰潭市人民医院2021年1月—2023年9月收治的81例接受期待治疗的未足月前置胎盘患者纳入研究,按随机数字表法分为研究组(41例)和对照组(40例)。对照组给予常规护理干预,研究组给予护理行为感知干预。比较两组心理健康、关怀感知、护理依从性、分娩结局差异。结果:干预后,研究组的9项患者健康问卷(PHQ-9)、分娩恐惧量表(CAQ)、7项广泛性焦虑障碍量表(GAD-7)得分均低于对照组,差异均有统计学意义(P<0.05)。干预后,研究组关怀行为量表(CBI)各维度及总分均高于对照组,差异均有统计学意义(P<0.05)。研究组干预期间护理依从性高于对照组(P<0.05)。研究组胎盘植入发生率低于对照组,差异有统计学意义(P<0.05);两组剖宫产、早产、产后出血、新生儿窒息、围生儿死亡发生率比较,差异均无统计学意义(P>0.05)。结论:护理行为感知干预可正向调节未足月前置胎盘期待治疗患者心理健康,提高关怀感知及护理依从性,降低胎盘植入风险。

尿中2,3-吲哚醌作为帕金森病预警标志物的研究

目的 通过对2,3-吲哚醌的测定,提出将其作为帕金森病预警标志物的依据。方法 采用高效液相色谱法对健康人和帕金森尿液中2,3-吲哚醌排泄量进行测定。结果 不同年龄组的健康人尿中2,3-吲哚醌的含量随增龄增加明显,各年龄组间测得数据有显著性差异(P<0.05),健康人与帕金森患者尿中2,3-吲哚醌含量有极显著性差异(P<0.01),严重程度不同的帕金森患者尿中2,3-吲哚醌的排泄量无显著性差异。结论2,3-吲哚醌尿排泄量随增龄增加,帕金森患者尿中2,3-吲哚醌的含量明显高于健康人。结果表明尿中2,3-吲哚醌可以作为帕金森病预警标志物。

妊娠期高血压疾病与妊娠结局的相关性

目的：分析妊娠期高血压疾病发病的高危因素以及孕期保健与并发症之间、治疗方案选择与妊娠结局的关系，探讨降低妊娠期高血压疾病的发生率、减少并发症的措施，从而改善母婴结局。方法：回顾性分析我院2004年7月～2006年6月妊娠期高血压疾病患者587例，分析其高危因素、孕期产检情况与并发症发生的比例，妊高征治疗方案选择与妊娠结局的关系。结果：妊娠期高血压疾病高危因素多为肥胖、高龄、精神紧张、双胎、营养差者；并发症的发生率与产检次数成反比，产检越正规、次数越多，并发症发生机会越少，正规产检与不正规产检及从不产检者并发症发生率分别为22．82％、37．41％、63．38％，三者比较P〈0．01，差异有显著性；妊娠期高血压疾病实施规范治疗方案与否与早产、低出生体重儿、新生儿窒息、早期新生儿死亡、子痫、心衰、胎盘早剥，差异有显著性。结论：大力宣传孕产期保健知识，加强流动人口管理，提倡正规产检，严格执行妊高征处理规范及三级转诊制度，可减少妊娠期高血压疾病及其并发症，改善母婴结局。

医护一体化模式在双水平气道内正压呼吸机辅助通气治疗中的应用

目的 探讨医护一体化工作模式对提高双水平气道内正压（BiPAP）呼吸机辅助通气患者的治疗依从性及效果。方法 将2012年6月~2014年6月在浙江省嘉兴市第一医院呼吸科接受BiPAP呼吸机辅助通气治疗的慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者100例,应用随机数字表法分为对照组与观察组,各50例,对照组给予BiPAP呼吸机辅助通气常规护理,观察组在此基础上,实施医护一体化护理模式,比较两组患者对BiPAP呼吸机治疗的依从性、动脉血气分析指标的变化、呼吸衰竭纠正时间、住院天数、住院费用等指标的差异。结果 观察组患者的依从率为86%,明显高于对照组（64%）,差异有统计学意义（χ2=6.45,P〈0.05）;治疗后24 h观察组血气分析与对照组比较有所改善,差异有统计学意义[（7.32±0.13）比（7.31±0.07）,P〈0.05],治疗后72 h观察组血气分析p H值、动脉血氧分压（Pa O2）、动脉血二氧化碳分压（Pa CO2）与对照组比较有所改善,差异均有高度统计学意义[（7.37±0.09）比（7.34±0.14）,（66.54±8.86）mm Hg比（63.32±7.35）mm Hg,（63.34±10.94）mm Hg比（68.57±9.45）mm Hg,P〈0.01]（1 mm Hg=0.133 k Pa）;观察组平均呼吸衰竭纠正时间、住院天数、住院费用与对照组比较,差异均有统计学意义[（23.59±6.33）h比（34.08±9.21）h,（11.66±3.71）d比（15.42±5.03）d,（1.36±0.44）万元比（1.79±0.52）万元,t=17.23、9.03、11.21,P〈0.05或P〈0.01]。结论 医护一体化护理模式能显著提高患者使用BiPAP呼吸机治疗的依从性,提高治疗效果,并有效降低住院费用。