社区卫生服务为企业医院走向市场带来新机遇

面对医改,受冲击最大的应该是那些所谓“不上不下、不大不小”的医院,企业医院就是这一类医院。企业医院靠企业拨款的日子已不复存在,加之起步晚,底子薄,基础差,地理位置欠佳,软、硬件建设都存在较大的不足,以前主要对企业内部服务,和社区脱节等等许多因素都使企业医院参与市场竞争的能力大打折扣,但是企业医院是不是就没有出路了呢?

河南省城市社区卫生服务利用现状

目的了解河南省城市社区慢性病监测网络中高血压、糖尿病患者对社区卫生服务的利用情况。方法对河南省城市社区慢性病监测试点的高血压、糖尿病患者进行面对面问卷调查。结果1/3以上的高血压、糖尿病管理患者将社区作为知识获取的第一途径;对社区卫生服务基本满意率为92.9%;6个月内到社区就诊率平均为64.6%;86.0%的高血压患者和54.1%糖尿病患者能做到1月内定期测量血压和检测血糖;60%的管理患者选择社区就诊;80.03%以上的管理患者接受了药物性治疗,有56.7%～82.3%的管理患者接受了非药物性治疗服务。结论要积极推广社区高血压、糖尿病综合防控适宜技术,加强患者规范管理,提升社区卫生服务能力,促进居民对社区卫生服务的利用。

适应社会需求 拓展社区卫生服务——天津市红桥区社区卫生服务实践与体会

1 适应需求,提高社区服务认识水平卫生工作进入市场经济后,面临着新的考验。这几年用我们切身体会的话讲就是“自行消化加大,内部竞争加剧,群众选择拓宽,运行负担加重”。如何适应变化了的新形势,尽快从工作的困境中、思想上的迷惑中解脱出来,是摆在我们面前的一大难题。我局党政班予坚持从区情实际出发,解放思想,大胆实践。

The social determinants of health influencing obesity for the aged in the Pakpoon community context:A qualitative study

Objective:This study aimed to describe the social determinants of health influencing obesity for the aged in a community context and based on the perspectives of various stakeholders.Methods:This was qualitative content analysis study using data from the focus group,individual in-depth interview,and observation.The study population was domiciled in Pakpoon Village,Mung Dis-trict,Nakhon Si Thammarat Province,a tight-knit settlement typical of most retirement communities.Data were collected through two focus group discussions,direct observation,and in-depth interviews with 19 participants.Respondents represented key community groups:local nurses and public health officers,elderly residents,family caregivers(family members),and village health volunteers.Results:The participants shared similar perspectives about the social determinants of health influencing obesity in the aged,which spanned three themes.These were:1)neighborhood food environment(easy access to unhealthy food,no choice to recruit healthy food);2)social networks influencing obesity(family affects food choices and prohibitions on exercise;belief,and socially imposed body image per-ceptions contributing to obesity in the aged);and 3)knowledge,attitudes,and beliefs behind lifestyle choices that cause obesity in the elderly(lack of awareness,personal attitudes,job and familial duties as barriers to engaging in physical activities;over-consumption behaviors lead to obesity in older people).Conclusion:These three themes were the root causes of obesity in the elderly in Pakpoon’s retirement community.This finding suggests that policymakers and nurses can create healthy environments,both to treat and prevent obesity,by raising awareness in younger generations,providing aging the provision of healthy food choices for older adults,encouraging health care professionals to share knowledge,and by modifying the attitudes and beliefs of both caregivers and older adults.

A Coverage-Aware Unequal Clustering Protocol with Load Separation for Ambient Assisted Living Based on Wireless Sensor Networks

Ambient Assisted Living(AAL) is becoming an important research field. Many technologies have emerged related with pervasive computing vision, which can give support for AAL. One of the most reliable approaches is based on wireless sensor networks(WSNs). In this paper, we propose a coverage-aware unequal clustering protocol with load separation(CUCPLS) for data gathering of AAL applications based on WSNs. Firstly, the coverage overlap factor for nodes is introduced that accounts for the degree of target nodes covered. In addition, to balance the intra-cluster and inter-cluster energy consumptions, different competition radiuses of CHs are computed theoretically in different rings, and smaller clusters are formed near the sink. Moreover, two CHs are selected in each cluster for load separation to alleviate the substantial energy consumption difference between a single CH and its member nodes. Furthermore, a backoff waiting time is adopted during the selection of the two CHs to reduce the number of control messages employed. Simulation results demonstrate that the CUCPLS not only can achieve better coverage performance, but also balance the energy consumption of a network and prolong network lifetime.

The study of urban community endowment service problem in China --Demand of the elderly in Taiyuan city

China＇s ageing, the service for elderly pension is become a serious problem, and the traditional way of pension is not enough to meet the needs of existing. In this case, the community endowment to its unique advantages to be the new choice to solve the problem of China＇s pension. Taiyuan city, Shanxi Province in China based on as the breakthrough point, to study the community endowment service of Taiyuan city. For multiple community in Taiyuan city by using the method of field survey and some residents to investigate analyze the present situation of Taiyuan city community endowment. Through the research that Taiyuan city community endowment exists does not reach the designated position on propaganda, unbalanced development, lack of funds, community service and social participation is not high, and even the poor community health care can＇t satisfy the elderly need to all sorts of problems. Put forward the corresponding suggestion, according to the issues can be solved through policy support, strengthen the propaganda, broaden the sources of funding, training and service team, strengthening community health service and diversified development, community service projects, so that the community endowment in China better development.

Self-harm attempters' perception of community services and its implication on service provision

Objective:This study aimed at exploring the attempters'perception of community social services included any barriers to seeking help and services.Method:The participants were patients with self-harming behavior aged 15 years or above.A set of guiding questions were designed to explore the general barriers and accessibility to community social services.A voice recording was made,which was later converted into a text transcript and then preceded for content analysis with co-occurrence and similarity matrix interpretation.Two males and nine females with a history of self-harm aged between 24 and 58 years were recruited for the interviews.Result:The participants had diverse experiences and backgrounds,and attitudes toward community social services.However,there was a shared perception of the need to enhance community social services.There were four main themes and 12 sub themes identified.The main theme included the service availability,service accessibility,affordability and acceptability.For details,participants were unaware of the available types of care/social services in the community,and were unaware about the nearby social services.They also suggested extending service hours and focused services should be offered to help people with different backgrounds and needs.Actually,those with experience of service utilization had both positive and negative perspectives and they gave suggestions for service delivery,mainly extending service hours and offering focused services such as for gambling control and financial planning.In view of interaction with service providers,counseling skills and trust were highly appreciated by the participants.Conclusion:The results identified common circumstances of falling into financial hardship(gambling)and social fragmentation(divorce,poor family relationships,and poor marital relationships),which also suggested to enhance services on center location,service arrangement,and skill of caregivers.

Social practices of nurse care coordination using sensor technologies e Challenges with an alert system adoption in assisted living communities for older adults

Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social workers)of an alert system in assisted living communities.Methods:Qualitative methods were employed by way of five user interviews and focus groups with six system developers.Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.Results:Results indicate that the clinical workflow changed over time,which led to a mismatch of nurse care coordination,social practices,and technology use.The results show different mental models of the socio-technical practice.Applying the coordination theory,the following recommendations could be developed to overcome the mismatch.First,it is recommended that nursing staff set goals together.Second,a communication rhythmwith the nursing staff and developer teams should be established,with guided questions to facilitate the conversation,to shed light on the different workflows and the difference in social practices when using sensor technologies or alert systems.Third,a checklist for new employees should be created so they know how and on which devices to use the alert system.Fourth,the user experience with the alert system should be improved(e.g.,an improved user interface).Conclusions:This work indicates recommendations to close the mental model gap to overcome the mismatch between optimal use of the alert system and how the nursing staff is actually using it.

Challenges faced by community health nurses to achieve universal health coverage in Myanmar:A mixed methods study

Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.

Taxonomy and molecular evolution of secondary metabolism pathway of isoflavones biosynthesis

We compared the cDNA sequences and amino acid sequences of Chalcone synthase （CHS）, Chalcone isomerase （CH1）, and lsoflavone synthase （IFS） in isoflavone biosynthesis pathway, found that their similarity were not always consistent; then we compared the amino acid sequences of CHS, CHI, and IFS, found that the clustering relationship of CHS and CHI were different in 13 kind of species; CHS and IFS were the same or similar in leguminous plants Medicago sativa, Medicago truncatula, Pisum sativum, Pueraria Montana, and Glycine max however disaccording with CHI. We prefer the amino acid sequence for cDNA sequence for evolution analysis, and think that the secondary metabolism mostly attributing to environmental stresses, and the functional genes on secondary metabolism pathway are unsuitable for taxonomy analysis.

社区小儿推拿养护联合“家庭式”护理在儿保工作中的应用

随着经济改革的发展和医学模式转变,社区儿童卫生保健工作正在从传统的生物医学模式向现代的生物—心理—社会医学模式转变。小儿推拿养护具有经济安全、操作简单、穴位少、家长易于学习等优点,适合在社区服务中推广。本文就其参与社区卫生服务的可行性、方式、内容、优势、存在的问题、解决方案和设想等方面,来实现小儿推拿养护社区服务。结合“家庭式”护理进行论述,认为小儿推拿参与社区卫生服务最理想的方式是社区成立专业的小儿推拿养护中心同时结合“家庭式”护理,使两者相互结合,发挥各自养护特长,使该方式成为儿童保健工作中最具特色的形式之一。