Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Role Expectation of Nurse Managers in Geriatric Health Services Facilities

Back ground: The characteristics of geriatric health services facilities (GHSF) in Japan include provision of care focused on the life of the residents, and there is a need for cooperation between care workers and physical therapists responsible for the care. Thus, it is expected that a nurse manager occupies specific roles suited for the above characteristics that are different from those of medical facilities. Thus, we aimed to clarify the role expected of nurse managers via a questionnaire survey administered to nurses and care workers in GHSF. Methods: We used a descriptive, cross-sectional design. The study was conducted in 56 GHSF all over Japan. The instrument used for data collection was a questionnaire. The questionnaires consisted of 35 items for determining role expectation of nurse managers, the background information of respondents. The role of nurse managers was analyzed using principal factor analysis (promax rotation). Findings: A total of 259 nurses and care workers participated in this study. We extracted 34 items by factor analysis, which were classified into three factors (promotion of home nursing, management of medical care, and environment creation for collaboration and education). Among care workers, four factors consisting of 33 items were extracted. Factors one, two, and three were similar to those of nurses;“intervention to ethical problem” was extracted as the additional fourth factor. Conclusion: The roles required for nurse managers in GHSF are the promotion of home nursing, which is the original role of the health services facilities, exhibition of the specialty as a healthcare professional, creation of a work environment that promotes mutual understanding for collaboration with other professionals, and enhancement of the education and training system.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Characteristics of Geriatric Health Service Facilities Designated as Sites of Death

There are many deaths occurring among the aged population in Japan. Geriatric Health Service Facilities (GHSFs) are highlighted as some of the chosen facilities designated as sites of death. The aim of our study was to clarify the characteristics and related factors, including physical signs first noticed by staff at the end-of-life period, in GHSFs designated as sites of death, using a nationwide survey in Japan. We administered a questionnaire to 3971 GHSFs in Japan. Eligible responses for the study were obtained from 854 GHSFs. We found that GHSFs designated as sites of death were more likely to have basic policies and documented preferences regarding end-of-life care. We also found that staff members in GHSFs designated as sites of death were less likely to first notice physical signs of pain. We found that GHSFs designated as sites of death tended to identify earlier symptoms, such as reduced oral intake and less vigor. Our results would enable elderly persons, their families, and staff in GHSFs to prepare for the elderly’s death more efficiently though earlier identification of the end-of-life period. We hope that GHSFs have an important role to play in end-of-life care provision to elderly persons in Japan, through the strengthening of these intermediate facilities.

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

康养旅居产业视域下的康养设施设计

目的:研究康养旅居环境中健康、养生、医疗、旅游等方面存在的潜在需求,解决康养人群的不同需求,例如针对老年人在带小孩的生活中,缺少休憩和锻炼的时间和机会,提出一种适用于这类老年群体的康养互动健身器材和休憩设施的设计方法。方法:针对康养旅居生活中户外运动、休憩、室内服务设施进行研究,构建公共康养设施设计策略,阐述设计实践的过程与内容,运用人机工程学原理进行人群行为分析,指导相关的适老化康养设施和产品设计。结果:通过对上述康养需求的研究,设计出能解决康养人群中的休憩、健身、生活等方面的适老化产品,以改善康养环境的硬件设施,优化康养人群的生活品质。结论:随着中国“老龄化”进程的加速,康养设施匮乏已经成为一个非常严峻的社会问题,以改良和创新相结合的方式,将康养服务理念融入公共设施设计中,促进未来康养产业的发展,从而满足更多人群对康养环境的产品需求,让老年人拥有更幸福的康养时光。

社会医学视角下社区养老卫生服务保障体系的构建与优化研究

基于社会医学视角了解社区养老卫生服务现状,随机对曾在陕西省西安市碑林区社区卫生服务中心就诊的老年人进行问卷调查。结果表明,整体上,社区养老卫生服务质量处于中等偏上水平,医疗设施维度和养老环境维度相对薄弱,是受访老年人认为最需要优化的两个方面。由相关性分析可知,受访老年人的满意度与社区养老卫生服务的便捷性、服务态度、服务公平性、医疗设施情况及养老环境显著相关(P<0.05)。需改善社区养老卫生服务的医疗设施条件,优化服务环境,强化服务的便捷性,提高服务水平,定期对其服务质量进行评估和改进,有效促进医养结合养老服务的发展,才能使社区养老服务体系更加完备和健全,从而更好地满足老年人多样化的养老需求。

Nurse staffing and life expectancy at birth and at 65 years old:Evidence from 35 OECD countries

Objective: To measure the possible magnitude of the role nurse staffing has on increasing life expectancy at birth and at 65 years old.Methods: The statistical technique of panel data analysis was applied to investigate the relationship from the number of practicing nurses' density per 1000 population to life expectancy at birth and at 65 years old.Five control variables were used as the proxies for the levels of medical staffing,health care financial and physical resources,and medical technology.The observations of 35 member countries of Organization for Economic Co-operation and Development (OECD) were collected from OECD Health Statistics over 2000-2016 period.Results: There were meaningful relationships from nurse staffing to life expectancy at birth and at 65 years with the long-run elasticities of 0.02 and 0.08,respectively.Overall,the role of nursing characteristics in increasing life expectancy indicators varied among different health care systems of OECD countries and in average were determined at the highest level in Japan (0.25),followed by Iceland (0.24),Belgium (0.21),Czech Republic (0.21),Slovenia (0.20) and Sweden (0.18).Conclusion: A higher proportion of nursing staff is associated with higher life expectancy in OECD countries and the dependency of life expectancy to nursing staff would increase by aging.Hence,the findings of this study warn health policy makers about ignoring the effects nursing shortages create e.g.increasing the risk of actual age-specific mortality,especially in care of elderly people.

美国卫生署与国立卫生研究院NIH主导的实验动物管理体系的演变和启示

美国卫生署是负责联邦实验动物法规的行政部门,国立卫生研究院(NIH)是实施该法规的专业部门并监管全美生物医学机构脊椎类实验动物使用和管理。1961年NIH最早建立了美国的实验动物管理框架,在实践中改进。1990年代后发布著名的《IACUC工作手册》和《实验动物管理与使用指南》,形成了较为完善的现代生物医学实验动物管理体系,被国际生物医学领域普遍采纳借鉴。本文介绍NIH实验动物政策演变、管理体系、实验动物使用与管理委员会IACUC的组成职责和工作运行机制,以期对我国实验动物行业有所启示。

河北省社区卫生服务中心中医药服务现状调查

目的调查河北省社区卫生服务中心开展中医药服务的现状,分析存在的问题,为有关部门制定政策提供依据。方法 2013年8月,选取河北省11个地级市的100家社区卫生服务中心及其覆盖的社区居民作为调查对象。采用自制调查表进行调查,内容包括中医药进社区概况、居民对中医药进社区的服务需求等。结果回收有效问卷99份,回收率为99.0%。99家社区卫生服务中心中82家设有中医科,其中75.6%(62家)成立时间是在2008年以后。中医科业务用房面积占总面积的6.2%;中医医师占中心医师总数的18.0%;中医科门诊就诊人次数占总门诊人次数的12.1%;中医医疗收入占总医疗收入的8.2%;中药收入占药品总收入的25.3%。3.8%(31例)的居民患病后首选社区卫生服务中心中医科就诊;居民接受社区卫生服务时首选西医者占54.3%(44例),首选中医者占14.8%(12例),首选中西医结合者占30.9%(25例)。812例居民中218例接受过社区卫生服务,接受率为26.8%(218例),其中满意者占74.3%(162例),不满意者占25.7%(56例)。64.8%(105例)的满意居民认为社区的中医药服务就近方便。结论河北省中医药社区卫生服务在资金投入、中医人力资源方面存在问题和不足,居民对中医药的认识不足,对中医药服务的选择率不高。政府应加大资金投入,制定倾斜政策,加强中医药宣传,鼓励私营性中医药服务与社区卫生服务中心合作。

广东省社区卫生服务人力资源配置现状及公平性分析

目的对广东省社区卫生服务人力资源配置的现状及公平性进行分析,为更好地发展广东省社区卫生服务提供理论依据。方法 2013年1月,对广东省2012年的社区卫生服务人力资源情况进行普查,计算人力资源按人口和地理分布的洛伦兹曲线、基尼系数及泰尔指数,并对泰尔指数(泰尔-L指数)进行分解以定量分析公平性。结果洛伦兹曲线显示,广东省全科医师、社区护士人力资源按人口分布的公平性较高,按地理分布的公平性较低;且全科医师人力资源配置公平性优于社区护士。全科医师、社区护士按人口分布的基尼系数分别为0.277和0.311;按地理分布的基尼系数分别为0.557和0.583。泰尔-L指数评价结果与基尼系数一致,区域间差异对总泰尔指数的贡献率高于区域内差异。结论广东省社区卫生服务人力资源整体配置不足,全科医师配置的公平性优于社区护士;按人口分布处于公平状态,但按地理分布公平性较低。卫生行政部门应充分考虑护理人员的合理配置及地理分布对社区卫生服务可及性的影响,克服由于区域间经济发展水平差异所导致的人力资源分布差异,最终实现社区卫生服务人力资源的公平分配与合理使用。

我国结核病防治服务体系的演变和思考

在过去的近100年中，我国结核病防治服务体系逐步完善，各项防控措施逐步落实，结核病防治工作取得良好成效，但是结核病负担仍然很严重。为快速地减轻我国结核病负担，我国将全面实施新的结核病控制策略。加强结核病定点医疗机构、疾病预防控制机构、基层医疗卫生机构分工明确、协调配合的新型结核病防治服务体系建设是新的结核病控制策略的重要组成部分。随着我国“十三五”规划的开始实施，这一新型服务体系的调整必将进一步加快和完善，并为实现终止结核病流行起到有力的促进作用。

重要会议和大型活动医疗保障工作的实践与思考

近年来,随着我国国际化发展步伐的进一步加快和全球经济一体化进程的不断推进,北京作为全国的政治、文化和国际交往中心,召开具有国际影响力的重要会议日益增多,举办各类大型活动日趋频繁,做好保障重要会议和大型活动的医疗保障工作也显得越来越重要。首都医科大学附属北京友谊医院近3年就平均每年承担医疗保障任务30余项,有着丰富的大量重要会议和大型活动医疗保障经验,本文从组织管理、工作流程和注意事项等多方面进行了经验分享。

北疆牧区基层医疗机构基本医疗服务能力现状调查

目的了解北疆牧区基层医疗机构的基本医疗服务能力现状。方法于2014年7—8月,采用典型抽样法抽取伊犁哈萨克自治州新源县哈拉布拉乡(哈乡)和阿勒泰地区青河县阿热勒托别乡(阿乡)的乡镇卫生院2所,另采用随机数字表法抽取辖区内村卫生室10所(哈乡6所、阿乡4所)作为调查机构,采用《卫生机构调查表(乡级/村级)》对纳入机构的基本情况、基本医疗服务开展情况、基础设施设备配置情况进行调查。采用随机数字表法在乡镇卫生院抽取卫生人员24例(哈乡18例、阿乡6例),同时纳入村卫生室的村医10例(哈乡6例、阿乡4例),采用《卫生人力资源调查表》对纳入卫生人员的基本情况、参加培训情况进行调查。同期,采用目的抽样的方法抽取哈乡和阿乡关键知情人15例,进行深入访谈。结果乡镇卫生院的平均基本医疗服务项目开展率为30.7%(17.5/57),哈乡和阿乡分别为42.1%(24/57)、19.3%(11/57);村卫生室均开展了血压测量、血糖监测、静脉滴注、肌肉注射等简单诊疗服务,但仅开展了门诊登记本和处方、家庭出诊2项基本医疗服务。34例卫生人员中,97.1%(33/34)为大专及以下学历,94.1%(32/34)为初级及以下职称,44.1%(15/34)不具备执业资格。共24例(70.6%)参加过培训,其中乡镇卫生院16例(66.7%)、村卫生室8例(80.0%)。2所乡镇卫生院的业务用房面积分别为1 977、700 m2,基础设备配置率为79.4%(27/34),配套设备配置率为21.4%(3/14);10所村卫生室的平均业务用房面积为(70±4)m2,常用设备配置率为41.4%(12/29)。深度访谈共提炼出3个相关主题,分别为牧区基层急救医疗开展不足、牧区基层基本药物缺乏、卫生人员匮乏已成为制约牧区基本医疗服务发展的关键。结论北疆牧区基层医疗机构的基本医疗服务能力较薄弱,卫生人员匮乏,卫生人员素质和参加培训情况、基础设施设备配置情况与国家要求仍有一定距离。

养老机构自理和半自理老年人护理服务框架及人员资质研究

目的:构建适合我国的养老机构自理和半自理老年人护理服务内容体系。方法:采用德尔菲法,通过对18名专家的两轮咨询,确定养老机构自理和半自理老年人护理服务框架及服务人员最低资质。结果:两轮咨询问卷的有效回收率分别为75%和100%,专家咨询的权威系数为0.874,判断系数为0.881,熟悉程度为0.867,专家意见协调性好;形成的养老机构护理服务内容体系包括3个服务业态,即独立生活区、辅助生活区和长期护理区;其中独立生活区包括2项一级指标、5项二级指标、18项三级指标,辅助生活区包括2项一级指标、13项二级指标、45项三级指标。结论:养老机构护理服务内容体系经检验,结果真实、科学、可靠,可为养老机构规范护理服务、配置护理人员等奠定基础。

甘肃省结核病实验室资源现况分析

目的了解甘肃省结核病控制体系实验室资源状况,提出改进建议。方法共收集了包括甘肃省省级、14个市(州)级,85个县(区)级结核实验室共计100个实验室信息,统计130名实验员的数量、年龄、教育背景、技术职称、专业构成情况,以及实验室设备和当前的工作,并描述性分析其百分比。结果33.1%(43/130)的实验员教育背景为中专及以下学历;非医学非检验专业人员占13.1%(17/130);兼职人员构成比为19.2%(25/130)。14个地市级实验室不能常规开展药敏试验,76个实验室缺乏生物安全柜,65个实验室缺乏恒温培养箱。结论甘肃省结核病实验室人力资源建设和实验室设备需要加强。

贵州省乡镇卫生院卫生人力现状分析

目的:探讨乡镇卫生院卫生人力存在的突出问题,为合理配置及开发乡镇卫生院卫生人力提供依据和指导.方法:利用贵州省2002年卫生事业统计报表资料,对贵州省1 426所乡镇卫生院的卫生人力数量、卫生技术人员的年龄、性别、学历、职称、专业结构,采用SPSS 12.0软件进行统计分析.结果:院均卫生技术人员数、院均护士数、每千农业人口卫生人员数偏低,与同期全国资料相比,差异有显著性(P＝0.000);性别构成男性占53.4%,女性占46.6%,年龄以25～34岁为主;大专以上(含大专)与中专学历比例为1:3.4,无专业学历者占15.2%;中、高级职称与初级职称之比为1:8;专业构成中医生、护士、技术人员的比例为1:0.19:0.39.结论:贵州省乡镇卫生院卫生人力总量偏低,质量不高,结构不合理,导致低素质人力-低提供能力-低卫生服务质量-低效益的恶性循环,已经成为制约贵州省农村卫生事业发展的主要因素.

北京市结核病防治机构护理人员现状分析

通过国家结核病管理信息系统采集2015年北京市18家结核病防治机构（简称“结防机构”）护理人员的数量、年龄、学历、职称、结防护理工作年限等信息，结合北京市2015年肺结核患者登记情况对护理人员人力特征进行比较分析。2015年北京市18家结防机构在编护理人员总数92名，其中6家独立结防机构占63．0％（58／92），隶属疾控中心及综合医院的12家结防机构占37．0%（34／92）；护理人员年龄中位数46岁（P25=36．00，P75=51．00）；大专及以下学历者占83．7％（77／92）；中级职称者占57．6％（53／92），高级职称者占1．1％（1／92）。北京市结防机构护理人员普遍存在年龄偏大，不同类型的结防机构护理人员数量分布不均衡，高级职称护理人员稀缺。结防机构护理人员的年龄、职称、学历构成及人员配置有待进一步优化。

中西部农村地区妇女保健发展的制约因素

在经济落后地区农村妇女保健服务状况堪忧,主要表现在孕产期保健服务质量不高;育龄妇女面临较高的生育风险;生殖系统疾病的困扰。影响这些地区妇女保健发展的因素涉及社会、经济以及妇幼保健服务能力等。通过加强基层医疗服务技术,完善妇幼保健网络,促进健康教育,新型合作医疗的覆盖等不同层次措施的开展,将会改善经济落后地区农村妇女保健的状况。