Feasibility assessment of invigorating grassrooTs primary healthcare for prevention and management of cardiometabolic diseases in resourcelimited settings in China,Kenya,Nepal,Vietnam(the FAITH study):rationale and design

Background:Cardiometabolic diseases are the leading cause of death and disability in many low-and middleincome countries.As the already severe burden from these conditions continues to increase in low-and middleincome countries,cardiometabolic diseases introduce new and salient public health challenges to primary health care systems.In this mixed-method study,we aim to assess the capacity of grassroots primary health care facilities to deliver essential services for the prevention and control of cardiometabolic diseases.Built on this information,our goal is to propose evidence-based recommendations to promote a stronger primary health care system in resource-limited settings.Methods:The study will be conducted in resource-limited settings in China,Kenya,Nepal,and Vietnam using a mixed-method approach that incorporates a literature review,surveys,and in-depth interviews.The literature,statistics,and document review will extract secondary data on the burden of cardiometabolic diseases in each country,the existing policies and interventions related to strengthening primary health care services,and improving care related to non-communicable disease prevention and control.We will also conduct primary data collection.In each country,ten grassroots primary health care facilities across representative urban-rural regions will be selected.Health care professionals and patients recruited from these facilities will be invited to participate in the facility assessment questionnaire and patients’survey.Stakeholders-including patients,health care professionals,policymakers at the local,regional,and national levels,and local authorities-will be invited to participate in indepth interviews.A standard protocol will be designed to allow for adaption and localization in data collection instruments and procedures within each country.Discussion:With a special focus on the capacity of primary health care facilities in resource-limited settings in lowand middle-income countries,this study has the potential to add new evidence for policymakers and academia by identifying the most common and significant barriers primary health care services face in managing and preventing cardiometabolic diseases.With these findings,we will generate evidence-based recommendations on potential strategies that are feasible for resource-limited settings in combating the increasing challenges of cardiometabolic diseases.

Task sharing in psychotherapy as a viable global mental health approach in resource-poor countries and also in high-resource settings

A global disparity exists between the burden of mental ill-health and the resources available to address this issue.Common mental disorders,such as mild-to-moderate depression,anxiety disorders and post-traumatic stress disorder,are associated with a significant decline in health and functioning and contribute significantly to the overall burden of disease.In view of a shortage of mental health professionals in most low-and middle-income countries,task sharing(task shifting)can make an important contribution to improving access to mental health services.Task sharing involves non-specialists in the delivery of health care.The use of lay health workers is premised on the assumption that the shorter training required for non professionals will allow an increase in the provision of required care without the need for an increase in resources and will strengthen and scale-up sustainable health systems.The need for low-tech support in the management of conunon mental disorders is widespread,and the core resource is humans trained to identify and treat those requiring mental health care.There is a strong evidence base for the effectiveness of task sharing in psychotherapy,and talk therapies,e.g.cognitive behavioral therapy,can easily be delegated to non-specialists,including non-specialist health workers,peer helpers and lay people.A(cost-)effective model of mental health care in low-resource settings as well as in high-income countries may include the medical school-based training of some psychiatrists and clinical psychologists in the treatment of referred patients with serious mental illness.These professional mental health specialists would also be trainers and supervisors of non-specialist health workers who would identify common mental health disorders and provide psychotherapy to people with these conditions in a community-based setting.Community-based generalism including task sharing rather than centralized specialism may be capable of preventing and treating many common mental disorders with minor financial expenditure.

Patient satisfaction and occupational health of workers in hospital care setting: Associations and reciprocity

Research studies conducted in the healthcare sector usually examine patients’ and workers’ wellbeing as separate entities;however, recent studies have revealed significant correlations between, for example, patient satisfaction, workers stress and burnout. The present study examines the relationships between patient perceived quality of care (in terms of satisfaction with regard to accessibility, organizational efficiency and humaneness of care), and workers’ perceived quality of organizational life (in term of organizational support and availability of resource and reward), quality of relationship in the work-unit (superior and coworkers), quality of relationship with patients (disproportionate client expectations and customer verbal aggression) and individual health (emotional exhaustion and depersonalization, job satisfaction). 147 workers and 132 patients from seven hospital wards in northern Italy constitute the data base for the study. Analyses showed that accessibility and humaneness of care were negatively associated with disproportionate patient expectations, patient verbal aggression, emotional exhaustion and positively associated with availability of material recourses. Moreover, accessibility was also positively associated with the organizational support while organizational efficiency with support from colleagues. Globally, the results of the present study confirm that staff wellbeing is an essential aspect in relation to the patient perception of the quality of care and supporting the assumption that healthy organizations improve the wellbeing of their workers, their organizational performance and the quality of their service at the same time.

Global Standards and Local Policies for School Diabetes Care

Objectives: The purpose of this study is to analyse the practical implementation of regional and na-tional policies through the Protocol of Care of Children and Adolescents in School (2010) in Extremadura Region (Spain), and to compare its contents with the international standards of diabetes care at school defined by American Diabetes Association and International Diabetes Federation. The measures not only affect the security and diabetes care, but also inclusion and the right to health. Methods: A documental comparative analysis between the local and international standards about diabetes care in school setting is carried out. This analysis is framed in a larger project focused on the study of health promoting school and diabetes education, in which perceptions of children and adolescents with diabetes, their parents and school staff were studied. Results: The Protocol of Care of Children and Adolescents in School (2010) contains some international recommendations about the care of T1DM at school, but in other cases the measures are non-specific. The distribution of responsibilities for care at school is unclear and no monitoring and evaluation indicators are defined. Some elements are identified to be implemented in the tool to favour the security, management of T1DM care and wellbeing. In general, these elements refer to school plan for diabetes care, school organization and teachers, and school community training. Conclusion: It is required to develop specific policies and decisive action to ensure the right to health of children with diabetes and the full application of international standards for diabetes care at school.

基于fsQCA组态视角的我国医疗资源配置效率提升路径分析

背景当前我国医疗资源配置区域失衡、公平性缺失问题仍然突出。党的“二十大”报告明确提出要“促进优质医疗资源扩容和区域均衡布局”。目的探究提升我国医疗资源配置效率的具体路径,为实现我国医疗资源合理且高效配置、促进基本公共服务均等化提供科学参考。方法于2022年9月—2023年2月开展研究,数据源于《2021中国统计年鉴》《2021中国卫生健康统计年鉴》。将医疗卫生机构数、卫生技术人员数、床位数作为投入指标,以诊疗人次和入院人数为产出指标,通过数据包络分析(DEA)方法对我国2020年31个省份医疗资源配置效率进行测度;以医疗资源配置效率为结果变量,以卫生技术人员占比、每千人口床位数、出院者平均住院日、人均国内生产总值(GDP)、居民可支配收入、财政收入分权和医疗卫生财政预算支出占比为条件变量,运用模糊集定性比较分析(fsQCA)方法从组态视角探究内外部要素对医疗资源配置效率的协同影响机制,剖析高或非高水平医疗资源配置效率的条件组态,明确医疗资源高效率和低效率配置的多重路径。结果2020年我国31个省份医疗资源配置效率整体水平较高,均值为0.852,但省际存在较大差异。组态分析结果可知,医疗资源配置效率的提升是多因素共同作用的结果,共存在3种医疗资源高效率配置的路径。路径1:政府主导型驱动路径,以广西壮族自治区为典型案例。路径2:内外协调型驱动路径,以云南省和甘肃省为代表案例。路径3:均衡型驱动路径,代表案例主要有广东省、福建省和湖北省。非高医疗资源配置效率的路径也存在3条。路径1:政府制约型路径。路径2:经济-政府双重制约型路径,代表案例有黑龙江省和吉林省。路径3:内外制约型路径,典型案例有山西省和西藏自治区。结论内外部各要素及要素间的协同在良性互动过程中共同影响着医疗资源配置效率水平,需优化内外部环境,并对关键资源要素进行有效整合,以形成合力,促进区域医疗资源合理配置。

General medical practice in China:evaluation of urban community health care service functions based on a rough set reduction theory

Objective:This study aims to achieve an empirical evaluation on the functional performances of urban community health care services in fi ve administrative districts of Nanchang city in China.Methods:In order to increase effectiveness,data collected from fi ve administrative districts of Nanchang city were processed to exclude redundant information.Rough set reduction theory was brought in to evaluate the performances of community health care services in these districts through calculating key indices’weighed importance.Results:Comprehensive evaluation showed the score rankings from high to low as Qing-yunpu district,Xihu district,Qingshanhu district,Donghu district,and Wanli district.Conclusion:The objective performance evaluation had actually reflected the general situation(including social-economic status)of community health care services in these administrative districts of Nanchang.Attention and practical works of community health service management were needed to build a more harmonious and uniform community health care service system for residents in these districts of Nanchang.

Priority Setting in Health Care with Disease and Treatment Risks

This paper deals with the issue of priority setting in health care under uncertainties about the severity of the illness and the effectiveness of medical treatment. We examine the effect of a disease uncertainty(a treatment uncertainty) on the allocation of health care resources in the presence of a treatment risk(a disease risk) and identify preference conditions under which the social planner allocates more resources to higher risk population. We allow for the simultaneous presence of two risks and investigate the joint effect of two-source uncertainties on health care allocation when the two risks are either small or positively quadrant dependent. The effect of inequality aversion on health care allocation is also analyzed by introducing an equity weighting function. Our work extends the previous model of health care priority to two-risk framework and provides new insights into the problem of health care decision making under uncertainty.

基层医务人员隐性缺勤现状及影响因素研究

目的了解基层医务人员隐性缺勤现状及影响因素。方法多阶段整群抽取陕西省汉中市9所乡镇医院及其下属村卫生室580名医务人员,采用斯坦福隐性缺勤量表进行调查。结果基层医务人员隐性缺勤得分中位数为15,高隐性缺勤率为49.4%;Logistic回归分析显示,性别、文化程度、职称、所属机构、是否倒班是隐性缺勤的影响因素(P<0.05,P<0.01)。结论基层医务人员隐性缺勤程度较高,应根据不同医务人员的个人特征开展干预研究,同时合理配置医疗资源,改善基层医疗工作状态,以降低隐性缺勤。

矿区生态系统健康评价的理论和方法

分析了矿区生态系统健康内涵,建立了评价指标体系,以模糊评价理论对矿区生态系统健康现状、以灰色预测和趋势函数法对矿区生态系统健康的发展趋势、以非线性理论对矿区生态系统的稳定性进行了评价,在此基础上提出了综合评价方法.实例研究的结果表明, 研究矿区生态系统处于亚健康状态,需要对其进行干预和调控.并提出了相应的对策和建议.

公共娱乐场所性服务小姐卫生保健服务模式探讨

目的 探讨针对公共娱乐场所性服务小姐开展卫生保健服务的模式及可行性。方法 选取 2个城镇为项目现场 ,分别建立试点门诊 ,开展外展宣传并提供性传播疾病及生殖健康相关问题的规范治疗服务。结果 以医院为基础的项目门诊运转顺利 ,能够较好提供卫生保健服务 ;而在公共娱乐场所集中区单独建立的门诊难以维持运转。结论 针对公共娱乐场所性服务小姐开展卫生保健服务不宜孤立进行 ,应提供综合性的卫生服务。

构建与国家卫生事业改革方向相适应的本科医学课程体系

通过初级卫生保健的模式实现人人享有卫生保健是我国和国际社会卫生事业改革的方向,医学人才模式如何适应新的医疗卫生模式,是地方医学院校的重大课题。文章结合自身院校实践,从人才培养目标定位、课程设置与内容、课程模式、实践教学等方面探讨了构建与国家卫生事业改革方向相适应的本科医学课程体系的问题。

试论“体育与健康”教育专业的构建

针对我国新的九年义务教育《体育与健康教学大纲》实施 ,中、小学迫切需要大量的专业“体育与健康”教育相结合师资 ,而我国很少有培养这类师资的相应专业 .为此 ,提出构建“体育与健康”教育专业 ,要加强专业师资队伍建设 ,处理好体育与健康教育两类课程“复”与“合”的关系 ,重视体育与健康教育课程的设计和设置 ,建立以增强体育 ,增进健康实效为中心的成绩考试制度等设想 .

高校体育保健康复专业的发展及可行性分析

体育保健康复专业是近年来随着我国城市功能的逐渐完善,社会体育、休闲体育及社区体育的快速发展而逐渐“兴旺”起来的热门专业。由于我国大部分体育院校并未开设这一专业,面对人才供应的短缺,建议部分具备开设这一专业条件的体育院校应开设体育保健康复专业,以推动我国社会体育事业的健康发展。

医养结合机构建设基本要求与职能设置的研究与实践

本课题组根据多年研究和实践经验,对医养结合的概念和医养结合机构进行了定义、分类和界定,提出对医养结合专业机构实施分级管理以及各级机构建设标准、职能设定、质量控制和等级评定的设想,建议将医养结合专业机构定名为“医养院”,列入国家医疗保健体制内,作为国家正式规范的慢病防治机构。

基于分支定价算法的多时间窗家庭医护人员调度问题研究

为了减少医护人员调度成本,提高客户满意度,研究了家庭医疗护理人员调度问题。考虑客户具有多个可接受服务的时间窗,并对不同时间窗具有不同偏好的特性,建立以总运营成本最小、满意度最大为目标的数学模型。基于Dantzig-Wolfe分解原理将所建模型重构为集合划分主问题和含多时间窗的最短路径子问题模型。运用将列生成嵌入分支定界框架中的分支定价算法对问题求解,并根据多时间窗的问题特性设计了快速获得初始解的随机贪心算法和求解子问题的改进标签算法。对50组算例进行测试,将所提出的算法与CPLEX对比,验证了算法的有效性。最后比较单时间窗和多时间窗算例结果发现,客户提供多个可接受服务的时间窗能有效降低调度成本。

面向健康医疗的分类关联规则挖掘研究

数据的爆炸式增长使知识和规则隐式地存在于数据中不被发现,形成资源孤岛,造成资源浪费。关联分析用以挖掘大规模、海量数据中隐式的关联规则模式。提出一种面向健康医疗的分类关联规则挖掘算法,用以挖掘大规模个人健康数据间隐藏的分类关联规则模式,对健康医疗及其它领域中基于关联规则的推荐具有新价值。

Barriers and Enablers That Influence Utilization of Ultrasound Screening Services among Antenatal Women in Kajiado and Kisii Counties Kenya

Background: The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of limited access to appropriate Point of Care Ultrasound Screening (POCUS) services in lower levels of developing countries’ Health Systems, cost of care, skills gap among care providers and unclear regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm viability of a pregnancy, gestational age, multiple pregnancies and it also helps rule out fetal abnormalities early enough. Methods: One year after intervention, a cross-sectional study was carried in the two pilot counties of Kisii (rural) and Kajiado (peri-urban). This followed after selected midwives in the two counties were trained on basic obstetric ultrasound screening for ANC women. A total of 366 women who were either in their last phases of pregnancy or had delivered within three months before the survey were interviewed. Cumulatively, the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies were identified. Open Data Kit (ODK) was used to collect quantitative data and analysed using STATA version 15. Descriptive statistics were used to summarize the data test associations between variables. Bivariate and logistic regression was used to identify predictive variables, and ORs with 95% confidence intervals used to measure the strength of the associations. Findings: Slightly more than a third (36%) of the women had recently delivered. In total, Kisii (rural county) had a representation of 59% of the respondents. Half of the respondents were aged between 25 - 34 years, 55% of the women interviewed were housewives while 48% had secondary level of education. Only 21% of the women had undergone routine ultrasound screening before 24 weeks of gestation with the average distance travelled by majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation was the major (68.1%) motivator for seeking the service in the two pilot counties. Employment status, household income, education level, pregnancy gestation and distance to the facility had a statistical significance (P < 0.05) with ultrasound utilization. Highest education level, pregnancy gestation and distance to the nearest ultrasound screening facility were found to significantly predict the likelihood of utilizing the ultrasound services (P < 0.05). The initial training and continuous hands-on coaching of midwives by TOTs contributed a lot to acquisition of the desired basic obstetric ultrasound screening skills. Conclusion: Women in developing countries are eager to access obstetric ultrasound screening services but for limited opportunities and sustainable implementation frameworks on Point of Care Ultrasound Screening (POCUS) services. Training and continuous coaching of frontline health professionals are critical in deployment of POCUS but there is limited access to standardised training content.

海南省康养产业核心岗位人才培养的课程建设研究

目的:通过对海南20家康养机构的工作岗位及其任务的调研分析,总结提炼出康养专业的课程构架,为创新康养专业课程建设提供理论依据。方法:采用专家咨询法、问卷调查法、实地调查法等对海南省20家康养机构进行调研,针对康养工作岗位人才需求情况和典型工作任务、职业能力进行调查分析。结果:通过对调查数据的总结分析,提炼出28项康养岗位典型工作任务,并以此为依据构建出一套康养专业核心课程。结论:依据核心岗位任务构建的中职康养专业核心课程,对海南康养专业建设有重要的参考价值。

门诊医护人员呼吸道感染风险评估体系的构建

目的建立一套适合于医疗机构门诊医护人员呼吸道感染的风险评估体系。方法利用头脑风暴法、文献荟萃法识别风险点,利用风险散点图对风险点进行分类和评价,利用层次分析法计算风险点权重值。结果风险评估体系包含诊疗过程、环境和布局、人员防护、应急处置四个风险类别,共计18个风险点。结论此研究构建的风险评估体系有助于对门诊医护人员呼吸道感染风险进行针对性的分类管理。

以嵌套集合模型管理国际社区医疗分类(ICPC)的整体实现

作为现代区域社区医疗卫生信息平台建设中不可缺少的基础医学信息,在系统设计和开发过程中的一个重要基础是标准化。国际社区医疗分类(ICPC)作为区域社区医疗卫生信息平台必备的标准化数据字典之一,其对整个区域社区医疗卫生信息平台的重要性不言而喻。故在实际系统开发层面上如何整体实现值得程序开发人员认真的考量。针对国际社区医疗分类(ICPC)字典在关系型数据库中提出了处理分层数据统一的数据嵌套集合模型,在此基础上讨论了分层数据结构编程的有关问题,主要为建立和管理数据集、分层数据结构的检索、节点的增加、删除等一般性操作处理,以及分层数据结构在用户界面上的表现方式等。