Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

An investigation of the health value and self-care capabilities of the elderly in urban-rural fringe area nursing homes and the related in？uencing factors

Objective：To investigate the health value and self-care capabilities of the elderly living in urban-rural fringe area nursing homes and the factors that influence these variables.Methods：A cluster sampling method was used to select 280 elderly individuals from seven urban-rural fringe communities in Xianning to complete a survey regarding their health value and self-care capabilities.Results：The total health value and self-care capability scores of the elderly were 7.45 ± 1.45 and100.25±22.56,respectively.Both of these scores significantly differed by age,education level,marital status,and income（P 〈 0.05,P 〈 0.01）.Self-care capability was correlated with health value（r=0.521）.A multivariate linear regression analysis showed that health value,marital status,and age predicted selfcare capability.Conclusions：Elderly people living in the urban-rural fringe area with higher health values also had higher self-care capabilities.The self-care capabilities of the elderly can be enhanced by improving their health value using the ＂knowing-trusting-acting＂ model.

Going the Distance A telemedicine company uses technology to meet Africa’s rural medical needs with prime health care

We have a scarcity of health care professionals in the rural areas and therefore we can offer medical services from a distance to the underserved rural population.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Quality assessment of the practice of focused antenatal care (FANC) in rural and urban primary health centres in Ekiti State

Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and challenges to the practice of FANC in urban and rural areas. Design: Cross sectional. Setting: Primary Health Centers Participants: Pregnant women and Heads of health facilities. Methods: Two hundred respondents each from urban and rural areas primary health centres were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package. In-depth Interviews were conducted with the heads of selected facilities. Data was analysed using descriptive statistics and Chi square test and content analysis for indepth interview. Results: More respondents 58 (29.3%) from the urban areas had the minimum contents compared to 41 (20.7%) of the rural respondents (p < 0.05) and 178 (90.8%) of the urban were taught a range of health education topics compared to 177 (88.5%) (p = 0.45). Urban respondents were about 1.6 times more likely to receive the minimum contents than rural respondents. In-depth interview results explicated the facilitating factors and challenges to focused antenatal care in the study areas. Conclusion: The findings of this study is consistent with other studies establishing the fact that better health service is available to urban residents than rural residents;however, this study has succeeded in comparing the documented standard of antenatal care with what was being practiced in the selected PHCs of the state. The basic contents of focused antenatal care in Ekiti state were received by a small proportion of the respondents, suggesting that focused antenatal care had not fully translated into quality service;one major challenge to the delivery of standard antenatal care was inadequate number of skilled health workers especially in the rural areas. The gap between quality and utilisation of antenatal in urban and rural areas is gradually being closed up;this success should be improved upon and maintained.

Significant Differences in Elderly Health between Urban and Rural Communities: A Literature Review

This study aimed to examine measures pertaining to elderly health in urban versus rural settings, and to identify differences in the health of elderly people living in urban and rural communities through a literature review. An electronic literature search was performed using PubMed for English articles published in peer-reviewed journals up to August 2018, with the following search terms: “urban”, “rural”, “comparison of community”, “elderly health”, and “comparison of community health”. A total of 35 articles were extracted for a critical full-text review, and six articles that met the inclusion criteria were subjected to analysis. Measures related to elderly health in urban and rural communities were classified into the following three categories: functional abilities, health, and health perception. Five of the six articles described functional abilities (e.g., social function) and health (e.g., mental health, depression) as categories with significant differences in elderly health between urban and rural communities. The results suggest that elderly health measures related to social function and mental health or depression are more important outcome measures of effective person-centered integrated community care systems from the perspective of community characteristics. As there were only a few articles reporting on elderly health according to differences in environment between urban and rural communities, further investigation is globally warranted.

福利多元视角下农村老年人群医疗服务供给主体构建

目的:探讨在国家乡村战略全面推进阶段的大背景下,提升农村老年人医疗服务保障能力和水平。方法:利用福利多元主义分析农村老年人口医疗条件现状及面临的问题。结果:现阶段利农村老年人群的医疗服务主体存在政府作用发挥不到位,市场能动性不足,社会参与程度较低、社区服务不完善等问题。结论:从政府主导、市场能动、社会参与、社区服务等主体入手,加强供给主体的功能发挥,有效提升农村老年人群的医疗卫生服务水平。

4~7岁儿童代谢综合征有关指标之间相关模式研究

目的探究4~7岁儿童代谢综合征有关指标之间的相关模式。方法依托前期开展的孕期增补复合微量营养素预防母婴不良结局项目,在河北满城、元氏2县选取参加项目孕妇所生儿童1454名,于儿童4~7岁时测量身高、体重、腰围、血压并检测血脂和血糖。采用Pearson相关分析检验体质指数(BMI)、腰围、总胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、空腹血糖(FPG)、收缩压和舒张压共9个指标之间的线性相关关系。参照美国心脏学会标准判定儿童中心性肥胖、高血压、高TG血症、低HDL-C血症和高血糖发生情况,采用关联分析的φ系数描述5个代谢综合征组分间的相关关系。结果儿童CHO与LDL-C相关关系强(r=0.82,P<0.001),腰围与BMI、收缩压与舒张压、CHO与HDL-C相关关系较强(r依次为0.63、0.60和0.74,P均<0.001),CHO与TG、TG与LDL-C、HDL-C与LDL-C中等强度相关(r依次为0.34、0.30和0.43,P均<0.001),其他指标之间为弱相关或无相关。儿童中心性肥胖与高血压、高TG血症、低HDL-C血症三者均呈弱相关关系(φ系数依次为0.06、0.08和0.07,P均<0.05),高血压和高TG血症呈弱相关关系(φ=0.05,P<0.05),其他代谢综合征组分间的φ系数无统计学意义。结论儿童收缩压与舒张压之间、腰围与BMI之间以及几个血脂指标彼此之间相关关系较强,包括HDL-C与CHO、LDL-C均为中等强度正相关关系,而血压、肥胖与血脂三类指标之间无明显相关,血糖与所有指标均无明显相关;儿童代谢综合征各组分间相关较弱或无相关,提示儿童代谢指标间相关模式与成人不完全相同,代谢综合征这一概念应用于儿童宜审慎。

乡村振兴战略下长白山池北区康养旅游 SOWT分析与发展研究

乡村振兴战略是我国全面建设社会主义现代化国家的重大历史任务之一,康养旅游业是现阶段推行“三农”规划的关键步骤。以吉林省长白山池北区为例,运用SWOT分析法,指出了吉林省长白山池北区康养旅游发展具有康养旅游资源丰富、旅游设施完备、国家政策大力支持、经济进步促使旅游消费观念升级等优势。根据吉林省长白山池北区康养旅游发展康养旅游资源开发不到位、旅游季节性强、生态系统脆弱这些劣势及面临的威胁,提出了提高安全服务系数、提升康养专业人才的综合素质、打造品牌、花样宣传加强对生态系统的保护、加强各部门合作,推动各产业融合发展的对策及建议,以期促进吉林省长白山地区康养旅游的发展和乡村振兴,让发展康养旅游业成为有意义的发展任务。

如何推进农村重点疾病人群基本卫生保健模式的改进:以人为本整合型健康管理政策证据简报

背景为了更好地应对我国基本卫生保健服务面临的问题与挑战,中国国家卫生健康委员会与盖茨基金会开展紧密合作,2017—2022年在山西省、湖北省以及河南省部分农村地区开展基本卫生保健项目。项目的总目标是探索基本卫生保健服务的有效模式,助力健康扶贫工作,加强中国国内经验分享,并惠及其他发展中国家。目的总结在以高血压和糖尿病为代表的农村重点疾病人群中开展以人为本整合型健康管理的经验。方法农村基本卫生保健项目资料和数据的收集包含了多个来源,包括医院信息系统数据、统计报表资料、基本公共卫生数据、定性访谈、患者调查、医生问卷调查、病历质量调查等,以描述性统计分析以及前后比较作为主要的评估方法。结果高血压和糖尿病患者规范化管理率保持稳定上升,住院患者次均住院费用下降,患者健康生活行为逐渐上升、患者服药依从性有明显改善。在健康结局方面,患者高血压控制情况明显改善但患者血糖控制情况变化不明显。结论项目地区重点疾病健康管理的服务理念和服务能力明显提升,相关措施已经变成政策在项目地区推广和落地,各类专家是项目推动实施的关键因素,各项措施的可持续性有待保持。

乡村振兴背景下数字化康养共享村落的建设研究--以礼泉县任池村为例

随着我国人口老龄化的加速推进,康养产业逐渐成为国家战略性新兴产业。为了加快实施乡村振兴战略,早日实现“农业强、农村美、农民富”的宏伟蓝图,陕西省咸阳市礼泉县昭陵镇任池村紧紧依托优美的自然环境,厚重的历史文化,淳朴向善的村风,充分利用、盘活闲置宅基地,建设“任池村共享村落永康颐养九嵕山唐院”项目。基于乡村振兴背景下数字化康养共享村落的建设是一个重要的发展方向,可以促进乡村振兴,改善居民生活品质,推动产业升级。文章立足于乡村振兴视角,分析当前数字化康养共享村落的建设探索,将信息技术和养老服务相结合,通过整合资源,为老年人提供更加全面、便捷和高效的养老服务,旨在加快信息化发展,整体带动和提升农业农村现代化发展。

大连市乡村康养旅游景观设计研究——以普兰店区天益堂村为例

依托大连乡村的康养资源,以安波天益堂村为例,分析了其区位特征,提出了融合弹性、包容性以及智慧旅游的设计策略,围绕“健康”展开设计,以恢复游客身心健康为目标。以“乡野自然、田园养生”为主题,设计出“一带、一环、五区”的布局形式,总结了大连安波村乡村景观规划设计的核心内容,指出了乡村康养景观设计应注重融合当地自然景观资源,突出乡村康养特色,满足五感需求,为游客提供优质乡村康养环境,从而实现景观的可持续发展。

病有所医、病无所恐:我国农村合作医疗制度发展历程、运行逻辑与未来进路

新中国成立70多年来,国家一直在探索如何更好地为农村人口供给可负担、高质量的医疗保障,在经历了从传统农村合作医疗到新型农村合作医疗的不间断探索后,形成了中国特色社会主义制度下的农民医疗保障全覆盖模式,这种连续性、从未间断的合作医疗形成了新中国治理变迁的独特经验,是形成国家发展的“中国奇迹”的一种基础保障力量。以历史变迁的长镜头观之,我国合作医疗历经了从“集体福利”“个体消费”“民生服务”走向基本公共服务均等化的实践轨迹,各个阶段都努力在现实需求与资源约束的矛盾运动下最大限度保证农民群众“人人看得起病”。为了在更高水平上保障农民“病有所医、病无所恐”,未来需要继续大力推动城乡居民基本医疗保障制度的一体化改革,扩展农民群众医保报销范围、降低个人承担份额,最终实现城乡居民人人享有健康权利的国家战略规划,迈向以人民为中心的社会主义“共同健康”之路。

农村康养产业发展的理论阐释、多元实践与政策协同

农村康养产业作为一种新兴业态,是秉承新发展理念,在乡村舒适性资源利用、后生产主义乡村价值兴起、农村产业融合驱动、城乡地域共同体功能再造、康养政策引领与市场开发的共同作用下发展起来的。在实践中,通过对自然资源、文化资源、中医药资源和森林资源的开发,与乡村旅游、文化体验、休闲度假、景观游赏等相融合,发展出田园康养、文化康养、医疗康养和森林康养等新型形态,在一定程度上满足了老年群体多样化的养老需求,建立了互益性城乡交流渠道,推动了乡村产业振兴和社区建设。但目前其发展的体制机制尚不成熟,存在统筹规划力度不足、业态短板比较突出、专业康养人才匮乏、数字化技术融入较低等问题。文章建议从主体、资本、人才、技术的角度构建政策协同的路径,加强顶层设计、突出康养特色、创新职业培训、推进科技创新,实现农村康养产业的可持续和高质量发展。同时,围绕农村康养产业发展,还应加强对城乡互益性养老服务机制的研究,探讨建立衔接有序、功能互补的城乡养老服务网络的可能路径。

Extension for Community Health Outcomes-hepatitis C:Small steps carve big footprints in the allocation of scarce resources for hepatitis C virus treatment to remote developing areas

Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.

乡村振兴背景下农村旅居康养的发展逻辑、限制与展望

农村退休迁移一度是西方多学科重点关注的研究话题,其兴起主要源自乡村生活价值重估、消费功能兴起以及老年人提高晚年生活质量的要求,但在国内学术界一直缺乏相应关注。伴随中国进入到城市化高速发展、乡村全面振兴的新发展阶段,珠三角、长三角等一些地方已开始出现与国外退休迁移相似的农村旅居康养动向。结合实地调查发现,相较于西方农村退休迁移的发展背景,国内农村旅居康养的产生是市场开发、政策引导、乡村建设和个体诉求共同作用的结果。鉴于国内农村旅居康养还存在全年段康养开发不足、医疗卫生基础薄弱、配套服务设施不完善、专业服务水平不高等问题,建议围绕城乡养老服务需求形成整合性框架,促进康养与旅游融合发展,引导乡村舒适驱动型发展,开展城乡互益性养老交流,建立城乡养老服务联合体,以实现城乡共建共享共富。

农村留守老年人用药安全及医疗保障状况调研——以辽宁省建昌县为例

目的 响应人口老龄化的国家战略,调查与研究农村留守老年人医疗保障情况与提升路径。方法 于2020年8-9月采用实地走访的调查方法,对辽宁省建昌县的15个村庄中符合纳入标准的300位老年人进行问卷调查,获得291份有效问卷。结果 (1)89.69%的农村留守老年人已参加城乡合作医疗保险,5.84%的农村留守老年人未参加任何医疗保险;(2)67.78%的常用药已纳入医保药品目录,有58.42%的老年人认为药品在定点医疗机构可持续性购买;(3)面对身体不适有68.73%的农村留守老年人选择非处方药进行自我药疗,却有高达13.74%的农村留守老年人曾因自我药疗而延误治疗;(4)有37.11%的农村留守老年人不阅读说明书,每次都会查看药品有效期的农村留守老年人只占41.58%。结论 当地医保政策虽然在一定程度上缓解了农村留守老年人看病难、看病贵问题,但也仍然存在药品保障能力不足、报销比例低等问题,导致农村留守老年人医疗负担依旧较重;当地基本药物制度不健全,农村留守老年人的用药安全隐患较大;社会各界和政府要积极健全农村留守老年人医疗保障的社会支持系统;不断完善城乡合作医疗制度,加大相关政策的合理宣传;建立健全基本药物制度,为这一特殊群体的医疗保障提供支撑。

协和继续医学教育助力国家乡村振兴健康战略

党的十九届五中全会明确“全面推进健康中国建设”的战略部署,要把人民健康放在优先发展的战略地位。乡村振兴战略的实施是推动新时代高质量发展的重大部署,决定着我国全面建成小康社会的成色和社会主义现代化的质量。百年协和发挥行业引领作用,协和继续教育学院的“顶天立地”项目,“顶天”计划包括以北京协和医学院创新领军学者临床新技术新进展培训项目在内的,偏向公益性质的继续医学教育项目;“立地”计划包括在西藏、新疆维吾尔自治区、青海省、贵州省、福建省等“老、少、边”地区开展基层医务工作者的培训项目。要用协和的优质继续教育资源为国家的乡村振兴战略做出贡献。为乡村振兴承担对口帮扶任务,为国家培养高素质的医疗卫生人才,努力把协和创新领军学者办成在全国具有影响力、标志性的公益培训品牌。更好地为我国的乡村振兴战略服务。

城乡互益性养老的理论内涵与实现路径

城乡互益性养老是通过乡村康养产业开发、志愿服务开展等形式,使城乡老年人共享互惠的新型养老形态。虽然这一现象在国内还没有形成普遍趋势,但伴随健康养老需求的增长、国家和地方政策的引领、乡村休闲旅游热度的攀升以及农村康养产业的开发,城乡互益存在着较多发展可能。从理论上看,城乡互益性养老以产业协作为基础,以组织协同为关键,以资源共享为目的,在现实中主要表现为高产业协作-高组织协同、高产业协作-低组织协同、低产业协作-高组织协同、低产业协作-低组织协同四种实践雏形,但在发展中还面临着谁来组织、谁来服务、服务什么、如何服务的问题,建议采用地域开发的整体性视野来通盘考虑城乡养老中的可能交集与互惠交流问题,统筹规划城乡养老产业布局,着力推动养老事业产业协同,深入推进智慧医养康养融合,科学设计城乡互益服务流程。