Psychiatric Epidemiology and Mental Health Service in the Tibet Autonomous Region of the People＇s Republic of China

概述:西藏自治区的精神疾病流行病学和精神卫生服务情况在国际上鲜有提及。本文综述了中国西藏自治区的精神疾病流行病学和精神卫生服务以及相关研究。目前在西藏,有很多人存在精神障碍和心理问题,但由于缺乏现代精神治疗机构和专家,仍有很多的治疗需求没有被满足。

Youth’s Perspectives on a Sustainable Model for the Provision of Youth Friendly Sexual and Reproductive Health Services in Kenya: A Quantitative Approach

Nearly half of the world’s population comprise youths. However, addressing their Sexual and Reproductive Health (SRH) remains a challenge. Globally countries are mandated to continually provide Youth Friendly Sexual and Reproductive Health services (YFSRHs) to the youth. The objective of this study was to assess and describe youth’s perspectives on a sustainable model for the provision of YFSRHs in Kenya. Data was collected among 400 youths aged 18 - 24 years in Embu and Kirinyaga counties, Kenya. A structured questionnaire was utilized as the data collection tool. Collected data was analyzed using SAS statistical software version 9.4. Statistical threshold of P ≤ 0.05 was used. Overall the mean age of the study participants was ±standard deviation (SD) 21.2 ± 1.86 years. Majority of the participants’ perspective on the health care system sustainability was that the waiting time at the facility should be less than an hour, accessible geographically (less than a kilometre), affordable (≤20 Ksh.), and convenient working hours (weekday and weekends ratio 1:1). Advocacy was on health care provider’s attributes of politeness, welcoming, confidential and non-judgmental. The most preferred locations for the youth friendly centres by the participants were community and school based locations. Similarly, parental and community support was reported to highly contribute to sustained utilization and provision of the YFSRHs (P < 0.001). Unlike popular belief, 99.8% did not see the need for recreational facilities at the youth centres to ensure sustainability of the model. To ensure a sustainable model for the provision of YFSRHs, there is need for a multi-sectoral and stakeholder involvement that is;youth, health care system structure, health care service providers, parents and community. Further research is needed on parents and health care service provider’s perspectives on how to sustain the provision of YFSRH services.

Cultivating global health professionals: evaluation of a training course to develop international consulting service competence in China

Background:China’s accelerating development and increasingly important role in global health engagement create a great demand for global health professionals including international consulting experts.This study reported the detailed development and evaluation of an international consulting training for global health workforce.Methods:Based on Kirkpatrick’s model,a mixed-methods approach was used to evaluate the effectiveness of the training.Quantitative and qualitative data on participants’reaction,learning,and application of the learned knowledge and skills were collected by a training evaluation survey at the ending of training and a follow-up interview in three months after the training.Results:Thirty-six participants attended the training and 34 of them completed quantitative investigation.The training satisfaction evaluations were positive,for which participants rated the training program highly and over 90%of them agreed with the usefulness of the training.About knowledge and skills change,participants showed improved consulting knowledge and skills from pre-to post-training(P<0.001).A total of 23 participants accepted follow-up interview,and most participants applied knowledge and skills learned from the training in their daily work or study.However,only 30.4%of participants applied their learning in the consulting program.The largest barrier of application was the lack of consulting opportunities.In addition,almost all the participants reported that they would be glad to attend more training courses in the future.Conclusion:The international consulting training program was well-received,and was feasible to improve the consulting service competence of global health professionals.According to participants’feedback,it is essential to develop and expand consulting training in the field of global health.

健康中国背景下“G-U-S”公益性体育服务模式的构建与实施

基于“健康中国”时代背景,对政府购买服务、高校提供服务和社会大众享受服务的“G-U-S”公益性体育服务模式构建的理论基础、主体框架及运行机制进行阐释,并以青少年体育服务为案例进行具体实施和效果检验。结果表明:“G-U-S”模式成效显著,服务对象满意度高,不仅能够达到提高其体育运动成绩,还能够促进体育兴趣培养和体育锻炼参与,具有校内和其他社会体育培训机构所不具备的优势。模式发展策略包括“G-U-S”的稳定发展有赖于高校资源共享的良性循环、高效运行离不开政府有效的组织监管、高质量服务必须坚持以服务对象需求为导向。

Limitations and possibilities on health assessment to women in violence situation

The aim was to know how health assessment to women in violence situation is developed. Literature review on LILACS and MEDLINE databases was conducted in April 2013 with the descriptors: “domestic violence” and “women’s health”, on a 1994-2012 timeframe. Statistics characterization and content theme analysis of the scientific production were developed. Results showed that the assessment is permeated by institutional limitation and an approach strictly clinical that makes identification and diagnosis of violence difficult, reinforcing invisibility in health care. Professional assessment is influenced by socio-cultural and the naturalization of the phenomena, which is not considered a public health issue. Technical knowledge is insufficient, making the possibility of promoting violence cycle rupture difficult. However, we envisage reception as a possibility to assess female demands. We conclude the need to include the theme in health undergraduate courses and also the urgency of this learning experience to support a multidisciplinary and intersectoral work web. Thus, rethinking assessment as a way of (re)organizing how health care is structured in order to compose an assessment web to women and guarantee reception of their demands is needed. Else, constructing competence allied to coping public policy to the problem and guaranteeing a human and full assistance will stay only on the academic field, constituting itself as a limit on protecting life of these women and their families.

基于B/S架构的合理医疗指引监管系统的研究

目的:为合理指引医务人员的诊疗行为、减少不良医疗事件的发生、减轻患者与医院的负担,开发合理医疗指引监管系统。方法:该系统采用浏览器/服务器(Browser/Server,B/S)架构,操作系统为Windows Server 2008,数据库采用MySQL,应用程序开发语言为Java。结果:该系统实现了抗菌药物的分级管理,可实时、有效地监管医嘱。结论:该系统的应用,加强了对医疗服务行为的监管,有效地控制了医疗成本,规范了诊疗行为,可以推广应用。

重庆市儿童医疗服务体系现状的SWOT分析与对策研究

目的:通过对重庆市儿童医疗服务体系现状的了解,分析存在的问题及导致这些问题的原因,提出合理的对策建议。方法:数据收集和现状了解主要采取访谈法、文献研究法,对目前存在的问题及原因则采用SWOT分析法,分析目前面临的优势、劣势、机会和威胁。结果:随着全面二孩政策的放开,对儿童医疗服务需求加大,但儿童医疗资源紧缺且分配不均,儿童医疗服务水平有待提高。结论:主管部门应根据国家医改政策和重庆市儿童医疗服务体系的现状制定适合重庆市儿童医疗服务改革的方针和措施,合理调配资源配置,酌情设立儿科建设专项基金,加强县级综合医院儿科建设发展,应用医保杠杆推行分级诊疗,提高全市儿童医疗服务的整体水平,缓解看病难的问题。

Review on Efficacy and Health Services Research Studies of Complementary and Alternative Medicine in Inflammatory Bowel Disease

Objective：To assess the evidence of the use and efficacy for complementary and alternative medicine（CAM） in inflammatory bowel disease（IBD）. Methods：A systematic literature search in MEDLINE was performed for randomized controlled trials（RCTs） in Crohn＇s disease and ulcerative colitis.Moreover,a selective literature search for health services research studies on the use of CAM in patients with IBD was performed.Results：Health services research studies showed a high use of CAM in adult and pediatric patients with IBD worldwide.In contrast to the high use among IBD patients,there was a lack of high-quality data for many of the used CAM methods.Although most of the studies showed positive results,the methodological quality of most studies was rather low;therefore,the results had to be interpreted with caution.While there were many studies for probiotics and fish oil,RCTs for the highly used method homeopathy, for most herbal products,and for traditional Chinese medicine methods apart from acupuncture RCTs were completely lacking.Conclusions：The lack of high-quality studies might be the consequence of the problems associated with the funding of clinical trials involving CAM.However,having the high user rates in mind,high-quality studies assessing efficacy and safety of those methods are urgently needed.Furthermore,there is a need for better representation of CAM in undergraduate and postgraduate medical education.

How to Implement Change in Asthma Management in a Developing Country

The goal of asthma management is to control symptoms, reduce the need for short acting beta agonist, and maintain optimal pulmonary function, and normal physical activities. Uncontrolled asthma can lead to obesity, suboptimal pulmonary function, poor quality of life and mortality. Children with bronchial asthma in River State University Teaching Hospital were just receiving acute care in the emergency room with no concrete plan for a follow up care for their chronic asthma;as a result most of the patients had uncontrolled asthma. In the hospital, the situation led to increased emergency hospitalization, resulting in decreased bed availability, increased burden on manpower and health resource utilization thereby putting more pressure on the limited health resources. Using the Kotter’s model for change management, transformational and situational leadership style, the change in the desired quality and scope of health service rendered to asthmatic patients was successfully implemented;as a result there was a decrease in emergency room visit for acute asthma by 57.5% and an increase in the uptake of scheduled clinic visits for asthma control services. The effect of these changes was an improvement in the control of asthma and quality of life of our patient cohort. Implementation of change in health service delivery is a delicate process that needs a stepwise approach in order to successfully implement and sustain the desired change.

Health service needs of women with reproductive tract infections in selected areas of China

OBJECTIVE: To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms. METHODS: A cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. RESULTS: The percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. CONCLUSION: The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.

接受人工流产术的未婚女性及其男伴参与互动式健康教育的效果

目的:探讨接受人工流产术的未婚女性及其男伴参与互动式健康教育的效果。方法:选取2022年2月-4月在郑州市某三级甲等医疗机构门诊接受人工流产手术的未婚女性病人作为研究对象,根据参与者意愿分为干预组62例和对照组64例。对照组女性接受流产后关爱(PAC)标准化流程健康教育服务,干预组女性及其男伴共同接受互动式健康教育服务,从有效避孕知识水平、人工流产术准备程度、术后随访行为落实情况进行评价。结果:两组未婚女性术后留观有效避孕知识得分比较差异有统计学意义(P<0.05),术后1个月、3个月的有效避孕知识得分比较差异有显著统计学意义(P<0.01)。干预组未婚女性术后留观、术后1个月、术后3个月的有效避孕知识得分比较差异无统计学意义(P>0.05),对照组未婚女性术后留观、术后1个月、术后3个月的有效避孕知识得分比较差异有显著统计学意义(P<0.01)。两组未婚女性人工流产术准备程度比较差异有统计学意义(P<0.05),两组未婚女性术后1个月、3个月随访形式比较差异有显著统计学意义(P<0.01)。结论:有效避孕知识需大力在未婚女性群体中普及,男伴参与互动式健康教育对接受人工流产术的未婚女性有效避孕知识水平改变及人工流产术后随访行为落实影响显著。

上海市40~60岁社区妇女保健门诊患者骨质疏松症的认知状况及对预防服务需求的影响

目的了解上海市40~60岁社区妇女保健门诊患者骨质疏松症知识掌握情况、相关服务需求与利用状况,为进一步完善围绝经期妇女骨健康的预防策略提供依据。方法2022年10月—2023年4月,在上海市10家社区卫生服务中心妇女保健门诊就诊的40~60岁患者人群中开展骨质疏松症知识评价、服务需求与利用的问卷调查。结果1278名40~60岁社区妇女保健门诊患者骨质疏松症的知识问卷总知识得分的不及格率为73.00%。不同类别知识的不及格率从高到低排序,依次是危险因素(75.98%)、运动知识(71.83%)和钙知识(31.77%)。经卡方检验,三类知识的不及格率、及格率和良好率的差异有统计学意义(χ^(2)=655.83,P<0.001)。不同年龄组、文化程度、工作情况、月收入的妇女的骨质疏松症知识得分差异有统计学意义(P<0.05)。文化程度越低,月收入越低,知识得分越低;在岗妇女的知识得分更高,无业妇女的知识得分较低。排在前2位的骨质疏松症防治服务项目为“40岁以上妇女体检要增加骨密度检测项目”(81.14%)和“社区定期开展骨质疏松症的筛查”(77.70%)。logistic回归分析结果显示,与三类知识均及格的妇女相比至少一类(OR值为1.714,95%CI为1.068~2.751)或两类(OR值为1.603,95%CI为1.043~2.545)知识不及格的女性未做过骨密度检测的可能性更高。结论在上海市严峻的人口老龄化背景下,应关注骨健康知识薄弱环节,关注低学历、低收入、无职业的围绝经期妇女等重点人群,在围绝经期妇女保健服务中纳入骨质疏松症的健康教育、早期风险识别的预防措施,充分发挥基层妇女卫生保健服务的存量资源作用。

青藏高原居民医疗服务满意度及影响因素研究

目的:了解青藏高原居民医疗服务满意度及其影响因素,为提升当地医疗服务效果提供参考依据。方法:利用县域尺度社会经济数据和1882份家庭层面问卷调查数据,依据Andersen医疗服务使用行为模型构建指标体系、借助多层次模型求解,对青藏高原居民医疗服务满意度及其影响因素进行了研究。结果:(1)89.96%的受访居民对医疗服务表示满意,选择医疗机构的主要影响因素为看病效果好和距离近,就医过程中遇到的主要困难为不熟悉就医流程和不熟悉医疗费用报销流程,基层巡回诊疗主要带来了免费体检以预防疾病和不出远门就能看病两项便利;(2)在个体层面上,居住地、是否有基层巡回诊疗、是否熟悉医疗费用报销流程、能否与医生顺利交流病情、是否符合风俗习惯和自评健康状况等是医疗服务满意度的显著影响因素;(3)在县区层面,万人卫生院数对医疗服务满意度有显著影响。结论:个体因素和区域因素均对居民的就医满意度产生显著影响,其中巡回诊疗、语言沟通和风俗习惯是影响青藏高原就医满意度的独特因素。建议通过加强基层巡回诊疗,宣传普及医疗保险并简化其报销流程,提升就医过程的便利性,增加医疗卫生机构配置和优化医疗服务机构布局等措施进一步改善青藏高原居民的就医满意度。

西藏高原地区全过程巡诊药品保障模式的实践与体会

藏区居民巡诊是当前西藏高原部队医院的一项常态化工作,药品保障工作作为巡诊工作的重要组成部分,其作用越来越突出。本文通过全程参与西藏高原地区巡诊前、中、后药品保障的实践活动,对巡诊的药品保障工作有深刻体会,如注重信息收集、科学筹备药品、加强翻译作用等方面。笔者提出全过程巡诊药品保障模式的建议,以利于藏族群众的合理用药,利于巡诊工作的顺利开展。

Women and Children's Health in Tibet

AS a doctor in the management of maternity and children’s hygiene in the Tibet Autonomous Region for nearly 20 years, I would like to present a brief introduction of the situation of Tibetan women and children’s health, as well as the related services. Prior the Liberation in Tibet, this region coveting over 1.2 million square kilometers, had few health care facilities for women and children. Such activities were carried out by three Tibetan medical institutions, a small number of folk doctors of Tibetan medicine, and a few private clinics. Under the feudal serf system in Tibet, women who gave birth were discriminated against because it was considered an obscene act. Women could not give birth in their tent homes, but were instead forced to seek shelter in cow stalls or sheepfolds no matter how severe the weather. Women and children at the time had no rights to health care. Countless women and children died of birthing complications

全国社区卫生服务现状调查

目的了解中国社区卫生服务发展的现状及成效.方法 2003年8～9月,应用分层随机抽样的方法,对全国11个省、自治区、直辖市的卫生行政部门、社区卫生服务机构、社区居民及社区卫生服务相关部门进行定性与定量调查.结果我国社区卫生服务已初具规模,政府专项经费的投入逐年增加,人员培训广泛开展,多数社区卫生服务中心/站的软、硬件条件基本能够满足社区卫生服务的需要,社区卫生服务举办类型的多元化局面已初步形成,社区卫生服务的优势得到一定程度的体现;我国社区卫生服务发展水平存在明显的地区差异,部分地区在政府经费投入、社保等社区卫生服务政策、社区卫生服务机构建设的基本条件等方面存在不足.结论应明确社区卫生服务机构的合法地位;加强政府对社区卫生服务的资金投入,合理分配社区卫生资源;制定医保倾斜政策,促进病人向社区卫生服务机构合理流动;根据不同地区社会经济发展水平制定不同的社区卫生服务政策,分类指导,开发符合当地实际情况的社区卫生服务政策;合理划分社区卫生服务中心/站的服务范围;认清社区卫生服务多元化的发展趋势,充分发挥政府对社区卫生服务的监管作用;加强社区卫生服务机构的硬件建设,完善其基本功能;加强全科医学培训,提高社区卫生人员业务水平;提倡对病人的就医指导,促进双向转诊制度的建立;发挥社区卫生服务在时间和地域可及性的优势,努力创造对技术和资源的可及性.

代际货币转移对中国农村老年人卫生服务利用的影响研究

采用Andersen卫生服务利用行为模型,研究了净货币转移对中国农村老年人门诊服务利用数量的作用。采用多级分层的方法调查老年人(1050例),研究可利用资源和所需因素之间的相互作用,同时利用泊松回归对主效应和交互效应进行研究。净货币转移与门诊服务利用数量并不相关,但净货币转移与自评健康之间的交互作用的确存在。自评健康状况差或一般的老年人,以及获得较多净货币转移的老年人,使用门诊服务更为频繁。老年人对医疗服务的利用主要与健康需求有关。建议提供与支付能力相当的医疗保险,加强对农村老年人的公共援助。

基于iPhone的免费戒烟应用程序内容分析及研究

目的分析2012年12月29日来自苹果商店iTunes 69款与戒烟相关的手机应用程序(Apps)的内容,得到其与美国公共卫生服务烟草临床指南的相关程度,为Apps开发提供参考和建议。方法根据美国国家烟草控制协作中心的条目将Apps分为5类,再将每个Apps的内容与美国公共卫生服务烟草临床指南作对比,给出相应的评分。结果 69款戒烟Apps平均得分为10.6,其中最高得分34.5,平均占用储存空间为2.8M。在5种类型的Apps中仅有13.9%与指南相关程度高,其中日历类有21.0%的Apps与指南相关程度高,催眠类Apps与指南相关程度最低。结论 Apps的内容与指南的相关程度低,应当以美国公共卫生服务烟草临床指南为准则,开发出质量更高的戒烟Apps。

产后和流产后使用长效可逆避孕方法的技术指南

产后及流产后是避孕的关键环节,及时或尽早落实可靠避孕可以有效降低非意愿妊娠,预防人工流产及其并发症的发生,保护育龄女性身心和生殖健康。以产后及流产后避孕指南为依据,重点阐述妇女产后和流产后可优先选择的长效可逆避孕方法(long-acting reversible contraceptive,LARC)包括宫内节育器、皮下埋植剂。为临床医生和咨询人员帮助服务对象知情选择并落实安全、有效、适宜的避孕措施提供指导。

湘西少数民族育龄妇女生殖健康认知调查

目的探讨在湘西少数民族地区开展生殖健康教育工作的新模式。方法2005年8月,采用自行设计的问卷,随机对8 527名少数民族育龄妇女进行了调查。结果少数民族育龄妇女的卫生保健知识水平、就医行为均普遍偏低、个人卫生习惯较差;易接受的生殖健康教育方式前3位分别是"看CD光盘或电视"(95.2%)、"发放宣传手册及相关书籍"(89.7%)、"办墙报或宣传栏"(76.8%);当前最急需了解的生殖健康相关知识是家庭保健常识。结论应加大少数民族地区预防生殖道感染的宣传普及力度,选择合适的健康教育方式和干预措施,增强少数民族育龄妇女生殖健康的自我保健意识和能力,提高生殖健康水平。