南通市港闸区居民健康生活方式宣传活动效果分析

目的 了解南通市港闸区居民参加健康生活方式宣传活动的效果,为今后有效地开展居民健康生活方式宣传教育工作提供科学依据.方法 采用多阶段抽样的方法,抽取南通市港闸区500名18～69岁的常住人口作为调查对象,进行面对面访谈式问卷调查.结果 参加健康生活方式宣传活动的居民平衡膳食、正常血压值范围的知晓率分别是93.6％和80.7％,自觉控制食盐摄入和控制油的摄入的报告率分别为84.2％和77.8％,参加者在健康生活方式相关知识的知晓率和健康行为的报告率方面都高于未参加者,差异均有统计学意义(均有P＜0.05).健康生活方式相关知识的知晓与健康行为相关.结论 健康生活方式宣传活动提高了居民健康生活方式相关知识的知晓和行为,有必要长期坚持不懈的开展健康教育和健康促进行动.     

不同性别职业人员促进健康行为及健康教育策略

目的了解职业人员健康知识和促进健康行为形成的状况,为制定有效的健康教育策略提供依据。方法采用整群抽样的方法,对557名职业人员进行自编统一问卷调查,将所有的数据运用SPSS 13.0软件包进行统计学处理。结果 WHO健康定义女性知晓率为77.5%,高于男性的67.4%（P〈0.05）,无论男女对健康四大基石的知晓率〈15%。日常基本健康行为只有运动和休息的形成率在60%左右,每天吃早餐、三餐规律及通风换气健康行为方面均超过80%,保健行为上给孩子接种疫苗〉90%,女性认同婚前检查行为为89.9%,明显高于男性的75.2%（P〈0.01）,男性定期进行前列腺液、女性宫颈脱落细胞涂片检查〈15%;有意识进行生殖器官自我检查的女性为52.4%,明显高于男性的19.0%（P〈0.01）;有近40%的男性过马路有危险行为,明显比女性的20.6%高（P〈0.01）、有超过40%的男女人不走红绿灯,但对孩子的交通安全教育却达到80%;在公共场所劝阻吸烟的行为〈30%,女性劝阻亲人和朋友吸烟的明显比男性高,达到80%。结论从健康知识知晓上,职业女性好于男性;从健康行为所处阶段上,需要激发动机,提供方法,鼓励环境支持。因此,从健康教育策略上,针对他们的工作特点开展灵活多样的健康干预措施,以强化他们的健康行为,提高职业人员的健康素质和生活质量,促进社会经济的发展。     

National Health Insurance: A conceptual framework from conflicting typologies

In the path to universal health coverage, policymakers discuss different alternative health system’s financing schemes. Classical typologies have been posited, including models such as National Health Service, Social Health Insurance and Private Health Insurance. More recently, National Health Insurance (NHI) has been suggested as a separate model. Nevertheless, there are discrepancies regarding what defines an NHI model. The purpose of this article is to propose a comprehensive definition of an NHI model, aimed to disentangle the current discrepancies in the conceptualization and the scope of this type of arrangement. Based on the previous literature we identified some common characteristics across NHI definitions, namely universal coverage, pooling in a single fund and a purchasing function based on a single-payer financing mechanism. Areas of controversy were also identified. While some authors emphasized the importance of an effective separation between the purchaser and provider functions, others highlighted the relative importance of privately-owned provision to define a system like NHI-type. Based on empirical data, we suggest that the ownership is not a critical variable to distinguish an NHI from other models, and instead, suggest that a pivotal characteristic of the NHI is the single payer mechanism that is not integrated with the health providers.     

The incorporation of activities to control dengue by community health agents

OBJECTIVE

To evaluate the performance of Community Health Agents when dengue control activities were added to their tasks.

METHODS

Performance was measured comparing the evolution of selected indicators from the Brazilian National Dengue Control Program and the Family Health Strategy for 2002 to 2008 in the municipality of Sao Gabriel do Oeste, MS, Central Western Brazil, with those of Rio Verde de Mato Grosso, neighboring municipality with demographic, socioeconomic and health services similarities. Data were collected from municipal databases of the Information System for Yellow Fever and Dengue and the Information System for Primary Healthcare of the Mato Grosso do Sul State Health Office. The variables selected for the family health strategy activities were: monthly home visits, pregnant women whose antenatal care began in the first trimester, children under one with up-to-date vaccinations and hypertensive patients. Those selected for the Brazilian National Dengue Control Program were: properties inspected with Aedes aegypti and properties not inspected.

RESULTS

The two municipalities maintained a similar trend in dengue control indicators in the period studied. With regard to the Family Health Strategy, in 2002 Sao Gabriel do Oeste was better off in three of the four indicators studied, however, this situation was reversed at the end of the period when the county was overtaken by Rio Verde de Mato Grosso in three of the four indicators analyzed, including, the monthly average community health worker visits per registered family, the main activity of a Family Health Strategy agent. CONCLUSIONS: Incorporating the National Dengue Control Program into the Family Health Strategy is viable and developed without prejudice to dengue control activities, however, the same did not occur with the activities of family health in Sao Gabriel do Oeste. The additional workload of the community health workers is the most likely hypothesis for the declining performance of these agents in the Family Health Strategy activities.     

Prenatal Care for Adolescents and attributes of Primary Health Care

Objective

evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC) guidelines.

Method

quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes.

Results

for all the participating units, the attribute Access scored ≤6.6; the attributes Longitudinality, Coordination (integration of care), Coordination (information systems) and Integrality scored ≥6.6, and the Essential Score ≤6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored ≤6.6, the others attributes scored ≥6.6; however, in the basic units, the Essential Score was ≤6.6 and, in the family health units, ≥6.6.

Conclusion

expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.     

深圳市社区居民病毒性肝炎知识、态度和行为的流行病学调查

目的了解深圳社区居民对病毒性肝炎,尤其是乙肝传播、危害等相关知识的知晓率及对待乙肝感染者的态度和行为,为当地制定相关健康教育策略提供依据。方法采用流行病学现况调查方法,随机抽取深圳市15～59岁的社区居民1 544名,采用自填式问卷调查获取居民病毒性肝炎知识、态度、行为信息进行分析。结果绝大多数调查对象表示听说过甲肝(71.9%)和乙肝(91.5%),而听说过丙肝(36.6%)、丁肝(20.7%)和戊肝(18.0%)的则相对较少;仅有不到一半调查对象了解乙肝的传播途径(45.0%),但一半以上的调查对象知道可以通过疫苗接种来预防甲肝(56.9%)和乙肝(75.6%);大部分的调查对象害怕与乙肝感染者近距离接触,有30.0%和27.1%的乙肝感染者遭遇过被人远离或升学就业的困难。结论应以社区为单位,长期、持续开展形式多样的健康教育活动,提高社区人群,尤其是流动人群对病毒性肝炎的传播、预防等相关知识的认知水平,从根本上消除"乙肝恐惧"和"乙肝歧视"现象。     

Influenza vaccination and all-cause mortality in community-dwelling elderly in Ontario, Canada, a cohort study

The objective of this study was to evaluate the effectiveness of influenza vaccines in reducing all-cause mortality among community-dwelling elderly. We included 25,922 Ontario residents over age 65 who responded to population health surveys. After full adjustment, influenza vaccination was associated with a statistically significant reduction in all-cause mortality during influenza seasons (hazard ratio (HR) = 0.61; 95% CI 0.47-0.79). Contrary to expectations, statistically significant associations between influenza vaccination and mortality were also observed during periods preceding (HR = 0.55; 95% CI 0.40-0.75) and following (HR = 0.74; 95% CI 0.59-0.94) influenza seasons, indicating the presence of residual confounding. Adjustment for functional status indicators, excluding individuals with high one-year predicted mortality at baseline, and moving the start date of follow-up failed to eliminate the refractory confounding. Since observational studies are prone to bias, future efforts to estimate vaccine effectiveness in the elderly should strive to minimize bias through improved data quality, novel data sources, and/or new analytical techniques.     

泰州市居民健康知识与行为素养水平分离情况的分析

目的 分析健康知识与健康行为相分离的影响因素,为制订科学的健康干预措施提供依据.方法 采用多阶段分层抽样及统一的调查问卷,于2013年9 ～10月对15～ 69周岁居民进行健康素养监测现场调查.结果 共调查了3 975人,有效样本数3 809份,样本回收率95.8％,其中筛选出知行分离768人(21.16％),知行统一241人(6.32％),单因素分析显示,知行分离比例在不同地区、学历、职业及具备不同纬度健康素养水平的人群分布中差异有统计学意义(均有P＜0.05).多因素Logistic回归分析显示,综合健康素养水平、传染病预防素养水平、慢性病预防素养水平、基本医疗素养水平为影响知行分离的主要影响因素.结论 知行分离现象在各类人群中普遍存在,健康素养水平的提高对人群知行分离的减少具有重要作用,将健康素养作为健康教育与健康促进工作的重点是有效的,也是非常必要的.     

某高校医学生食用方便面知识态度行为调查

了解某高校医学生方便面的食用情况及影响因素,为医学生饮食习惯的改善提供建议.方法 采用二阶段整群抽样方法获得研究样本,利用自制调查问卷对北京某高校898名在校学生方便面食用情况进行调查.结果 51.5%的学生1个月以上吃1次方便面,96.5%的学生每次食用1袋或不足1袋.女生对方便面的健康认知得分高于男生[(2.25±0.06)分、(1.78±0.06)分,P<0.01)],研究生高于本科生[(2.26±0.09)分、(2.00±0.05)分,P<0.05)];但女生将方便面作为正餐的比例要高于男生(72.7%,39.7%,P<0.05),研究生高于本科生(73.8%,54.3%,P<0.05).结论 医学生方便面的食用方式不合理,性别、年级是影响医学生方便面知信行的重要因素.应着重改变现有的健康教育方式,针对学生群体的特征开展全方位的健康促进.     

大学生健康素养核心信息精确概率劝导模型分析结果评价

目的 以精确概率劝导模型对大学生健康素养核心信息进行健康教育实施前评价,为提高大学生健康教育效力提供依据.方法 采用分阶段目的抽样和方便抽样相结合的方法,在北京、昆明、广州、武汉、南京、哈尔滨和西安7个城市各选取4所不同类型非医学高校的1357名大学生进行调查.使用自编信息评价表,对大学生健康素养核心信息进行评价.结果 大学生不同信息得分存在差异.55条核心信息评价得分最高72.24分,最低62.79分.大学生对健康素养核心信息评价的影响因素为性别、个体对健康知识和对健康相关技能的认知.结论 在大学生健康教育中,应考虑大学生性别的影响,并根据大学生对信息的认同度来设置健康教育信息内容.     

大学生对保健品的认知态度行为调查

目的了解大学生对保健品的认知及服用后的功效自我评价。方法在江苏省4所高校采取随机抽样的方法进行问卷调查。结果仅有24.7%的大学生知道保健食品的认证标识,考试临近时服用所占比例最高为40.1%,有55.0%的服用者认为服用后有一定的改善,但在对待保健品的态度上,仍有50%态度的人不相信他的功效。结论大学生对于保健品的认知比较模糊,对于保健品服用后的功效评价不高。为促进大学生对保健品的健康行为的建立,应从学校和政府机构2个方面抓起。     

河北省某高校大学生饮水知信行现状

了解河北省某高校大学生饮水知信行情况及其可能存在的问题,为开展饮水方面的宣教提供科学依据.方法 采用随机整群抽样方法,于2017年3月在河北省保定市某高校抽取715名学生,对大学生饮水知识、态度及行为进行调查.结果 大学生对于每天饮水量为1 500~1 700 mL知晓率为19.0%;对于饮水方式为少量多次的知晓率为95.0%,对临睡前是适宜饮水时间的知晓率为30.1%,女生知晓率高于男生,医学专业学生高于非医学专业学生(x2值分别为22.16,12.49,P值均<0.05);对饮水不足与中风、高血压、冠心病之间关系的知晓率较低,分别为1.3%,14.3%,2.2%,二年级学生对于饮水不足与中风之间关系知晓率高于一年级学生(x2=11.10,P<0.05).大学生理想获得饮水知识的途径比例最高为网络(60.0%),其次为校园宣传/课堂教学(48.3%).99.6%的大学生认为饮水对健康重要,98.3%愿意改变饮水习惯,93.0%愿意关注饮水宣教,女生比例均高于男生(x2值分别为5.46,6.49,8.01,P值均<0.05).在实际生活中,大学生晨起空腹、临睡前饮水比例分别为48.4%和40.7%,45.5%想起来就喝水.结论 河北省某高校大学生饮水知识不足,不同性别、年级、专业学生饮水知识存在差异.大学生饮水态度较好,但饮水行为存在一定问题,相关部门需根据调查对象不同特征开展相应的健康宣教.     

世界卫生组织健康调查资料的结构方程模型

目的 探索2002年世界卫生组织(WHO)健康调查数据中,人群自述健康水平、实际健康水平、社会人口学特征、危险因素之间的潜在关系,及各调查指标对自述健康和自述健康对实际健康水平的影响程度.方法 数据来源于WHO提供的2002年包含印度、巴西、布基纳法索、匈牙利、尼泊尔、俄罗斯、西班牙、突尼斯、越南等9个国家在内的健康调查数据(包括自我评价部分和健康情景部分)(29 971例).本研究利用健康情景资料对自我评价资料进行校正和消除切点位移偏倚后,用自我评价资料构建自述健康水平、实际健康水平、社会人口学特征、危险因素之间关系的结构方程模型.结果 最终结构方程模型:实际健康水平=0.80×自述健康水平+(-0.04)×社会人口学特征+(-0.08)×危险因素(R2=0.66),自述健康水平=(-0.70)×社会人口学特征+0.10×危险因素(R2=0.55);自述健康水平对实际健康水平的标准化总效应达0.80,人口学特征对自述健康水平和实际健康水平的标准化总效应分别为-0.70与-0.60;自述健康水平的16项指标含8个维度,按照对其影响程度由大到小依次为:活动能力、疼痛不适、睡眠情况、认知、情绪、自理能力、视觉能力、交际活动能力.结论 实际健康水平与自述健康水平之间、自述健康水平与社会人口学特征之间均有较强的线性关系,自述健康水平对实际健康水平有较大影响,2002年WHO健康调查所用16项指标在人群健康评价中占有重要的地位.     

Effectiveness of motivational interviewing at improving oral health: a systematic review

OBJECTIVE

To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status).

METHODS

A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated.

RESULTS

Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated.

CONCLUSIONS

We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions.     

广州市青少年性相关行为发生情况分析

目的 了解广州市青少年性相关行为现况,为制定干预措施提供科学依据.方法 采用“中国青少年健康相关行为调查问卷”,对分层整群随机抽取的广州市66所大中学校11939名学生进行问卷调查.结果 15.22％的中学生看过色情书籍和音像制品,农村(16.46％)高于城市(14.44％)；男生(25.07％)高于女生(6.23％)；职中生最高(25.41％),普通中学(13.93％)高于重点中学(10.71％),差异均有统计学意义(P值均＜0.01).在看过色情书籍、音像制品的学生中,曾发生性行为率高达22.35％.在高中、职中学生中,35.82％曾单独约会异性朋友,34.95％有亲密行为,7.26％曾经发生过性行为,2.10％学生有被迫性行为,73.97％从学校接受过有关艾滋病知识教育,63.44％知道艾滋病病原体是病毒,31.76％对艾滋病感染者持正确态度.8.87％大学生有过性行为,使用安全套的比例占68.52％.结论 广州市青少年性相关行为频发但预防教育不足,要加强对青少年性观念及行为的正确引导.     

广东经济欠发达农村留守学生营养健康教育效果评价

了解广东省经济欠发达地区农村留守学生营养知识和饮食行为健康教育效果,为进一步改善留守学生营养状况提供依据.方法 采用多阶段整群随机抽样方法,抽取广东省经济欠发达地区6所小学和6所中学学生1 909名作为研究对象.采用问卷调查的方式进行基线调查和干预5个月后效果评估.结果 调查对象干预前后营养知识得分分别为(5.9±3.5)和(9.8±3.1)分,父母不同外出状况学生间差异均有统计学意义(P值均<0.05).调查对象干预前后饮食行为得分分别为(5.1±1.9)和(5.8±1.2)分,父母不同外出状况学生间差异有统计学意义(P值均<0.05).结论 开展有针对性的营养健康教育,可以提高留守学生营养知识知晓率,促进健康饮食行为形成.