上海黄浦区社区卫生服务绩效评价与SWOT分析

公立医院规划布局是卫生资源配置极为最重要的一个环节。公立医院的合理配置、优化布局有助于提高医疗资源运行效率,使居民获得最大健康产出。从系统角度出发,要更好地配置公立医院资源,必须更好地发挥公立医院与社区卫生服务机构的协同作用,建立有序的分级诊疗模式。因此,文章结合全民健康覆盖的四个条件,对上海市黄浦区社区卫生服务作绩效评估与SWOT分析,为社区卫生服务的进一步发展提供建议,也为更好地配置公立医院资源提供参考。     

Creating community agency placements for undergraduate medical education: a program description

PROGRAM OBJECTIVE: To provide first- and second-year medical students with stimulating learning experiences in the community. SETTING: Three hundred placements representing a broad array of urban community agencies providing both general and specialized health care services. PARTICIPANTS: All first- and second-year medical students at the University of Toronto (n = 354). Other participants include staff of community agencies and tutors from the Faculty of Medicine and from the community. PROGRAM: The Health, illness and the Community course is mandatory and consists of 3 components. The first, in the first semester of first year, emphasizes the provision of health care in the community for individuals and populations. The second, in the second semester of first year, introduces a health promotion paradigm. The third component, throughout second year, allows students to engage in an in-depth study of the interconnection between a health problem and a social issue in a community agency setting. OUTCOMES: Students have expressed high levels of satisfaction with the community agency placements. The feedback from agencies has also been enthusiastic. Patients in the home care program have reported that visits by medical students are a positive experience. CONCLUSION: It is possible to recruit and maintain large numbers of urban community agencies as learning sites for medical students. It is hoped that this approach will help to produce socially responsive medical practitioners.     

The role of school medicine doctors in health education in Croatia--past, present and future

Croatia never had a separate vocation (occupation) of a health educator. Health education is one of the main tasks in the long tradition of preventive work of doctors-school medicine specialists. Additionally, in the school curriculum in the Republic of Croatia the health-educational contents are integrated into various subjects, and are conducted by teachers. However, there are requests to introduce a new subject into schools called Health Education. We asked physicians of school medicine their opinion on the introduction of this new subject. 30% of the physicians were dissatisfied with the current condition, 10% were satisfied, while there were no very satisfied school medicine doctors. They believe that health education goals are oriented solely to passing on knowledge (facts), while efforts are not done to change habits and attitudes of young people. They recognize themselves as persons mostly involved in health education in schools. Half of the school medicine doctors believe that the school curriculum should contain both a separate subject as well as integration of health education into other subjects. Before introducing any changes into healthcare or education system, it is necessary to examine the attitudes of students and parents, to direct the changes towards the promotion of the cooperation between the healthcare system, education, civil society, school and community where investing into the health of young people is done through comprehensive and holistic programmes.     

推进生物多样性保护与人类健康的共同发展——One Health

随着新冠肺炎(COVID-19)的暴发, 野生动物、生物多样性和人类健康的关系再次引起广泛讨论。近20年来, 国际社会对于生物多样性与健康的研究日益增多, 并将它作为生物多样性保护与研究的重要方向之一。One Health作为一个新的理念框架, 通过交叉学科的研究和行动来推动包括人、所有其他动物及环境的健康。这个理念被不同国家、国际组织及协定所接纳及推广, 包括《生物多样性公约》等。本文通过总结近些年生物多样性对健康的影响方式、One Health的定义与发展历史、进入生物多样性议程的过程, 提出中国应用One Health改进相关野生动物管理以降低公共卫生危机的可能性的建议, 以及One Health框架内增强生物多样性保护所需的研究方向。One Health在中国的应用与发展应重视生物多样性研究和保护在其中的作用, 利用在景观生态学、群落内物种关系动态变化、气候变化影响、土地利用变化模式与趋势的研究, 与人类健康相结合, 提高One Health在应对公共健康和环境健康风险方面的准确性与及时性。同时, 需要加强我国在野生动物管理方面的投入和力度, 增强生物多样性保护与公共健康的联系, 将预警与干预措施前移, 减少疾病暴发带来的社会经济成本。     

Exploring Health Literacy in Medical University Students of Chongqing,China: A Cross-Sectional Study

Health literacy is important in public health and healthcare, particularly in effective communication between patients and health professionals. Although most medical students will eventually work as health professionals after graduation, research on health literacy of medical students is scarce. This study aimed to assess the health literacy level of medical students in Chongqing, China, and its influencing factors. A cross-sectional study was conducted and 1,275 participants (250 males and 1,022 females) who majored in five different disciplines were involved. The Health Literacy Questionnaire was used as the survey tool. The junior students obtained the highest scores, whereas the freshman students had the lowest scores on each scale. The average score of males was higher than that of females except in “feeling understood and supported by healthcare providers,” and the average score of students who reside in urban areas was higher than that of students in rural areas. Moreover, the average score of engineering students was higher than that of medical or health sciences students. Multiple linear regression models (R_adj² = 0.435, P = 0.000) showed that the grade, socioeconomic status, and parent’s highest level of education were positively correlated with health literacy. In conclusion, the health literacy levels of the medical students are insufficient and need improvement.     

从医联体到康联体防控慢性病策略的变化——以上海市闵行区为例

本文介绍了复旦大学附属上海市第五人民医院在不断巩固区域医疗联合体的基础上,试图建立一种以预防疾病,控制慢性疾病如慢性呼吸道感染、慢性肝病、糖尿病等,加强健康教育为目的的社区健康联合体(简称康联体)。这是一项卫生服务可持续发展的模式,其建立是基于复旦大学和闵行区的长期合作,以智慧医疗技术为依托,以"防大病、管慢病、促健康"为核心服务内容,以期及早预防社区居民严重疾病的发生,对社区慢性病患者进行方便、有效的监控,并向社区介绍先进的人口健康理念,实现全方位、全生命周期保障社区居民健康,为闵行区康联体的扩大与完善提供参考依据。希望这些方法能促进优质医疗服务的合理布局,使社区居民终身健康关怀得到发展,并在防控慢性疾病及慢性感染中发挥有效作用,在今后也能应用于其他区域。     

Is 2020 the year when primatologists should cancel fieldwork? A reply

The aim of this article is to explore the impact of coronavirus disease (COVID-19) pandemic on primate-related conservation work. The withdrawal of primatologists and conservation staff from field research can lead to a number of detrimental effects not just on conservation but also on local communities in low- and middle-income countries. Inequalities in access to health and financial insecurities may be drivers for the illegal wildlife trade and the lack of tourism and research activity may allow poachers to work with greater ease. The paper also looks at how conservation organizations and research bodies should modify their field protocols by developing robust occupational health policies that will not only make field work safer but also support local staff as they are likely to face the greatest threats to their physical health, psychological health, and economic loss from COVID-19. By adopting a One Health approach that considers the complex interactions between human and primate health, researchers will be able to find new ways of working not only to protect primates but understand how they adapt to the COVID-19 pandemic.     

Linking Human and Ecosystem Health: The Benefits of Community Involvement in Conservation Groups

This study explored the health, well-being, and social capital benefits gained by community members who are involved in the management of land for conservation in six rural communities across Victoria. A total of 102 people participated in the study (64 males; 38 females) comprising 51 members of a community-based land management group and 51 controls matched by age and gender. Mixed methods were employed, including the use of an adapted version of Buckner’s (1988) Community Cohesion Scale. The results indicate that involvement in the management of land for conservation may contribute to both the health and well-being of members, and to the social capital of the local community. The members of the land management groups rated their general health higher, reported visiting the doctor less often, felt safer in the local community, and utilized the skills that they have acquired in their lifetime more frequently than the control participants. Male members reported the highest level of general health, and the greatest satisfaction with daily activities. Members also reported a greater sense of belonging to the local community and a greater willingness to work toward improving their community than their control counterparts. Of equal importance is evidence that involvement in voluntary conservation work constitutes a means of building social capital in rural communities which may help reduce some of the negative aspects of rural life.     

Experience on healthcare utilization in seven administrative regions of Tanzania

Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM) and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.     

Ecosystem Health in Professional Education: The Path Ahead

This supplement shows that ecosystem health has become a vital part of the curriculum in a small number of medical, veterinary, and public health schools. This limited, but important, experience provides the groundwork for further expansion into other professional schools and into other universities. Although ecosystem health has defined underlying principles, previous experience has shown that each professional faculty should define what ecosystem health means for the institution and for its students. Based on this definition, it is important that detailed learning objectives be defined for ecosystem health as it pertains to the profession. A model for further development is proposed in this editorial. This model focuses on developing the necessary skill sets for ecosystem health education, the expansion of ecosystem health into earlier and later stages of learning (high school through undergraduate, through postgraduate, and onto practicing professional levels), and raising the awareness of ecosystem health in the local community and at national and international levels. Once comprehensive, transdisciplinary, continuous ecosystem health programs become mainstream, one can expect a “sea change” in the attention given to the interrelationship between humans and their environments, and a more concerted effort to restore the health of our planetary ecosystems.     

International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of S?o Paulo School of Medicine in Ribeir?o Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.     

Ethical Study on the Reform and Development of Medical and Health Services in China

At an early stage of its foundation, new China became clear about the nature of public welfare and quickly developed medical and health services, which was well received by the World Health Organization. The marketization and the reduction of input into medical and health services from the 1980s created severe adverse consequences. After the SARS' outbreak in 2003, China started to give serious consideration to its medical and health system, and to work at developing medical and health services. The new healthcare reform launched in 2009 re‐emphasizes fairness and public welfare, and China's achievements have been remarkable. Of course, there are still many problems to be solved in the reform, which also paves the way for increasing the reform in future.     

大学生口腔保健知识态度行为调查与研究

目的:评价大学生口腔保健知识、态度、行为情况,为实施口腔健康指导计划提供基线资料。方法:采用随机抽样的方法,对314名青岛大学新生进行了口腔保健知识、态度、行为的问卷调查;其中男生151名,占总数的48%,女生163名,占总数的52%。结果:大学生对龋病知识的知晓率高,但牙周知识及牙周状况差。大学生认为定时拜访牙医有助于口腔疾病预防,口腔健康与全身健康密切相关,但约一半学生害怕就医或推迟就医。只有55.7%的大学生一天刷牙两次,25.5%的大学生没有接受过专业刷牙指导。在口腔保健知识、态度及行为方面,女生优于男生。结论:大学生缺乏牙周方面基础口腔保健知识,缺少专业的口腔卫生指导。结构合理的口腔健康教育系统亟需实施。     

Beyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia

BackgroundThe focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources.MethodWe employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered.ResultsThe district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities.DiscussionThe plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention.     

Time for the osteopathic profession to take the lead in musculoskeletal research

We describe a four year collaborative experience with an on-site, community school-based health center that is staffed by the Vallejo City Unified School District and supervised by the pediatric faculty of the Touro University College of Osteopathic Medicine, with particular attention to first grade student exclusion rates. Patient demographics (including payer source), first grade enrollment statistics, and first grade exclusion rates were analyzed using school district enrollment and exclusion data, billing data, and Child Health Disability Program data. An ethnically diverse patient population is described, with the payer source in 99% of patients being the State of California Child Health Disability Program or no insurance source. Ninety-one percent of office visits were for well child care and immunizations. First grade student exclusion rates for failure to meet the state-mandated physical examination requirement fell 74% over the first four years of the school-based health center's operation. In summary, our school-based health center serves a patient population that is primarily uninsured. Reduction in first grade student exclusion rates enhances student education and reduces the loss of attendance-based state matching funds. Additionally, our school-based health center has been well accepted by the local community.     

Postgraduate Veterinary Training in Conservation Medicine: An Interdisciplinary Program at Murdoch University, Australia

Although many veterinarians in Australia have been interested in wildlife conservation, the concept of active and worthwhile involvement in biodiversity conservation has often seemed difficult to achieve. There are many boundaries which may hinder the ability of veterinarians to contribute effectively to wildlife conservation initiatives. This article discusses postgraduate veterinary educational initiatives at Murdoch University, Perth, Western Australia, which aim to train veterinarians to effectively participate in biodiversity conservation programs. The Master of Veterinary Studies (Conservation Medicine) and the Postgraduate Certificate in Veterinary Conservation Medicine have a flexible program structure and can be undertaken entirely by distance education. Their establishment required the removal of disciplinary, institutional, cultural, experiential, and professional development boundaries, which have traditionally impeded veterinary involvement in wildlife conservation projects. The programs have proven to be very successful and have attracted students across Australia and internationally. The strong commitment of Murdoch University to interdisciplinary study and distance education, the goodwill of staff from other divisions within the university, and enthusiastic support from collaborating institutions were critical for the development and establishment of the programs.     

Improving cross-cultural skills of medical students through medical school-community partnerships.

Postulating that a program integrating language skills with other aspects of cultural knowledge could assist in developing medical students'' ability to work in cross-cultural situations and that partnership with targeted communities was key to developing an effective program, a medical school and two organizations with strong community ties joined forces to develop a Spanish Language and Hispanic Cultural Competence Project. Medical student participants in the program improved their language skills and knowledge of cultural issues, and a partnership with community organizations provided context and resources to supplement more traditional modes of medical education.     

Emergency Health Planning

This paper outlines the development of emergency health planning as a function of government. Ten provinces have the basic responsibility for the organization, preparation and operation of medical, nursing, hospital and public health services in an emergency. The Department of National Health and Welfare is responsible for the provision of advice and assistance to the provincial and municipal governments in such matters. Eight provinces have now hired full-time planning staffs to co-ordinate the health planning of the Provincial Departments of Health and Provincial Emergency Measures Organization.Four major programs have been established. The first program provides for the continuity of leadership and guidance by health authorities at the federal, provincial and municipal level. Essential records have been developed and emergency legislation prepared. This program, however, will be of little use unless health services are organized at the municipal level. In this organizational program, advice and assistance have been provided to existing hospitals and departments of health in the conduct of disaster planning. The efforts of these agencies are co-ordinated by municipal health authorities into a community disaster plan. The third program deals with information and education of the general public and the health workers. This program is designed to make the family unit self-sufficient for up to seven days and the health worker prepared to undertake his emergency role. The first three programs are directed to the organization and training of manpower; the fourth program provides the necessary supplies. From the national medical stockpile of $18,000,000, some $12,000,000 has been received, packaged for long-term storage and distributed to regional depots across the country. To ensure their ready availability in time of emergency an agreement has been reached with seven provinces for the release of hospital disaster kits.     

Medical Students’ Attitudes About Cosmetic Pesticides before and after an Ecosystem Health Seminar: A Pilot Study

The University of Western Ontario has incorporated ecosystem health as an integral component of its Community Health course for medical students. There is increasing concern regarding the negative health effects of pesticides. The issue of pesticides is, therefore, an obvious topic for the Community Health course. The goal of this pilot study was to compare the attitudes of medical students about cosmetic pesticide use before and after attending a special seminar on that topic. Sixty-three students were surveyed on their opinions before and after the pesticides seminar. After the seminar, the students’ attitudes shifted towards a more negative view of unrestrained cosmetic pesticide use. The students also felt that there were greater risks involved with the use of pesticides (P < 0.001) after attending the seminar. The results of this pilot study demonstrate the need and the effectiveness of including ecosystem health topics in medical curricula.     

海洋保护区管理与保护成效评估的方法与进展

全球物种多样性的持续下降使得生物多样性保护面临巨大挑战, 海洋生物多样性的保护任务尤其艰巨。海洋保护区是保护生物多样性的有效方式之一, 如何对其成效进行评估是当前研究热点。然而, 目前针对海洋保护区的评估体系较少, 而且评估指标多侧重于管理成效。近年来随着全球生物多样性监测网络和数据库的建立, 以及多种新技术(如遥感、声呐系统、卫星追踪、基因组学等)在海洋生物多样性监测中的应用, 使得从生态系统到基因水平的多层次连续监测成为可能。基于此, 建议未来我国海洋保护区成效评估应在充分利用新技术方法的基础上, 加强长期科学监测, 建立并完善生物多样性监测数据库和信息共享机制, 发展跨学科的综合保护成效评估体系, 加强基于生物多样性监测的保护成效评估。