激励发展中国家的卫生研究——再思考与研讨新策略时代正在兴起

发展中国家需要更清晰地明确其卫生研究面临的优先项目,即国家应共同分担全球性研究项目,增强激励和纳入研究轨道的国家能力,把循证决策人微言轻政策决策的基础,加强国家与国际合作问题是卫生研究中的中心议题。     

Resident-Led Neighborhood Development to Support Health: Identifying Strategies Using CBPR

Evidence suggests that where people live, learn, work, and play affects a range of health outcomes for children and adults. Differential access to social, economic, and environmental supports puts some community members at greater risk, leading to disparities in health and well-being. The 2014 release of the For the Sake of All report highlighted persistent health disparities for African Americans in St. Louis, Missouri, and their social and economic impacts on the St. Louis region. This study extends this work by developing partnerships with community organizations and neighborhood residents to address health disparities. Community-based participatory research (CBPR) methods were utilized to engage partners in a 10-month research process to address community concerns that impact health. Seven community residents, neighborhood researchers, engaged in workshops to learn about the research process and used techniques to gather information to implement action strategies. Neighborhood researchers selected 14 vacant lots to implement their action plan, which included visions for repurposing the land into a community park, produced a report for dissemination, and organized a community action forum to communicate their findings. This study highlights a promising approach to promote healthy communities and health equity by empowering neighborhood residents using participatory methodologies.     

Examining the influence of group diversity on the functioning of community-based participatory research partnerships: A mixed methods study

Public health has endorsed the use of community-based participatory research (CBPR) to address health inequities involving diverse and marginalized communities. However, few studies have examined how group diversity among members of CBPR partnerships influenced how well the partnerships achieve their goals of addressing health inequities through equitable collaboration. We conducted secondary, convergent, mixed methods analysis to (1) evaluate the association between group diversity and participatory decision-making within CBPR partnerships, and (2) identify the perceived characteristics, benefits, and challenges of group diversity within CBPR partnerships. Using data from a cross-site study of federally funded CBPR partnerships, we analyzed and integrated data from surveys of 163 partnerships (n = 448 partners) and seven in-depth case study interviews (n = 55 partners). Quantitatively, none of the measured characteristics of group diversity was associated with participatory decision-making within the partnerships. Qualitatively, we found that partnerships mainly benefited from membership differences in functional characteristics (e.g., skillset) but faced challenges from membership differences in sociocultural characteristics (e.g., gender and race). The integrated findings suggest the need to further understand how emergent group characteristics and how practices that engage in group diversity contribute to collective functioning of the partnerships. Attention to this area can help promote health equity achievements of CBPR partnerships.     

共享信息资源 促进卫生研究

近20年来,由于住处技术的迅速发展,住处的采集、处理和传播也随之发生了革命性的变化,住处技术的应用是提高卫生研究能力的有效措施之一,必须把计算机和网络功能等住处技术在卫生研究领域中的广泛应用提高到战略高度来认识,在卫生研究创新中住处是必备的条件,信息筛选和加工本身就是研究工作,需要发展、促进。卫生研究的成果,不仅要公开发表,而且要向决策者提供,互联网上拥有大量的医药卫生信息,要充分发挥它的巨大潜力。行政管理部门应充分重视作为信息源的网络建设和互联网的利用,信息开放和共享能力的提高是加强卫生研究能力、促进卫生研究发展的重要条件。     

Enabling Action: Reflections upon Inclusive Participatory Research on Health with Women with Disabilities in the Philippines

People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.     

关注健康公平,保障健康权益

在卫生改革与发展的过程中,健康公平与健康权益的问题不断引出争论,而且,出现的许多新问题也都与健康公平相关.获得基本医疗服务对于全体居民来说,并不仅仅具有提高劳动力素质的意义,而且还是人们充分发挥自身潜力的一个前提,是人们参与社会经济政治决策过程的一个前提,有着超出个人投资回报的社会效益.因此,在卫生改革过程中应该关注健康公平,合理保护居民的健康权益.     

The Association Between Life Satisfaction and Self‐Reported Health Status in Europe

Previous research has shown that life satisfaction (LS) and self‐reported health status are strongly related to each other. However, it is not clear whether this association holds across different nations or whether certain country‐level indicators significantly affect this association. The study was based on nationally representative samples of 32 countries from the first six rounds of the European Social Survey (N = 291 686). Results from hierarchical multilevel modelling indicated that there was a positive association between LS and self‐reported health status across countries, but this association was slightly stronger in countries where governments spent less on the health care of their residents. Self‐reported health ratings were also more strongly tied to LS judgements in countries where variability in LS ratings was larger. These results suggest that, especially in less wealthy European countries, policies should target reducing overall social inequality and the negative impact of governments' underinvestment in health care on LS. Copyright © 2015 European Association of Personality Psychology     

Application of a CBPR Framework to Inform a Multi-level Tobacco Cessation Intervention in Public Housing Neighborhoods

African American women in urban, high poverty neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco-related health disparities. Prior research utilizing conventional "outsider driven" interventions targeted to individuals has failed to show effective cessation outcomes. This paper describes the application of a community-based participatory research (CBPR) framework to inform a culturally situated, ecological based, multi-level tobacco cessation intervention in public housing neighborhoods. The CBPR framework encompasses problem identification, planning and feasibility/pilot testing, implementation, evaluation, and dissemination. There have been multiple partners in this process including public housing residents, housing authority administrators, community health workers, tenant associations, and academic investigators. The advisory process has evolved from an initial small steering group to our current institutional community advisory boards. Our decade-long CBPR journey produced design innovations, promising preliminary outcomes, and a full-scaled implementation study in two states. Challenges include sustaining engagement with evolving study partners, maintaining equity and power in the partnerships, and long-term sustainability of the intervention. Implications include applicability of the framework with other CBPR partnerships, especially scaling up evolutionary grassroots involvement to multi-regional partnerships.     

医院和医疗保险的经济学分析

随着医疗卫生体制改革的深入,应对老龄化危机,降低不断提高的医疗服务费用,提高医疗服务质量,提高医疗服务可及性和公平性,是我们面对的切实问题.医院是提供医疗卫生服务的场所,也是提供医疗卫生服务的主体单位,了解医院的经济学特性和组织特点,有利于我们对市场经济环境下的医院行为有所了解,为卫生体制改革和医疗保险改革提供理论依据.     

Underemployment: Consequences for the Health and Well-Being of Workers

This paper addresses the question of how the adequacy of a person's employment status influences their health. We draw on and extend the Labor Utilization Framework to distinguish between different forms of underemployment (hours, income, skills, and status) and test their relative effects on a range of physical health and psychological well-being outcomes. Using data drawn from a nationally representative sample (N=1,429) of adults of working age, we assess the concurrent effects of underemployment through a longitudinal design that controls for prior levels of health and well-being. The results indicate that underemployed workers do report lower levels of health and well-being than adequately employed workers. However, the relationship varies by both types of underemployment and indicator of health and well-being. We conclude by discussing future research to explore the relationship between underemployment and health and well-being.     

Building Leadership,Capacity, and Power to Advance Health Equity and Justice through Community‐Engaged Research in the Midwest

The Health Equity Advancement Lab (HEAL) at the University of Iowa College of Public Health began in 2012 to support students, researchers, and community members interested in tackling persistent health inequities through a community‐based participatory research (CBPR) approach. Using concepts from critical consciousness theory, we developed an approach to building students’, faculty members’, and community partners’ capacity to engage in CBPR to promote health equity that involved immersion in developing CBPR projects. Our paper describes the evolution of HEAL as a facilitating structure that provides a support network and engages diverse stakeholders in critical reflection as they participate in research to advance health equity, and resulting political efficacy and social action. We describe one HEAL‐affiliated research project that employs a CBPR approach and has a strong focus on providing transformative learning experiences for students, faculty, and community members. We highlight challenges, successes, and lessons learned in the application of critical consciousness as a framework that engages diverse academic and community partners seeking to promote health equity. We argue that critical consciousness is a relevant theoretical framework to promote transformative learning among students, faculty, and community partners to promote health equity research in diverse communities.     

美国卫生保健的公正和分配问题

除了卫生保健服务的费用问题以外,美国社会中关于医疗卫生保健的比较严重的问题是服务的公平和分配问题,在美国无论是城市还是农村,在经济上处于弱势地位的人,在医疗上也处于不利地位,另一个由公平性问题影响的社会层面是;大量的美国人没有参加健康保险,他们中的大多数人是生活贫困的究人或接近于贫穷的人。此外,美国卫生保健提供体系在地理分布上是不均衡的,初级保健医生或家庭医生在医生中也没有充分的代表性,医生的矩缺不只限于农村,也扩展至城市的某些区域。     

我国心理健康研究现状的文献计量学分析

对收录在中国期刊网上的488条心理健康研究的论文题录进行计量学分析,发现心理学刊物上的心理健康研究论文数量不多,主要集中在心理健康相关因素和现状调查两个方面,内部合作研究已经成为心理健康研究的主要形式,研究力量的机构分布主要集中在高等师范院校和医科院校及医院,研究力量的地区分布主要集中在经济较为发达地区。     

卫生资源配置与改善医患关系

从基本卫生资源配置角度来探讨如何改善医患关系,认为基本卫生资源配置失衡是引起医患纠纷的重要因素,从而指出公平优先原则指导下的基本卫生资源配置有利于改变医患关系紧张的现状,并据此观点提出实现基本卫生资源配置公平优先的相关保障措施.     

Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership.     

Adapting to Context in Community-Based Participatory Research: “Participatory Starting Points” in a Chinese Immigrant Worker Community

Community-based participatory research (CBPR) is increasingly being used to better understand and improve the health of diverse communities. A key strength of this research orientation is its adaptability to community contexts and characteristics. To date, however, few studies explicitly discuss adaptations made to CBPR principles and processes in response to community context and partners’ needs. Using data from our CBPR study, the San Francisco Chinatown Restaurant Worker Health and Safety Project, and drawing from literature on immigrant political incorporation, we examine the links between the contexts of the Chinese immigrant worker community, adaptations made by our collaborative, and study outcomes. In particular, we explore the concepts of contexts of reception and participatory starting points, which may be especially relevant for partnerships with immigrant communities whose members have historically had lower rates of civic and political participation in the US. We discuss contextual findings such as worker partner accounts of language barriers, economic and social marginalization, and civic skills and participation, as well as subsequent adaptations made by the partnership. We also describe the relative effectiveness of these adaptations in yielding equitable participation and building partners’ capacity. We conclude by sharing lessons learned and their implications for CBPR and partnerships with immigrant communities more broadly.     

国际健康目标与卫生改革的新导向——重视预防保健的作用

由于认识到卫生系统的大部分资源主要花费在疾病的治疗上,这种资源配置不当不仅导致巨额医疗费用负担和低效率,并没有获得好的健康结果;因此,近年许多发达国家的健康目标与卫生改革出现了一个新的导向,日益重视预防保健的作用;并采取优先选择的方式,确保资源优先配置给对人群健康最需要、资源投入最具有成本效果的保健服务。这种改革已取得了一些成效。这一改革导向对我国正在进行的医药卫生体制改革的制度设计与政策开发提供了启示。     

发展健康研究

试图讲座在健康研究中,如何适时、恰当并有效地把性别融合于其中,第一,我们应更注意健康研究的结果;第二,在健康研究中注重性别差异的意义;第三,分行性别健康的可持续性研究环境。     

流行病学实践与研究相关的伦理学视角与思考

随着社会的发展,公共卫生领域的伦理学问题不断显露,有必要对其重新审视。探讨了目前在公共卫生领域流行病学实践与研究中存在和涉及到的一些伦理问题,有传染病报告、隔离、免疫规划、艾滋病防治、传染病应急机制、流行病学调查和试验研究等,并就公共卫生领域中的伦理实践原则进行了概括。