健康城市--发展历程、建设方法和评估机制

健康城市的研究、监督和评价,必须建立在科学的方法和方法论基础上.调查既往导致健康不公平的因素,收集社会人口数据及编辑相关资料,总结市政当局直接或间接处理公平性问题的政策及程序,选择上述政策可产生影响和不能影响的政策进行比较,评价影响参与健康城市项目的各个因素,评价主观与客观的效益,寻求促进健康公平性的措施,这就是健康城市的评价与建设要回答的问题.     

中国健康城市建设的进展及理论思考

中国健康城市的建设走过了探索和实质性发展两个阶段.它以健康促进的理念为指导,以"健康社会、健康环境、健康人群"为主线,成为了当前开展健康促进的典范.健康城市能呈现实质且快速发展的势头,政府主导是其重要的特点.它既符合中国社会文化背景和现状,也是以"上游策略"来解决全人群健康问题创新性举措.中国健康城市推行的深远意义在于,它为当前公共卫生体系建设赋予了先进的内涵,与世界卫生组织倡导的"健康促进曼谷宪章"的核心精神是完全相符的,成为了引领中国公共卫生汇入国际现代公共卫生运动的领头兵.但是,它的茁壮成长仍需要有远见的政治家的呵护和支持.     

Recurrent binge eating with and without the "undue influence of weight or shape on self-evaluation": implications for the diagnosis of binge eating disorder

Levels of eating disorder psychopathology, impairment in psycho-social functioning and use of health services were compared among probable cases of binge eating disorder (BED) with and without extreme weight or shape concerns ("undue influence of weight or shape on self-evaluation") recruited from a large community sample of women. Data for obese non-binge eaters (n=457), also recruited from the community sample, and for a clinical sample of eating disorder patients (n=128), recruited separately, were included for comparative purposes. BED cases who reported extreme weight or shape concerns (n=51, 46.4%) had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not report such concerns (n=59), after controlling for between-group differences in age and body weight. In addition, BED cases who reported extreme weight or shape concerns were more likely to have sought treatment for an eating or weight problem than those who did not. Whereas levels of eating disorder psychopathology and functional impairment were markedly elevated among BED cases with extreme weight or shape concerns, BED cases who did not report extreme weight or shape concerns resembled obese non-binge eaters in most respects. The findings support the inclusion of an undue influence of weight or shape on self-evaluation as a diagnostic criterion for BED. In the absence of this influence, eating disorders that otherwise resemble BED do not appear to be "clinically significant".     

国内城市社区健康教育和健康促进研究

分析了我国城市化加速发展过程中出现的城市社区健康问题及其影响因素。在对社区健康教育与健康促进的作用和意义进行探讨的基础上,提出解决这些城市健康问题的根本途径是城市社区健康教育与健康促进策略,并针对我国城市社区健康教育与健康促进的研究和发展现状提出对策建议。     

Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa

Increasing empirical evidence supports the validity of binge eating disorder (BED), a research diagnosis in the appendix of DSM-IV, and its inclusion as a distinct and formal diagnosis in the DSM-V. A pressing question regarding the specific criteria for BED diagnosis is whether, like bulimia nervosa (BN), it should be characterized by overvaluation of shape and weight. This study compared features of eating disorders in 436 treatment-seeking women comprising four groups: 195 BED participants who overvalue their shape/weight, 129 BED participants with subclinical levels of overvaluation, 61 BN participants, and 51 participants with sub-threshold BN. The BED clinical overvaluation group had significantly higher levels of specific eating disorder psychopathology than the three other groups which did not differ significantly from each other. Findings suggest that overvaluation of shape and weight should not be considered as a required criterion for BED because this would exclude a substantial proportion of BED patients with clinically significant problems. Rather, overvaluation of shape and weight warrants consideration either as a diagnostic specifier or as a dimensional severity rating as it provides important information about severity within BED.     

Thin-Ideal Internalization: Mounting Evidence for a New Risk Factor for Body-Image Disturbance and Eating Pathology

Body-image disturbance and eating disorders are a significant physical and mental health problem in Western countries. We describe emerging work on one newly identified variable that appears to be a potent risk factor for the development of these problems internalization of societal standards of attractiveness. Work conducted independently in our labs over the past decade has included scale development, correlational studies, prospective risk-factor studies, randomized experiments, and randomized prevention trials. Findings collectively suggest that internalization is a causal risk factor for body-image and eating disturbances, and that it appears to operate in conjunction with other established risk factors for these outcomes, including dieting and negative affect. Future research is needed to examine the specific familial, peer, and media influences that promote internalization and to replicate and extend our prospective and experimental studies.     

Selective processing of food,weight, and body-shape words in nonpatient women with bulimia nervosa: Interference on the Stroop task

The study investigated whether the Stroop interference effect could be found in nonpatients with a self-report consistent with a diagnosis of bulimia nervosa. The nonpatient bulimic group showed significantly more interference to disorder-specific words (food, weight, and body shape) than to control words. The two nonpatient comparison groups, a depressed-nonbulimic group and a nonbulimic-nondepressed group, showed no interference. These results indicate that nonpatients with bulimia nervosa can be used to test various models of the cognitive and emotional processes involved in bulimia nervosa with the modified Stroop task. Methodological issues in the use of the computerized Stroop task with clinical populations are also noted.     

Selective information processing and schematic content related to eating behavior

An adaptation of the Stroop color-naming task was used to investigate selective information processing related to eating behavior in 90 undergraduate women. This study differed from previous studies by (a) treating eating behavior as a continuous variable and (b) looking at five separate categories of words including color, neutral, food, body shape, and other emotionally salient words. We did not find a strong pattern of relation between the Stroop task and eating and body image measures. Results suggest that in a nonclinical population, direct methods of accessing cognitions related to eating may be more fruitful than indirect measures.     

The influence of caloric information on cafeteria food choices

We evaluated the effect of posting caloric information on food purchases at a cafeteria. Purchases of more than 14,300 entrees, vegetables, and salads by 6,970 customers were unobtrusively monitored via the cash register inventory control system during 15 evening observations. A quasi-multiple-baseline design across food groups was used to test the additive effect of labeling the three lowest caloric choices for vegetables, salads, and entrees. A linear logit analysis confirmed that labeling increased the probability of low calorie selections for vegetables and salads, but not for entrees. Observations of meals purchased by a subsample of 413 customers indicated labeling did not change the total caloric content of meals. The number of customers and total sales per evening were unaffected by the labeling intervention. The results suggest that manipulating environmental cues may be an effective method for changing food purchases in a cafeteria, but labeling individual items may not be the best way to decrease total calories purchased.