Uso de agrotóxicos em canaviais de Pernambuco e danos à saúde do trabalhador / Use of pesticides in Pernambuco sugarcane fields and damage to workers' health

RESUMO O presente estudo teve por objetivo analisar a exposição aos agrotóxicos e os danos à saúde dos trabalhadores das plantações de cana-de-açúcar em Pernambuco. Trata-se de pesquisa participante desenvolvida em territórios rurais de cinco municípios com forte expressão em área plantada de cana-de-açúcar. Os dados primários foram produzidos em oficinas com trabalhadores rurais para construção de diagnóstico rural participativo, analisados mediante condensação de significados e interpretados à luz do referencial teórico da epidemiologia crítico latino-americana. Os resultados estão apresentados em três seções: i) Fluxograma do trabalho nas plantações de cana-de-açúcar; ii) Exposição aos agrotóxicos utilizados nas lavouras; iii) Danos à saúde do trabalhador. Conclui-se que a exposição permanente aos agrotóxicos envolve o trabalho nas plantações de cana-de-açúcar e emerge de um construto histórico e socioambiental, em que se encontram subsumidos os modos de vida dos territórios sob o domínio do agronegócio canavieiro. Recomendam-se políticas públicas de fomento à agricultura familiar com diversificação, escoamento e distribuição da produção agroecológica, além do fortalecimento da Atenção Primária à Saúde e de ações integradas de vigilância epidemiológica, sanitária, ambiental e do trabalhador.

ABSTRACT This study aims to analyze exposure to pesticides and harm to the health of workers on sugarcane plantations in Pernambuco. This participatory research was conducted in rural territories of five municipalities with a strong presence in sugarcane-planted areas. The primary data were produced in workshops with rural workers to construct a participatory rural diagnosis, analyzed through condensation of meanings, and interpreted in light of the theoretical framework of Latin American critical epidemiology. The results are presented in three sections: i) Flowchart of work on sugarcane plantations; ii) Exposure to pesticides used on crops; iii) Harm to worker's health. We conclude that permanent exposure to pesticides involves working on sugarcane plantations and emerges from a historical and socio-environmental construct in which the ways of life of the territories under the control of sugarcane agribusiness are subsumed. Public policies are recommended to promote family farming with diversification, flow, distribution of agroecological production, and strengthening primary health care and integrated epidemiological, health, environmental, and worker surveillance actions.

Cuidados paliativos en la atención primaria de salud / Palliative care in primary health care

En la actualidad, la oferta de cuidados paliativos especializados ha sido superada por la demanda, por lo cual la atención a pacientes con enfermedades en estado terminal o en fase final de la vida suele estar a cargo del médico del nivel primario de asistencia. En ese sentido, los cuidados paliativos primarios incluyen el diagnóstico, el tratamiento paliativo, la planificación anticipada, la gestión y coordinación de intervenciones multidisciplinarias y la transferencia a cuidados especializados cuando sea necesario y haya disponibilidad para ello. Al respecto, en este artículo se exponen brevemente algunos elementos sobre el tema y se propone, además, un algoritmo práctico y fácil de aplicar en la atención primaria, que permitirá identificar a la población aquejada por dolencias en esas etapas, con diferenciación en cuanto a afecciones neoplásicas o no neoplásicas.

Nowadays, the offer of specialized palliative care has been overcome by the demand, reason why care to patients with terminal illness or in end-of-life period is usually in charge of the doctor from primary care level. In that sense, primary palliative care includes the diagnosis, palliative treatment, early planning, administration and coordination of multidisciplinary interventions and referring to specialized care when it is necessary and the service is available. In this respect, some elements on the topic are shortly exposed in this work and, also, a practical and easy implementation algorithm in primary care is proposed that will allow identifying population suffering from pain in those stages, with differentiation as for neoplastic or non neoplastic affections.

Uso y conocimiento tradicional de plantas medicinales en comunidades de Villa Corzo, Chiapas, México / Use and traditional knowledge of medicinal plants in communities of Villa Corzo, Chiapas, Mexico

The use and knowledge of native and naturalized medicinal plants were evaluated in four communities of Villa Corzo, Chiapas, Mexico. The information was obtained through semi - structured surveys conducted with 1 18 people of different age and gender categories. To determine the most important plant species, indexes of value and frequency of use were generated. Seventy - nine species of 49 families were recorded, as well as their use in the treatment of various disea ses according to local knowledge. The species with the highest value of use were Aloe vera (L.) Burm. f., Verbena officinalis L. (verbena), Ocimum basilicum L. (basil) and Psidium guajava L. (guava). (guava). The most important families by number of specie s used were, in order of importance: Asteraceae and Rutaceae with five species Lamiaceae, Fabaceae and Rosaceae with four species each.

Se evaluaron el uso y conocimiento de las plantas medicinales nativas y naturalizadas en cuatro comunidades de Villa Corzo, Chiapas, México. La información se obtuvo a través de encuestas semiestructuradas realizadas a 118 personas de distintas categorías de edad y género. Para determinar las especies de plantas más importantes se generaron índices de valor y frecuencia de uso. Se registraron 79 especies de 49 familias, así como su uso en el tratamiento de diversas enfermedades de acuerdo al conocimiento local. Las especies con mayor valor de uso fueron Aloe vera (L.) Burm. f. (sábila), Verbena officinalis L. (verbena), Ocimum basilicum L. (albahaca) y Psidium guajava L. (guayaba). Las familias más importantes por el número de especies utilizadas fueron, en orden de importancia: Asteraceae y Rutaceae con cinco especies, Lamiaceae, Fabaceae y Rosaceae con cuatro especies cada una.

Desafios avaliativos em cenário ribeirinho: pistas metodológicas para o acesso à rede de urgência e emergência / Evaluation challenges in a ribeirinho context: methodological clues in accessing the urgency and emergency network / Desafíos evaluativos en el escenario ribereño: pistas metodológicas para el acceso a la red de urgencia y emergencia

O acesso à saúde e às políticas públicas em áreas remotas é um desafio relevante aos sistemas públicos no Brasil, dada sua dimensão e diversidade territorial. Este artigo tem como proposta apresentar o modelo teórico-lógico elaborado para avaliar o acesso da população ribeirinha à rede de urgência e emergência (RUE) em cenário amazônico, com vistas a fortalecer o planejamento, o monitoramento e a avaliação em saúde voltados para populações específicas. O ponto de partida metodológico foi a revisão temática sobre o acesso à saúde e o contexto amazônico na sua inter-relação com a proposta da pesquisa, que foi problematizada em encontros com colaboradores. Em seguida, buscou-se compreender e analisar os componentes teórico e lógico do modelo e adaptá-los à tríade donabediana ­ estrutura, processo e resultado. O resultado configurou a construção do modelo propriamente dito, com centralidade nas características que representam a oferta dos serviços (sócio-organizacional) e que retratam principalmente o espaço (geográfico). Esses pontos de construção do modelo demonstram sua contribuição para subsidiar outros processos avaliativos e o impacto final na tomada de decisão para qualificar o acesso da população ribeirinha à saúde em momento de sofrimento agudo, auxiliando na superação das condições que segregam essas populações.

Access to health and public policies in remote areas is a major challenge for public systems in Brazil, given its dimension and territorial diversity. This article presents a theoretical-logical model designed to assess the ribeirinho population's access to the urgency and emergency network in the Amazon as to strengthen health planning, monitoring, and evaluation aimed at specific populations. Starting from a thematic review on access to health and the Amazon in its interrelation with the research proposal, which were problematized in meetings with collaborators, the research sought to understand and analyze the model's theoretical and logical components and adapt them to the Donabedian triad (structure, process and result). This resulted in the model itself, centered on service provision (socio-organizational) and the space (geographic). These points demonstrate its contribution to support other evaluation processes and the final impact on decision-making to qualify this population's access to health under acute suffering, helping to overcome current restrictive conditions.

El acceso a la salud y a las políticas públicas en áreas remotas es un desafío relevante para el sistema público en Brasil dada su dimensión y diversidad territorial. El objetivo de este artículo es presentar un modelo teórico-lógico desarrollado para validar el acceso de la población ribereña a la red de urgencia y emergencia en el escenario amazónico, para fortalecer la planificación, la vigilancia y la evaluación de los resultados de salud de poblaciones específicas. El punto de partida metodológico fue la revisión temática sobre el acceso a la salud en el contexto amazónico, en especial su interrelación con la propuesta de investigación, que fue problematizada en reuniones con colaboradores. Después, se buscó comprender y analizar los componentes teórico y lógico del modelo y adaptarlos a la tríada donabediana ­estructura, proceso y resultado. El resultado configuró la construcción del modelo propiamente dicho, con foco en las características que representan la prestación de los servicios (social-organizacional) y que retratan principalmente el espacio (geográfico). Estos puntos de construcción del modelo destacan su contribución para subsidiar otros procesos evaluativos y el impacto final en la toma de decisiones para calificar el acceso de la población ribereña a la salud en un momento de sufrimiento agudo, ayudando a superar las condiciones que segregan a estas poblaciones.

Estrategias usadas en la atención de la salud sexual de poblaciones rurales de bajos ingresos / Strategies Used in Sexual Health Care for Low-Income Rural Populations / Estratégias utilizadas na atenção à saúde sexual de populações rurais de baixa renda

Introducción: en la ejecución de políticas públicas de salud sexual, resultan cruciales las estrategias utiliza-das en la construcción de la relación agente de salud-usuario. En la literatura son pocos los artículos que exploran las estrategias que utilizan los agentes de salud para interactuar con pobladores rurales al abor-dar estas problemáticas. Este artículo se propone describir y comprender las estrategias que utilizan los agentes de salud en la atención de la salud sexual y reproductiva de pobladores rurales de bajos ingresos. Para ello, se conceptualiza la relación médico-paciente como una interfaz social, es decir, como un espacio de articulación entre los mundos de sentido de los actores involucrados. Materiales y métodos: se desarrolló un estudio de carácter exploratorio-descriptivo de tipo transversal. Se realizaron 21 entrevistas semiestruc-turadas a agentes del sistema de salud, y su análisis se hizo desde un enfoque cualitativo. Resultados: los agentes de salud utilizan un amplio repertorio de estrategias para abordar la salud sexual de los pobladores rurales. Se identificaron y caracterizaron dos tipos de estrategias (dialógicas y monológicas), con sus respectivos subtipos. Conclusión: el estudio visibiliza las estrategias dialógicas como modo alternativo de relación médico-paciente, en contraste con estrategias tradicionales, de tipo monológico. Además, contribuye a la formación de los agentes de salud, y en la conformación de los equipos que abordan la salud sexual y reproductiva en contextos rurales

Introduction: The strategies used for constructing health agent-user relationship are crucial for exe-cuting public policies on sexual health. In the literature, few articles explore the strategies used by health agents to interact with rural residents when addressing these problems. We aimed to describe and understand these strategies used by health agents for sexual health care in low-income rural resi-dents. To achieve this, the doctor­patient relationship is assumed to be a social interface and a space of articulation between the worlds of meaning of the actors involved. Materials and methods: An explor-atory, descriptive, and cross-sectional study was developed. Overall, 21 semistructured interviews were conducted with health agents, and the results were qualitatively analyzed. Results: Health agents use a wide repertoire of strategies to address the sexual health of rural residents. Two types of strategies (dia-logical and monological) and their respective subtypes were identified and characterized. Conclusion:Dialogic strategies are an alternative to the doctor­patient relationship and are contradictory to the traditional monological strategies. They impact the training of health agents and the formation of teams that address sexual and reproductive health in rural settings

Introdução: na execução das políticas públicas de saúde sexual, as estratégias utilizadas na construção da relação agente de saúde-usuário são cruciais. Na literatura são escassos os artigos que exploram as estratégias utilizadas pelos agentes de saúde para interagir com os moradores rurais na abordagem desses problemas. Este estudo se propõe a descrever e compreender as estratégias utilizadas pelos agen-tes de saúde na atenção à saúde sexual e reprodutiva de moradores rurais de baixa renda. Para isso, a relação médico-paciente é conceituada como interface social, ou seja, como espaço de articulação entre os mundos de sentido dos atores envolvidos. Materiais e métodos: foi desenvolvido um estudo transver-sal exploratório-descritivo. Foram realizadas 21 entrevistas semiestruturadas com agentes do sistema de saúde e sua análise foi feita a partir de uma abordagem qualitativa. Resultados: os agentes de saúde utilizam um amplo repertório de estratégias para abordar a saúde sexual dos residentes rurais. Dois tipos de estratégias (dialógicas e monológicas) foram identificadas e caracterizadas, com seus respecti-vos subtipos. Conclusão: este estudo torna visíveis as estratégias dialógicas como modo alternativo de relação médico-paciente, em contraste com as estratégias tradicionais de tipo monológico. Além disso, contribui para a formação de agentes de saúde e na formação de equipes que abordem saúde sexual e reprodutiva em contextos rurais.

Establishment of a risk prediction model for poly victimization among rural left behind children / 中国学校卫生

Objective@#To construct a risk prediction model for poly victimization (PV) among rural left behind middle and high school students in Chaoshan, and to evaluate the prediction effect of the model, so as to provide scientific basis for early identification and prevention of PV among students.@*Methods@#A questionnaire survey was conducted among 1 005 left behind students, selected from 7 middle and high schools in rural areas of Shantou City and Jieyang City by a stratified random cluster sampling method from January 2020 to September 2021, for the personal, family, external environmental factors, psychological factors (mental resilience, coping approaches, self esteem and social support) and PV situations. R software and Logistic regression were used to screen predictor variables to build a risk prediction model, and the area under the ROC curve (area under the curve, AUC), accuracy, precision, recall, F1 value and calibration curve were used to evaluate the model s effect.@*Results@#The incidence rate of PV among left behind middle and high school students was 23.38%. The results of Logistic regression analysis showed that physical illness or disability ( β =1.02), grade retention during the past year ( β =1.31), having no close partner ( β =1.00), self harm intention (seldom: β = 0.58 , occasionally: β =0.79), negative peer behavior ( β =0.90), family member smoking ( β =0.59), criminal offenses of parents ( β =1.04), witnessing school bullying ( β =0.78), house moving ( β =0.58), using venting ( β =0.34) and the coping style of patience ( β =0.28) were positively correlated with PV among left behind children in Chaoshan area, and family support in psychological flexibility ( β =-0.31) was negatively correlated with PV ( P <0.05). A nomogram prediction model was constructed for the meaningful variables included in the multivariate analysis, and the prediction model AUC was 0.88, the accuracy was 82.00 %, the precision was 77.78%, and the F1 value was 43.75%. The calibration plot fitted well, and the model had good discrimination and calibration.@*Conclusion@#The risk prediction model for left behind middle and high school students with PV has good predictive performance and is helpful for schools and communities to early identify high risk middle and high school students with PV.

Relationship between metal exposure and blood pressure in rural primary school students in Shiyan City, Hubei Province / 中国学校卫生

@#To explore the relationship between metal exposure level and blood pressure, so as to provide a scientific basis for verifying the relationship between metal exposure and elevated blood pressure among primary school students.@*Methods@#In July 2022, a total of 555 students of second to sixth grade were selected by cluster random sampling method from two primary schools in Zhuxi County, Shiyan City, Hubei Province. A questionnaire survey was conducted to obtain the socio demographic characteristics and living habits of the participants. The height, weight, body mass index(BMI) and blood pressure were obtained by physical examination. At the same time, the urine of the subjects was collected, and the metal mass fraction in urine was detected by inductively coupled plasma mass spectrometry. The relationship between metal mass fraction in urine and blood pressure was analyzed by generalized linear regression.@*Results@#The detection rate of elevated blood pressure in primary school students was 15.86% , and there was a statistically significant difference in the detection rate of elevated blood pressure among obese primary school students (yes:37.25%,no:13.69%, χ 2=19.28, P <0.01).There were statistically significant differences in BMI[15.80( 14.69 ， 17.92 )，17.87(15.49，20.89)kg/m 2] between the non elevated blood pressure group and the elevated blood pressure group of elementary school students ( Z =-4.67, P <0.01). The geometric mean mass fraction of zinc in urine was the highest ( 6 942.86 μg/g), titanium was the lowest (2.20 μg/g). Zinc and lead were positively correlated with elevated systolic blood pressure( β = 0.054 , 0.014), zinc and cadmium were positively correlated with elevated diastolic blood pressure ( β =0.038,0.029) ( P <0.05).@*Conclusions@#Metal zinc, lead and cadmium concentration are associated with elevated blood pressure. It is necessary to intervene and control the exposure of zinc, lead and cadmium in the environment to promote the blood pressure health of primary school students.

Prevalence rate and related factors in urban and rural residents with hyperuricemia / 公共卫生与预防医学

Objective To explore the prevalence rate and related factors of urban and rural residents with hyperuricemia (HUA). Methods A total of 360 subjects in physical examination department of Sanliusan Hospital from January 2020 to January 2023 were selected and divided into urban residents and rural residents according to their permanent residence addresses, and the demographic information, living habits and underlying diseases were collected. Fasting blood glucose (FBG), serum uric acid (SUA), body mass index (BMI) and triglyceride (TG) were measured. The risk factors of HUA were analyzed by logistics regression analysis. Results The incidence rates of HUA in urban and rural residents were 12.18% and 12.88%. There were statistically significant differences in education level, occupation, BMI, sleep time, alcohol drinking, FBG and TG between urban and rural residents (all P24 kg/m2, alcohol drinking and chronic kidney disease were independent risk factors for HUA occurrence among urban residents (all P<0.05). Chronic kidney disease, FBG≥7.0 mmol/L and TG≥2.3 mmol/L were independent risk factors for hyperuricemia occurrence among rural residents (all P<0.05). Conclusion Rural residents should strengthen health education and blood glucose and lipid control, and urban residents should pay more attention to reasonable exercise, control alcohol consumption and reduce HUA occurrence.

The Prevalance of Depression and Anxiety among Elderly People in Dai Rural Areas of Jinggu County Yunnan Province and Its Relationship with Socio-economic Status / 昆明医科大学学报

Objective The aim of this study is to analyze the prevalence of depression and anxiety symptoms and its relationship with the socio-economic position(SEP)among the elderly people in Dai rural areas of Jinggu County,Yunnan province.Methods A multi-stage stratified random sampling method was used to conduct a questionnaire survey among 1409 people aged 60 and over in Dai rural areas of Jinggu County,Yunnan Province.The individual SEP index was constructed using the principal component analysis.Results The prevalence of anxiety symptoms,depression symptoms,and mixed anxiety-depressive disorder symptoms was 4.8%,52.0%,and 4.2% among them,2.6%,49.4%,and 2.3% among the males,and 6.8%,54.5%,and 6.0% among the females respectively.Females had the higher prevalence of anxiety symptoms and mixed anxiety-depressive disorder symptoms than males(P<0.05).Elderly people with the higher level of education,annual per capita household income and SEP had the lower prevalence of anxiety symptoms and mixed anxiety-depressive disorder symptoms than their counterparts(both P<0.05).The prevalence of depression symptoms increased with age(P<0.01).The difference in the prevelence of depression symptoms among the elderly people with the different numbers of chronic conditions was statistically significant(P<0.01).The results of multivariate logistic regression analysis showed that the elderly people with lower SEP were more likely to suffer from the anxiety symptoms(OR=0.707,95% CI:0.566～0.883),depression symptoms(OR=0.492,95% CI:0.438～0.552),and mixed anxiety-depressive disorder symptoms(OR=0.602,95% CI:0.469～0.773).Conclusion There are significant socio-economic differences in the prevalence of anxiety symptoms and depression symptoms among the elderly people in Dai rural areas of Jinggu County,Yunnan province.Future mental health interventions should more focus on females,elderly people with advanced age,multiple chronic diseases and low SEP,so as to reduce the occurrence of depression symptoms and anxiety symptoms.

Mental Health Status and Its Influencing Factors Among Elderly Hypertension Patients from Rural Areas of Chuxiong and Honghe Prefecture in Yunnan / 昆明医科大学学报

Objective To investigate the mental health status and its influencing factors among elderly hypertensive patients from Rural Areas of Chuxiong and Honghe Prefecture in Yunnan.Methods Multi-stage random sampling method was adopted to select elderly hypertensive patients from rural Yi ethnic areas in Yunnan.Questionnaires were used to collect their basic information and mental health status.Multivariate logistic regression was performed to explore the influencing factors of mental health among the elderly hypertensives.Results 21.82%(209/958)of elderly people with hypertension have poor mental health status in Chuxiong and Honghe Prefecture,Yunnan.Age of 80-89 years(OR = 2.395,P<0.05)and over 90 years(OR = 3.293,P<0.05),as well as physical disability(OR = 2.037,P<0.05),were risk factors for poor mental health.Compared with those who rated their economic situation as very difficult,rating as somewhat difficult(OR = 0.490,P<0.05),moderate(OR = 0.632,P<0.05)and relatively affluent(OR = 0.344,P<0.05),having a spouse(OR = 0.655,P<0.05),received full concern from the offspring(OR = 0.411,P<0.05)and maintain good relationships with offspring(OR = 0.339,P<0.05)were protective factors.Conclusions The mental health status of elderly people with hypertension is relatively poor in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.Special attention should be paid to the mental health of older and physically disabled elderly hypertensives.Economic and mental support from children was crucially important in improving the mental health of elderly hypertensive patients in rural areas of Chuxiong and Honghe Prefecture in Yunnan Province.

Analysis of treatment gap of convulsive epilepsy patients in rural areas of Jiangsu Province / 临床神经病学杂志

Objective To explore the treatment gap and influencing factors of convulsive epilepsy in rural areas of Jiangsu Province.Methods The clinical data of 7836 rural convulsive epilepsy patients screened from 2005 to 2020 were statistically analyzed,and the treatment status,treatment gap and related influencing factors of epilepsy patients were analyzed.Results A total of 7836 patients with convulsive epilepsy were enrolled in this study.The treatment gap for convulsive epilepsy in rural areas of Jiangsu Province was 69.05%.There was no significant difference in the treatment gap between different genders(P＞0.05).There were statistically significant differences in the treatment gap between age(χ2 = 12.196,P =0.007),age of onset(χ2 =58.658,P＜0.001),disease duration(χ2 =65.430,P＜0.001),seizure frequency(χ2 =171.276,P＜0.001),and hospitalization level(χ2 = 122.076,P＜0.001).Multivariate Logistic regression analysis showed that the older the age of onset was,the shorter the course of the disease was,the more frequent the seizures was,and the greater the treatment gap in patients with epilepsy was(all P＜0.05).Patients aged 45-59 years(P =0.012)and treated in municipal and county hospitals(P＜0.001)were more likely to receive regular anti-epileptic treatment.Conclusions There is a significant treatment gap for convulsive epilepsy patients in rural areas of Jiangsu Province.This may be due to insufficient awareness of epilepsy and the underdevelopment of primary healthcare institutions.

The Effects of Urban-Rural Medical Insurance Integration on Rural Households'Catastrophic Health Expenditure / 中国卫生经济

Objective:To evaluate the effect of urban-rural integrated medical insurance on rural households'catastrophic health expenditure(CHE),thereby proposing targeted optimization strategies for the integration.Methods:Based on the five tracking data of the China Household Tracking Survey(CFPS)from 2010 to 2018,Process Specification Model-Dynamic Integrity Dimension(PSM-DID)was used to empirically test the impact of urban-rural integrated medical insurance on rural households'catastrophic health expenditures.Results:The urban-rural integrated medical insurance system significantly reduces the incidence of CHE in ru-ral households.Mechanism testing indicates that health levels,human capital expenditures,and household asset accumulation are important channels of action.Conclusion:It is suggested to continuously promote the urban-rural integrated medical insurance sys-tem,formulate comprehensive policies for medical insurance according to local conditions,and incorporate catastrophic health indi-cators into the detection and warning indicator system for rural residents returning to poverty.

Research on Financial Security for Rural Public Health Service Personnel Talent/ / 中国卫生经济

The quantity and quality of rural public health service personnel are crucial for ensuring the health of rural residents.However,there are current challenges including insufficient personnel quantity and professional competence,severe talent loss,and low levels of rural public health services.The main reasons behind these challenges include insufficient financial investment,an imperfect salary system,inadequate performance evaluation mechanisms,and uneven resource allocation.In 2023,the National Health Commission and other departments jointly initiated anti-corruption efforts in the medical field while deepening healthcare system reforms.These reforms focus on strengthening the public health system,especially in rural and community areas,and revamping grassroots salary structures with an emphasis on decoupling salaries from revenue generation.However,specific measures for financial security of rural health personnel have not been clearly outlined.To bring in and retain rural health personnel,the financial security mechanism needs to be improved.It is recommended to increase financial investment by expanding budget allocations,implement a"dossier system"with salaries paid directly to individuals'accounts from municipal or county-level budgets,refine the salary system,reform performance evaluation mechanisms,raise overall remuneration,rationalize the allocation of resources,enrich health talents and encourage retired doctors to settle in rural areas.By gradually improving the financial security mechanism for rural public health service personnel,sustainable development of rural public health services can be achieved.

Research on the operation efficiency of the basic medical insurance system for urban and rural residents in China and its influencing factors / 中国卫生政策研究

Objective:Operational efficiency and influencing factors of China's basic medical insurance system from 2020 to 2021 is conducted to provide reference for improving the operational efficiency and optimizing the input-output relationship.Methods:The super-efficiency SBM model based on unexpected output and the Malmquist index are used to measure the static and dynamic efficiency of resident medical insurance in 31 provinces in China,and Tobit regression analysis is employed to analyze the influencing factors.Results:The overall operational efficiency of resident medical insurance still needs improvement.The operational efficiency of resident medical insurance in the central and western regions is lower than that in the eastern region,and the gap is significant.Different levels and regions have differentiated main constraints on the operational efficiency of resident medical insurance.In terms of dynamic efficiency,the total factor productivity of resident medical insurance operation shows an increasing trend,mainly due to technological progress.In terms of influencing factors,the degree of aging,the level of medical expenses and the level of medical insurance supervision have a significant impact on the operational efficiency.Suggestions:Efforts should be made to bridge regional disparities,promote the equitable development of medical insurance,reasonably control the level of medical expenses,strengthen the supervision of medical insurance funds,and implement active aging policies.

A Research of Factors Influencing Rural Residents'Willingness to Use Telemedicine / 中国医院管理

Objective Explore the factors affecting rural residents'willingness to use telemedicine in China,and put forward relevant suggestions to promote the development of telemedicine in rural areas.Methods A research model was built based on Technology Acceptance Model,data were collected through using a questionnaire survey and analyze by structural equation modelling for validation.Results The awareness rate of telemedicine among rural residents was 62.0%and the usage rate was 10.0%,which was low.Perceived usefulness,perceived ease of use,social participation,social support,and facilitators positively influence rural residents'willingness to use telemedicine(P＜0.05),while perceived risk and social connection have no effect on the willingness of rural residents to use telemedicine(P＞0.05).Conclusion Promote the construction of telemedicine system infrastructure to comprehensively enhance the level of rural medical and health services;improve telemedicine laws and regulations to promote the policy guarantee of the three medical institutions;give full play to the role of social capital to improve the information literacy of rural residents in the use of telemedicine.

Concentration and health risk assessment of trichloromethane in drinking water for rural primary and middle school students in Tianjin / 中国学校卫生

Objective@#To evaluate the distribution characteristics and health risk of trichloromethane (TCM) in the drinking water supply of primary and middle schools in rural areas of Tianjin, so as to provide a scientific basis for improving drinking water safety in rural schools.@*Methods@#A total of 60 water samples from 30 rural primary and middle schools in 10 agricultural districts of Tianjin were collected from April to June (dry season) and July to October (wet season) in 2023 with direct selection method. The content of TCM was detected according to the Standard Methods for the Examination of Drinking Water, and a risk assessment method recommended by the United States Environmental Protection Agency was used to evaluate the health risk of TCM through oral exposure.@*Results@#The concentration of TCM in drinking water was no detection to 54.00 μg/L, with an average of (13.44±14.88) μg/L, and the value was higher during the wet season [12.90(1.40,32.28)μg/L] than the dry season [2.40(1.40,18.13)μg/L] (Z=-2.09, P<0.05). The concentration of TCM for primary and middle schools were [3.38(1.40,20.75) μg/L] and [5.30(1.40,28.23)μg/L] respectively, and there was no statistically significant difference between different types of schools (Z=0.50, P>0.05). The carcinogenic risk through oral exposure ranged from 3.84×10-7 to 2.05×10-5, while the noncarcinogenic risk ranged from (0.00-0.16), all within the acceptable range. Children aged 6 to 9 years old were at the highest risk.@*Conclusions@#TCM has been detected in the drinking water of rural primary and middle schools to a certain extent in Tianjin, and attention should be paid to the potential health risks of oral exposure. The monitoring and management of disinfection byproducts in drinking water should be strengthened to further reduce the risk of exposure to children.

Long-term effectiveness evaluation of the construction of “mosquito-free village” in Pujiang County / 预防医学

Objective@#To evaluate the effectiveness for the construction of "mosquito-free village" in Xuejia Village, Pujiang County, Zhejiang Province, so as to provide the guidance for the construction of "mosquito-free village" in other rural areas.@*Methods@#Density of adult mosquitoes in Xuejia Village was investigated using light trap method and density of larval mosquitoes was investigated using larval straw method from April to November each year. Totally 30 households of villagers were randomly selected, and their awareness rates of mosquito control knowledge, mosquito control behavior forming rates and satisfaction rates were surveyed through questionnaires. Investment during construction (from August 2016 to December 2018) and maintenance period (from 2019 to 2023) of "mosquito-free village" were investigated through data review and interviews. Long-term effects of "mosquito-free village" construction in Xuejia Village were evaluated in terms of mosquito density from 2016 to 2023, effectiveness of health education for villagers, satisfaction and investment.@*Results@#Compared with the year 2016, the densities of adult and larval mosquitoes in Xuejia Village were significantly decreased from 2017 to 2023. The average monthly density of adult mosquitoes in 2023 decreased by 98.34%, and the average monthly 100 household index of larval mosquitoes decreased by 98.45% compared to 2016. The average monthly density of adult mosquitoes from 2019 to 2023 was less than or equal to one mosquito per light trap in a night, and the average monthly 100 household index of larval mosquitoes was less than or equal to five places per 100 households. The awareness rate of mosquito control knowledge was 93.33%, the behavior forming rate was 86.67%, and the satisfaction rate was 90.00%. By December 2023, the total investment during construction and maintenance period was 450 thousand Yuan, with an average annual investment of 60.7 thousand Yuan and average annual investment of 206.61 Yuan per household. The average annual investment during maintenance period was 36.2 thousand Yuan, and the average annual investment per household was 109.70 Yuan.@*Conclusion@#The mosquito density, effectiveness of health education for villagers and satisfaction of "mosquito-free village" in Xuejia Village all meet the evaluation criteria of "mosquito-free village", and the investment is reasonable, making it suitable for promotion to other rural areas.

Survey on the recognition of the post competency index system among Chinese rural general practice assistant physicians and analysis of influencing foctors / 中华全科医师杂志

Objective:To investigate the recognition of the post competency index system among rural general practice assistant physicians and its influencing factors.Methods:This study was a cross-sectional survey. A questionnaire survey on the recognition of post competency index system was conducted from October 2020 to September 2021 among rural general practice assistant physicians from 10 provinces/municipalities selected by stratified cluster sampling method. The recognition of rural general practice assistant physicians at all levels of indexs and the factors influencing recognition were analyzed.Results:A total of 1 123 questionnaires were distributed and 1 024 valid ones were collected with a recovery rate of 91.18%. Of the 1 024 respondents, 529 were male(51.7%) and 435 were aged 40-49 years(42.5%), which was the highest proportion by age group. The average overall recognition score of the index system was 4.41, and the scores of the primary indexes were 4.32-4.45. Three primary indexes had the highest recognition scores: professional competence, basic health care services, and interpersonal communication and teamwork. The recognition scores on the second level index were 4.18-4.61, and the proportion of recognition scores greater than 4 was over 80%. There were significant differences in the recognition scores of the index system among assistant physicians with different working years, educational background, professional title and work unit ( F/H=6.41, 14.83, 12.45, 7.53, P<0.01). Educational background(associate degree: B=0.091, P=0.015; bachelor degree and above: B=0.196, P<0.001) and professional title(intermediate professional title and above: B=-0.234, P<0.001) were the independent factors influencing the recognition degree of the index system for rural general practice assistant physicians. Conclusions:The post competency index system is generally recognized by rural general practice assistant physician, and academic qualifications and professional title status may influence its recognition.

Application feasibility of the post competency index system of rural general practice assistant physicians / 中华全科医师杂志

Objective:To evaluate the application feasibility of the post competency index system of rural general practice assistant physicians, and to analyze and compare the post competency of rural general practice assistant physicians with different characteristics through a survey among rural general practice assistant physicians in China.Methods:This study was a cross-sectional study. A questionnaire survey was conducted among rural general practice assistant physicians in 10 provinces/municipalities selected by stratified cluster sampling method from October 2020 to September 2021. The post competency scores were self-evaluated based on the post competency index system of rural general practice assistant physicians. The results of the survey were analyzed and the application feasibility of the index system was evaluated.Results:A total of 1 123 questionnaires were distributed and 1 024 valid questionnaires were returned with a recovery rate of 91.2%. Of the 1 024 respondents, 529 were males (51.7%), 435 were aged 40-49 years (42.5%), 434 had a secondary school education or less (42.4%), and 531 were junior practitioners (51.9%). The Cronbach′s α coefficient of the overall questionnaire was 0.987, and the Cronbach′s α coefficient of the first level index ranged from 0.897 to 0.974. The cumulative variance contribution rate of exploratory factor analysis was 72.012%. The confirmatory factor analysis showed χ2/ df=3.926, RMSEA=0.076, CFI=0.858, IFI=0.859, indicating that the model fit was basically good. The average self-evaluation scores of the first level index ranged from 3.95 to 4.25, and the average self-evaluation scores of the second level index ranged from 3.74 to 4.36. There were significant differences in self-evaluation scores of post competency among rural general practice assistant physicians with different working years, professional titles, working units and economic regions( F=4.67, 10.54, 22.16 and 20.90,all P<0.05). People with low self-evaluation scores of post competency had the following characteristics: working 10-19 years, intermediate or above titles, working in community health service centers, located in the eastern region.People with high self-evaluation scores of post competency had the following characteristics: primary professional title, working in the village clinic. Conclusion:The competency index system of rural general practice assistant physicians has good application feasibility,and it can be used to evaluate post competency for the education and training of rural general practice assistant physicians.

Labor shortage of physicians in rural areas and surgical specialties caused by Work Style Reform Policies of the Japanese government: a quantitative simulation analysis / Journal of Rural Medicine

Objective: The Japanese government’s physician workforce reform, which commenced in April 2024, introduced regulations on physicians’ working hours. However, in areas facing physician shortages such as rural regions and surgical medical specialties, healthcare provision relies heavily on the extended working hours of each physician. The anticipated impact of this reform, when implemented, was significant.Materials and Methods: Using publicly available government data, we estimated the current working hours of physicians in various medical specialties in each prefecture across Japan. Subsequently, we calculated the ratio of surplus or deficit physicians when hypothetically assuming that all physicians adhered to the regulatory upper limit of 58.4 working hours per week nationwide.Results: Assuming that all physicians work to the regulated maximum, there would be a shortage of doctors in various medical specialties across Japan, such as surgery, neurosurgery, orthopedic surgery, obstetrics and gynecology, and emergency medicine. Geographically, shortages of doctors are observed in rural prefectures such as those in the Tohoku region, particularly in emergency- and surgery-related specialties, indicating a critical shortage of physicians in rural areas. Additionally, it has become evident that even in medical specialties with a calculated surplus of physicians nationwide, the margin of surplus is generally only a few percentage points.Conclusion: Currently, rural areas and surgical medical specialties in Japan have limited leeway in the physician workforce, and the strict application of workforce reform may lead to a severe shortage of physicians in these areas. It is noteworthy that as similar reforms may subsequently be implemented in other countries, analogous challenges would arise. Thus, the implementation of workforce reform requires a flexible approach to minimize its negative effects, which widen the existing disparity in the workforce.