On the training of rural-order tuition-waived medical students and its impact on grass-roots public health services / 中华医学教育探索杂志

Objective:To discuss the role of rural-order tuition-waived medical students in grass-roots public health, and put forward pertinent suggestions for further improving the effectiveness of rural directional general practitioner training programs.Methods:Through interviews with 63 graduated rural-order tuition-waived medical undergraduates from rural primary medical institutions in Sichuan Province, the standard procedures of spindle encoding and content analysis were used to analyze the influence of the training effect of rural-order tuition-waived medical students on grass-roots public health services.Results:The results showed that the training effect of rural-order tuition-waived medical students mainly reflected in theoretical learning, practical work ability, future career planning and post-graduation education, among which the training effect of theoretical learning and practical work ability was better. Rural-order tuition-waived medical students played a positive role in grass-roots public health services, mainly in the protection of key populations, home prevention and management of the elderly and chronic diseases patients, and home prevention and management of children and pregnant women.Conclusion:The measures for rural-order tuition-waived medical students to provide grass-roots public health services should include that the supporting policies of the state and schools can be continuously improved and implemented, college teachers should pay more attention to the guidance of the humanistic spirit of general medical students, and the curriculum system construction of rural-order tuition-waived medical students should highlight the courses related to grass-roots and general medicine. In the process of student training, we should construct effective practical methods and strengthen post-employment continuing education.

Cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN), estado nutricional de idosos e sua relação com desigualdades sociais no Brasil, 2008-2019: estudo ecológico de série temporal / Cobertura del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN), estado nutricional de los ancianos y su relación con las desigualdades sociales en Brasil, 2008-2019: un estudio de serie temporal ecológica / Food and Nutrition Surveillance System (SISVAN) coverage, nutritional status of older adults and its relationship with social inequalities in Brazil, 2008-2019: an ecological time-series study

Objective: to analyze the temporal trend of Food and Nutrition Surveillance System (Sistema de Vigilância Alimentar e Nutricional - SISVAN) coverage and the nutritional status of older adults, and its correlation with indicators of social inequality in Brazil between 2008-2019. Methods: this was an ecological study using records from SISVAN, related to the population aged 60 years and older; the temporal trend of coverage and the correlation between indicators of social inequality and increment rate of nutritional status were analyzed; slope index of inequality and concentration index were used to measure absolute and relative inequalities. Results: 11,587,933 records were identified; national coverage increased from 0.1% (2008) to 2.9% (2019), with a statistically significant upward trend; a moderate inverse correlation with an annual increment rate of overweight between human development index and gross domestic product per capita, was found. Conclusion: there was an increasing trend in SISVAN coverage; the increase in overweight was associated with social inequality.

Objetivo: analizar la tendencia temporal de cobertura del Sistema de Vigilancia Alimentaria y Nutricional (SISVAN), y el estado nutricional de adultos mayores, correlacionándolos con indicadores de desigualdad social, en el período 2008-2019. Métodos: estudio ecológico mediante registros del SISVAN sobre la población ≥60 años. Se realizaron análisis de correlación entre indicadores de desigualdad social y la tasa de incremento del estado nutricional y análisis de desigualdades absolutas y relativas para obtener el índice de desigualdad angular y el índice de concentración. Resultados: se identificaron 11.587.933 registros. La cobertura nacional evolucionó del 0,1% en 2008 al 2,9% en 2019, con una tendencia ascendente estadísticamente significativa. Se encontró una correlación inversa moderada con la tasa de incremento anual de sobrepeso para IDH y PIB per cápita. Conclusión: hubo una tendencia de crecimiento en la cobertura del SISVAN. El aumento del sobrepeso se asoció con la desigualdad social.

Objetivo: analisar a tendência temporal da cobertura do Sistema de Vigilância Alimentar e Nutricional (SISVAN) e do estado nutricional de idosos, e sua correlação com indicadores de desigualdade social no Brasil, no período 2008-2019. Métodos: estudo ecológico, sobre registros do SISVAN relativos à população na idade de 60 anos ou mais; analisaram-se a tendência temporal da cobertura e a correlação entre indicadores de desigualdade social e taxa de incremento do estado nutricional; os índices angular e de concentração foram utilizados para medir desigualdades absolutas e relativas. Resultados: foram identificados 11.587.933 registros de idosos; a cobertura nacional evoluiu de 0,1% (2008) para 2,9% (2019), com tendência de aumento estatisticamente significativa; foi encontrada correlação inversa moderada com taxa de incremento anual de sobrepeso, para índice de desenvolvimento humano e produto interno bruto per capita. Conclusão: houve tendência de crescimento da cobertura do SISVAN; o aumento de sobrepeso esteve associado à desigualdade social.

Establishment of a hypertension risk assessment model among middle-aged and elderly populations based on the basic publichealth service program / 预防医学

Objective@#To establish a hypertension risk assessment model among the middle-aged and elderly populations based on residents' electronic healthcare records of the basic public health service program, so as to provide insights into prevention of hypertension.@*Methods@#Demographic features and physical examinations were collected among residents at ages of 40 years and older from residents' electronic healthcare records of the basic public health service program in a county of Zhejiang Province from 2019 to 2020. The risk factors of hypertension were identified using a multivariable logistic regression model, and the odds ratio (OR) for each risk factor was transformed into approximate relative risk (RR), which was included in the formula for calculation of the disease risk proposed by Harvard School of Public Health to create a hypertension risk assessment model. The predictive value of the model was evaluated using a receiver operator characteristic (ROC) curve.@*Results@#Totally 7 275 subjects were enrolled, with a mean age of (66.15±7.91) years, and the participants included 3 189 males and 4 086 females, with a male-to-female ratio of 0.78∶1. There were 190 cases with new-onset hypertension (2.61%). Multivariable logistic regression analysis revealed that overweight, obesity, central obesity, borderline high triacylglycerol (TG), elevated TG, abnormal fasting plasma glucose (FPG), prehypertension and family history of hypertension were included in the hypertension risk assessment model, with approximate RR values of 1.66, 1.96, 1.54, 1.17, 1.64, 1.45, 1.69 and 1.11. The area under the ROC curve (AUC) of the model was 0.678 (95%CI: 0.641-0.715, P<0.001), and the optimal positive cut-off was 0.899. The model predicted 139 subjects with RR>0.899 for hypertension, with a sensitivity of 73.16% and specificity of 55.79%.@*Conclusions@#The hypertension risk assessment model created in this study is feasible to predict the RR for developing hypertension among the middle-aged and elderly populations, which has a predictive value in healthcare management.

Intergenerational differences and influential factors of basic public health service utilization for floating population / 中南大学学报(医学版)

OBJECTIVES@#The Fourth Plenary Session of the 19th Central Committee of the Communist Party of China put forward the idea of "promoting the equalization of basic public services". The utilization of basic public health services by the floating population is an important indicator to measure the equalization of basic public health services. This study aims to understand the intergenerational differences in the utilization of basic public health services between the older generation and the new generation of floating population, and to analyze the influential factors.@*METHODS@#We employed the personal questionnaire (A) of the national health and family planning dynamic monitoring survey on floating population in 2017. Pearson Chi-square test, bi-grouping logistic regression, and Poisson regression were applied to analyze the basic situation of the floating population and the intergenerational differences in the use of basic public health services between the new and old generations.@*RESULTS@#The proportions of the new generation and the old generation who had established the residents' health records in the inflow area were 36.42% and 34.96%, respectively, with the significant difference (@*CONCLUSIONS@#Although the coverage of basic public health services for the two generations of floating population is obviously different, the utilization of basic public health services of the floating population is still at a low level both in the new generation and in the old generation. There is an urgent need to improve the utilization of public health services for the whole floating population according to the characteristics of generations.

Discussion on primary public health service and rural doctors' team construction / 上海预防医学

In China, rural doctors and primary health institutions take important responsibilities as the basic of public health system.They play the fundamental role in the construction of public health system in the rural area. However, primary public health is facing the challenge of poor infrastructure, weak human resources, and inefficient services in most areas. We employed field investigation and literature review to identify major problems on the implementation of primary health service and the development of rural doctors' team. The recommendation in this study might provide scientific evidence to improve the construction of public health system and policy-making in rural area in China.

Influencing factors for blood pressure control in elderly patients with hypertension in Hangzhou / 预防医学

Objective@#To understand the situation of blood pressure control and its influencing factors in elderly patients with hypertension in Hangzhou, and to provide basis for the management of elderly patients with hypertension in community. @*Methods@#The subjects of this study were hypertension patients aged 60 years and over in Hangzhou community health management of basic public health services. Demographic data and life behaviors were collected by a questionnaire survey, physical examination and laboratory tests were carried out. The multivariate logistic regression model was used to analyze the influencing factors for blood pressure control in elderly patients with hypertension.@*Results@#A total of 109 583 people were investigated, with 50 500（46.08%） males and 59 083（53.92%） females. The control rate was 47.70% ( 52 273/109 583 ). After adjusted for age and gender, regular medication ( OR=0.874, 95%CI: 0.838-0.912 ) was the protective factor, obesity ( OR=1.291, 95%CI: 1.260-1.324 ), abnormal fasting plasma glucose ( OR=1.218-1.344, 95%CI: 1.178-1.410 ), the number of unhealthy lifestyles ( OR=1.271-1.292, 95%CI: 1.231-1.344 ), the items of dyslipidemia ( OR=1.047-1.253, 95%CI: 1.017-1.311 ), and the number of cardiovascular risk factors above ( OR=1.254-2.109, 95%CI：1.175-2.281 ) were the risk factors for blood pressure control in elderly patients with hypertension.@*Conclusions@#The control rate of elderly patients with hypertension in Hangzhou is 47.70%, which is associated with irregular medication, unhealthy lifestyle, obesity, dyslipidemia, abnormal fasting plasma glucose and clustering of these factors.

Desigualdades nas Taxas de Mortalidade por Malformações do Sistema Circulatório em Crianças Menores de 20 Anos de Idade entre Macrorregiões Brasileiras / Inequalities in Mortality Rates from Malformations of Circulatory System Between Brazilian Macroregions in Individuals Younger Than 20 Years

Resumo Fundamentos Os óbitos por malformações do aparelho circulatório (MAC) em 2015 corresponderam a 43% daqueles por malformações congênitas (MC) em menores de 20 anos de idade no mundo. Os óbitos por MAC apresentam maior impacto sobre a redução da mortalidade, pelo fato de serem evitáveis na maioria das vezes, com o correto diagnóstico e tratamento. Objetivo Conhecer a distribuição da mortalidade por MAC por sexo, grupos etários e macrorregiões do Brasil no período de 2000 a 2015, nos menores de 20 anos de idade. Métodos Estudo descritivo das taxas de mortalidade por 100 mil e sua mortalidade proporcional, por MAC, outras malformações congênitas (OutMC), doenças do aparelho circulatório (DAC), causas mal definidas (CMD) e causas externas (CE) no Brasil, no período de 2000 a 2015 nos menores de 20 anos. As populações foram obtidas no Instituto Brasileiro de Geografia e Estatística e os óbitos no Departamento de Informática do Sistema Único de Saúde/Ministério da Saúde. Resultados Ocorreram 1.367.355 óbitos por todas as causas nos menores de 20 anos de idade, sendo 61,7% do sexo masculino e 55,0% dos óbitos nos menores de 1 ano. Os óbitos por MC em quaisquer órgãos ou sistemas foram 144.057 e os por MAC corresponderam a 39% desses óbitos. Em ambos os sexos, a mortalidade anual por MAC foi de 5,3/100 mil habitantes e a mortalidade proporcional (MP) foi de 4,2%, por DAC 2,2%, por CMD 6,2% e por CE 24,9%. As MAC não especificadas apresentaram as maiores taxas de MP em todas as idades e sexos, notadamente nas regiões Norte e Nordeste (60%). Os óbitos por quaisquer MC ocorreram 5,7 vezes mais no primeiro ano de vida do que nas outras faixas etárias (MAC: 5,0; OutMC: 6,4). Conclusão No Brasil, de 2000 a 2015, nos menores de 20 anos de idade, a MAC foi a principal causa de óbito dentre todas as malformações, sendo duas vezes mais importante do que as DAC, principalmente nos menores de 1 ano de idade.A frequência de diagnósticos imprecisos de óbitos por MAC ainda é elevada em todas as idades, sexos, e principalmente nas regiões Norte e Nordeste, o que requer fortalecimento das estratégias de saúde pública e maior atenção ao recém-nascido com objetivo de diagnosticar e instituir tratamento precoce das cardiopatias congênitas com consequente redução na mortalidade. (Arq Bras Cardiol. 2020; 115(6):1164-1173)

Abstract Background Deaths from malformations of the circulatory system (MCS) have a major impact on mortality reduction. given that most cases are avoidable with correct diagnosis and treatment. Objectives To describe the distribution of mortality from MCS by sex. age. and macroregion in Brazil. in individuals under the age of 20. between 2000 and 2015. Methods A descriptive study of mortality rates and proportional mortality (PM) from MCS. other congenital malformations (OCM). circulatory system disease (CSD). ill-defined causes (IDC). and external causes (EC) in Brazil. Results There were 1.367.355 deaths from all causes in individuals younger than 20. 55.0% under 1 year of age. A total of 144.057 deaths were caused by congenital malformations. 39% of them by MCS. In both sexes. the annual mortality from MCS was 5.3/100.000. PM from MCS was 4.2%. CSD 2.2%. IDC 6.2% and EC 24.9%. Unspecified MCS showed the highest PM rates in both sexes and age groups. especially in the north and northeast regions (60%). Deaths from malformations occurred 5.7 times more frequently during the first year of life than in other ages (MCS: 5.0; OCM: 6.4). Conclusions MCS was the leading cause of death among all malformations. being twice as important as CSD. mainly under 1 year of age. The frequency of misdiagnosis of MCS as cause of death was high in all ages and both sexes. especially in the north and northeast regions. These findings highlight the need for the development of public health strategies focused on correct diagnosis and early treatment of congenital cardiopathies. leading to a reduction in mortality. (Arq Bras Cardiol. 2020; 115(6):1164-1173)

O yoga no serviço de orientação ao exercício (SOE) de Vitória: uma ascese contemporânea religiosa e corporal / Yoga at the exercise orientation service in Vitoria (Brazil): a contemporary religiously and bodily ascetism / El yoga en los servicios de orientación al ejercicio ( SOE) de Vitória/ES (Brasil): un ascetismo contemporáneo religioso y corporal

Este artigo pretende analisar a presença da religiosidade em aulas de yoga ofertadas pelo serviço público de saúde na cidade de Vitória. O trabalho de campo teve duração de um ano e sete meses e acompanhou duas turmas, constituindo-se por uma pesquisa qualitativa em que foram utilizados os seguintes instrumentos metodológicos: ob- servação participante, entrevistas semiestruturadas, aplicação de ques- tionário e formulação de diários de campo. Assim, identificamos que as aulas de yoga tinham uma conotação em que os aspectos religiosos eram sua marca identitária, conformando-se em uma ascese contem- porânea própria de processos ambivalentes e mostrando-se como uma prática exemplar dos processos de hibridização cultural.

This paper intends to analyze the presence of religiosity discourses in yoga classes at the public health service in Vitória/ES (Brazil). Field research lasted a year and seven months and followed two yoga groups, constituting a qualitative research in which are used the following methodological instruments: semi-structured interviews, participant observation, surveys and formulation of field diaries. It was identified a particular connotation on yoga classes, where religious aspects were their identity mark, conforming a contemporary ascetism which is part of an ambivalent processes and showing this corporal practice as an example of a cultural hybridization processes.

Este artículo pretende analizar la presencia de la religiosidad en clases de yoga ofrecidas por el servicio público de salud en la ciudad de Vitória/ES (Brasil). El trabajo de campo tuvo una duración de un año y siete meses y acompañó a dos grupos, constituyéndose de una investigación cualitativa en que fueron utilizados los siguientes instrumentos metodológicos: observaciones participantes, entrevistas semiestructuradas, aplicación de encuestas y formulación de diarios de campo. Identificamos que las clases de yoga tenían una connotación en que los aspectos religiosos eran su marca identitaria, conformándose en un ascetismo contemporáneo propio de procesos ambivalentes y mostrándose como una práctica ejemplar de los procesos de hibridación cultural.

Fragilidades na atuação dos profissionais das equipes de saúde da família descritas na literatura / Weaknesses in the performance of the professionals of the family health teams described in the literature / Fragilidades en el desempeño de los profesionales de los equipos de salud familiar descritos en la literatura

Este artigo tem como objetivo identificar as fragilidades ocorridas no serviço realizado pelos profissionais integrantes das equipes de Estratégia Saúde da Família (ESF)em diferentes localidades do mundo. Trata-se de uma revisão sistemática de literatura baseada no método Systematic Search Flow, pelo qual foram considerados os estudos de acordo com o objetivo, independentemente da localidade e do ano de realização. Para verificar a recorrência das fragilidades encontradas, foi utilizado o método de análise de conteúdo. Obteve-se um portfólio bibliográfico de 24 artigos. A partir da análise de conteúdo de cada um deles, foram extraídas as unidades de contexto e categorizadas em cinco unidades de análise, para representar as fragilidades. Independentemente da localidade, ocorreram as mesmas fragilidades, remetendo a uma interpretação de que o caminho para que as equipes de ESF consigam alcançar uma atuação mais efetiva e eficaz, no que se refere ao impacto na redução das taxas de internações evitáveis, poderá ser bastante trabalhoso. Porém, estudos como este podem ajudar a compreender tal cenário de forma mais clara e detalhada, e talvez sejam um atalho na busca por melhorias e avanços na atuação dessas equipes de saúde.

This article aims to identify the weaknesses that occurred in the service performed by professionals of the Family Health Strategy teams in different locations around the world. This is a systematic literature review that was based on the Systematic Search Flow method, studies were considered according to the objective regardless of location and year. To verify the recurrence of the weaknesses, the content analysis method was used. A bibliographic portfolio of 24 articles was obtained. From the content analysis of each study, the context units were extracted, categorized into five units of analysis, to represent the weaknesses. Regardless of the location, the same weaknesses occurred, leading us to an interpretation that the way for Family Health Strategy teams to achieve a more effective and efficient performance regarding the influence on reducing avoidable hospitalization rates, can be quite laborious. However, studies like this can help to understand this scenario in a clearer and more detailed way, perhaps a shortcut in the search for improvements in this and advances in the performance of these health teams.

Este artículo tuvo como objetivo identificar las debilidades que ocurrieron en el servicio realizado por profesionales que forman parte de los equipos de la Estrategia de Salud Familiar (ESF) en diferentes lugares del mundo. Esta es una revisión sistemática de la literatura basada en el método Systematic Search Flow, en que los estudios se consideraron de acuerdo con el objetivo, independientemente de la ubicación y el año. Para verificar la recurrencia de las debilidades encontradas, se utilizó el método de análisis de contenido. Se obtuvo una cartera bibliográfica de 24 artículos. Del análisis de contenido de cada estudio, se extrajeron las unidades de contexto, clasificadas en cinco unidades de análisis, para representar las debilidades. Independientemente de la ubicación, ocurrieron las mismas debilidades, lo que nos lleva a una interpretación de que puede ser bastante laboriosa la forma en que los equipos de la ESF pueden lograr un desempeño más efectivo y eficiente con respecto al impacto en la reducción de las tasas de hospitalización evitables. Esto puede ayudar a comprender este escenario de una manera más clara y detallada, tal vez un atajo en la búsqueda de mejoras y avances en el desempeño de estos equipos de salud.

Demência, familiares cuidadores e serviços de saúde: o cuidado de si e do outro / Dementia, family caregivers and health service: the care of yourself and the other

Resumo O estudo buscou conhecer a percepção dos familiares cuidadores acerca do cuidado ao idoso com demência realizado por eles e pela ESF. A pesquisa qualitativa analítica-descritiva foi realizada através de entrevistas semiestruturadas, com cinco familiares cuidadores usuários de uma unidade de atenção primária organizada pela ESF, localizada no município do Rio de Janeiro. O material coletado foi submetido à análise de discurso da Escola Francesa. Análise dos sintomas que impactam na rotina e nos sentimentos do cuidador gerando mudanças consideráveis; o histórico familiar, a forma da família lidar com situações difíceis e o apoio ao avesso representado pela falta de suporte dos outros familiares e do Estado intensificam os problemas relacionados ao cuidado; A abdicação de si, o isolamento e as interpretações subjetivas negativas são produtores e agravantes de sofrimento psíquico do familiar cuidador. A ESF apesar de suas limitações acolhe o idoso com demência e o cuidador, mas não é considerada referência de cuidado pelos familiares cuidadores. Para os familiares cuidadores, o que intensifica os desafios do cuidado é a situação de abandono experienciada por eles, impactando como uma dinâmica subjetiva de opressão e abdicação de si, levando a conflitos que refletem na situação de cuidado.

Abstract This study sought to identify the perception of the family caregivers regarding care provided by them and the ESF to the elderly with dementia. This qualitative, analytical and descriptive research was carried out through semi-structured interviews, with five family caregivers users of a primary care facility organized by the ESF, located in the city of Rio de Janeiro. The collected material was submitted to the French School of discourse analysis. Analysis of the symptoms that affect the routine and the feelings of the caregiver generate considerable changes. Family history, family coping with difficult situations, and support for backwardness represented by lack of support from other family members and the State intensify care-related problems. Self-abdication, isolation, and negative subjective interpretations are the producers and aggravators of the psychic distress of family caregivers. Despite its limitations, the ESF receives seniors with dementia and caregivers, but it is not considered a reference of care by family caregivers. Family caregivers affirm that what intensifies the challenges of care is the situation of abandonment experienced by them, impacting as subjective dynamics of oppression and self-abdication, leading to conflicts that reflect in the care situation.

Psicoterapia de grupo para tratar pacientes con esquizofrenia hospitalizados en servicios de salud pública / Group psychotherapy to treat patients with schizophrenia hospitalized in public health services

Se plantea la necesidad de la atención integral al paciente con esquizofrenia hospitalizado en servicios de salud pública en todos sus niveles, incluidos el cultural y el espiritual. En la atención al nivel psicológico se propone la psicoterapia breve, de grupo institucional, orientada a la solución de problemas a corto plazo aquí y ahora" con la utilización de recursos basados en el efecto de la palabra, didáctico-inspirativos, así como otros según las necesidades de los enfermos. Desde la admisión hospitalaria se le brindará al paciente apoyo emocional. Se recomienda cumplimentar la atención a este nivel con sesiones individuales de psicoterapia, intervenciones familiares, terapia ocupacional y trabajo social. Al egreso, se debe continuar la atención a este enfermo en los centros de salud mental.

The necessity of comprehensive care to the patient with schizophrenia hospitalized in public health services in all its levels, including the cultural and the spiritual one is stated. In the care at psychological level, brief psychotherapy of institutional group is proposed, which is directed to the solution of problems at short term here and now, with the use of resources based on the effect of the word, the didactic-inspirative effect, as well as others according to the necessities of the sick persons. From the hospital admission the patient will be offered emotional support. It is recommended to give care at this level with individual sessions of psychotherapy, family interventions, occupational therapy and social work. At discharged, care should be continued to this sick person in the mental health centers.

The present situation of access to HIV/AIDS public health services among cross-border couples in Dehong Prefecture / 中华疾病控制杂志

Objective To investigate the accessibility of HIV-related public health services among cross-border couples living in Dehong Prefecture and age differences. Methods A cross-sectional survey was conducted among cross-border couples in Dehong Prefecture from January 2017 to July 2019. Results In total, 32 182 participants were included. The proportion of people who had received HIV testing services, HIV-related intervention services in past year, care and help in the past year, and participated in new rural cooperative medical services (NCMS) were 57.8%, 92.7%, 6.5% and 94.5%, respectively; and the latter three services were significantly different across age groups (P<0.001). In multivariable Logistic regression model, variables significantly associated with having ever received HIV testing services older age (51-85 years: OR=0.71, 95% CI: 0.63-0.81), women (OR=1.14, 95% CI:1.03-1.25), county/city (Longchuan: OR=6.30, 95% CI: 5.72-6.93; Lianghe: OR=1.27, 95% CI: 1.11-1.44; Yingjiang: OR=0.88, 95% CI: 0.82-0.94), Dai ethnic minority (OR=1.60, 95% CI: 1.50-1.72), marriage registration (marriage registration for border inhabitants: OR=0.60, 95% CI: 0.56-0.65; non-registration: OR=0.66, 95% CI: 0.62-0.70), years of marriage (4-5 years: OR=1.21, 95% CI: 1.12-1.31; 6-60 years: OR=1.30, 95%CI:1.22-1.39), having not received care and help in the past year (OR=0.64, 95% CI: 0.58-0.71) and having not participated in NCMS (OR=0.58, 95% CI: 0.52-0.65). Conclusions The accessibility to HIV-related public health services are relatively high among cross-border couples in Dehong Prefecture. However, the relatively low proportion of receiving AIDS testing services, particularly among certain groups and counties/cities, need to be strengthened.

Effects of Public Health Service Impartiality on Subjective Health Happiness: Mediated Effect of Public Health Service Quality / 보건행정학회지

BACKGROUND: The purpose of this study is to analyze the effect of impartiality in providing public health services on subjective health happiness and the mediated effects of public health service quality. Based on this, this study intends to present policy implications to improve public health services. METHODS: The research method is multiple linear regression analysis. The analysis of the mediating effects is performed by Baron & Kenny's test, Sobel-Goodman's test, and Bootstrap. RESULTS: The impartiality of public health services and the quality of public health services are shown to have a statistically significant effect on subjective health happiness. Quality of public health service appears to be mediating the relationship between impartiality in providing public health care and subjective health happiness. CONCLUSION: To promote people's subjective health happiness, it is necessary to secure impartiality in providing public health services in the first place and improve the quality of public health services.

Eliasz Cynamon e o Programa do Rio Doce (Sesp): contribuição de fontes para a história das ações de saúde e saneamento no Brasil, 1952-1960 / Eliasz Cynamon and the Rio Doce Program (SESP): contribution of sources to the history of health and sanitation actions in Brazil, 1952-1960

Resumo Apresenta pesquisa acerca da atuação de Szachna Eliasz Cynamon no Programa Vale do Rio Doce (1952-1960). Privilegiamos como fonte de consulta os acervos dos departamentos de Arquivo e Documentação e de Saneamento e Saúde Ambiental, na Fiocruz, e o ainda pertencente à família. Na época, a região contava com altos índices de malária. Cynamon, nascido na Polônia e imigrado ainda criança nos anos 1930 para o Brasil, onde se graduaria em engenharia sanitária, foi contratado para atuar em Colatina (ES) e em Governador Valadares (MG), entre 1952 e 1960. Nessas localidades, dedicou-se ao tratamento e abastecimento de água e esgoto sanitário, além de realizar cursos de educação sanitária para a população local, como parte de acordo de cooperação Brasil-EUA.

Abstract Research into the work of Szachna Eliasz Cynamon in the Rio Doce Valley Program (1952-1960) is presented. The key sources are from the Department of Archives and Documentation and the Department of Sanitation and Environmental Health at Fiocruz, as well as the family's own archive. At the time, the rates of malaria in the region were high. Born in Poland, Cynamon migrated to Brazil in the 1930s while still a child, where he graduated in sanitary engineering. He was hired to work in Colatina (Espírito Santo) and Governador Valadares (Minas Gerais) between 1952 and 1960, focusing on sewage and water treatment and supply, while also holding sanitation education courses for the local people as part of a Brazil-USA cooperation agreement.

Status and Influencing Factors of Public Health Services Utilization among Rural Patients with Severe Mental Illness in Yunnan Province / 昆明医科大学学报

Objective The aim of this study was to analyze the status and influencing factors of public health service utilization in rural patients with severe mental illness in Yunnan province. Methods The main caregivers of patients with severe mental illness in Yunnan province were selected by stratified cluster sampling method. Multivariate logistic regression was used to analyze the influencing factors of public health service utilization. Results A total of 284 cases of rural patients with severe mental illness were investigated, including 144 males (50.7％) and 140 females (49.3％) . The rate of medical file filing, follow-up rate of village doctor, participation rate of free physical examination and health education acceptance rate among patients with severe mental illness were 89.8％, 84.9％, 73.2％and 56.7％respectively (<0.05) . Female patients had higher participation rate of free physical examination than male patients, and patients having work and patients with controlled disease condition and their caregivers had higher rates of health education acceptance rate than their counterparts ( <0.05) . Conclusion Measures should be taken to strengthen the work of medical examination for male patients, and to expand health education activities for patients having no work and patients with uncontrolled disease condition, so as to improve the public health service utilization in rural areas of Yunnan province.

The application of cost-effectiveness analysis and TOPSIS method in the evaluation of basic public health services in provincial region:A study of Hubei province / 中国卫生政策研究

Objective:To comprehensively evaluate the provincial basic public health service projects and put forward feasible policy recommendations for further improving the basic public health service projects and propose a more scientific and reasonable evaluation method of the implementation status of the projects. Methods:stratified ran-dom sampling method was used to obtain the data on basic public health service information system through institu-tional survey,and relevant policy documents were obtained from governmental institutions' websites. Through Delphi method ( -expert consultations),combined with analytic hierarchy process, evaluation indicators and weights were determined;and cost effect analysis and weighted TOPSIS method were applied to comparatively evaluate the perform-ance of basic public health service projects vertically and horizontally, respectively. Results: The actual per capita project subsidy standard was found to be low;the cost effectiveness of some projects has improved,especially the standard-ized health management of patients with chronic diseases;and there is still a relatively large disparity of the performance of basic public health service in different counties with the highest Ci value is 0.7811 while the lowest is only 0.2694. Con-clusions and Suggestions:Based on the evaluation analysis of this study,it was found that it is very meaningful to integrate the floating population into the budget scope and establish a dynamic growth mechanism;optimize the performance apprais-al program and comprehensively applying cost effect analysis and TOPSIS method to overcome the defects of a single meth-od;and increase fiscal investment to promote the construction of primary medical institutions.

Study on residents' satisfaction of basic public health services of urban and rural primary health care institutions / 中国卫生政策研究

Objective:To analyze the satisfaction degree and influencing factors of basic public health services in urban and rural areas in Hubei province,and to provide the evidence for further improvement of the quality of basic public health services. Methods:A total of 12 primary health institutions (6 urban community health service centers and 6 rural township hospitals) were selected from Wuhan,Huanggang,Jingzhou of Hubei Province. A questionnaire survey was conducted on the satisfaction,accessibility,comfort,safety and effectiveness of basic public health services among 719 residents. Results:The overall urban and rural residents'satisfaction score of basic public health service was 71.62 points,and the total satisfaction rate was 73.44%. The urban residents overall satisfaction score was 74.67 points,and the overall satisfaction rate was 75. 34%. The rural residents overall satisfaction score was 67.64 points,and the overall satisfaction rate was 71.52%. Among the specific indicators,the most satisfactory items were the convenience of visits (83.03%),privacy protection (80.25%),and indicators least satisfactory were medical technology(61.61%)and equipment facilities(64.53%). Logistics regression analy-sis showed that accessibility,comfort and safety of basic public health services had a greater impact on community residents' satisfaction;and gender and annual medical expenditure had a certain impact on residents'satisfaction. Conclusions:The over-all satisfaction of basic public health services in urban and rural residents of Hubei province is at a general level and still to be promoted. Urban residents'satisfaction is higher than that of the rural area. The basic public health services should further strengthen the quality improvement to further promote the equalization of basic public health services in rural as in urban areas.

Application of Geographically Weighted Regression Model(GWR) in the Economics of Health and Health Care: Based on the In-troduction of Arc GIS 10.4 / 中国卫生经济

Objective: It analyzed the current situation and influencing factors of provincial essential public health service level index(PHI) in 2016. The ordinary least square(OLS) and the geographically weighted regression model(GWR) were constructed respectively. The advan-tages of GWR in the field of health economics were compared. Methods: Moran’s I was used to analyze spatial auto-correlation and hetero-geneity of PHI. OLS and GWR models were constructed to estimate the main influencing factors and their directions. Results: There were a positive spatial auto-correlation in provincial PHI and a weak agglomeration pattern in geographical distribution; the level of economic devel-opment and government funding, population size, population structure and population urbanization level were the main influencing factors of the PHI. There was spatial heterogeneity in provincial regression indexes estimated by GWR. Conclusion: When dealing with geographically related issues in the health economics, the GWR model was better than the OLS with a higher degree of goodness of fit.

Relative workload measurement based on RBRVS theory on village level basic public health service projects / 中华医院管理杂志

Objective To scientifically measure the workload of basic public health services project on village level .Methods 257 village doctors and 24 public health administrators that work in rural health clinics in Qianjiang city ,Hubei province and Qianjiang distrcit ,Chongqing city were sampled ,with questionnaire survey and key informant in-depth interview methods used to screen basic public health service projects affordable on village level ,for workload measurement .Results 35 basic public health service projects were chosen as the measurement projects regarding their relative workload. Hypertension follow-up workload 100 was set as the benchmark ,finding the rest relative workload of other projects range from11～936 .Conclusions It is reasonable to use the relative value measurement based on RBRVS theory on village level basic public health service projects. Results of this study can offer support for the pricing and further dynamic modification of the basic public health service projects .