目的 分析我国疾控中心卫生人力资源配置情况及公平性分析.方法 采用集聚度和Theil指数对我国疾控中心卫生人力资源进行分析与评价.结果 我国疾控中心卫生人员数由2014年192397人下降至2019年187564人,平均每年以0.42％的速度下降;我国疾控中心各类卫生人力资源主要分布在人口较为密集的东部地区和中部地区,但2014-2019年我国东部地区和中部地区疾控卫生人力资源的集聚度均>1,西部地区各类疾控卫生人员的集聚度均<1;区域内部的差异是造成我国疾控中心卫生人力资源配置不公平性的主要原因.结论 应进一步调控疾控中心卫生人力资源总量,优化卫生人力资源的区域布局,不断改善区域内部各省份卫生人力资源配置的公平性.

ObjectiveTo examine changing trend and regional disparity in the insufficiency of government predominance in maternal health care financing and the maternal mortality ratio (MMR) in Beijing and Shanghai during 2000 to 2017 for exploring a rational government predominance in maternal health care financing. Methods Documents and literatures about maternal health care financing in Beijing and Shanghai published from 1995 through 2017 were searched; from which, the information on government predominance financing was extracted and the insufficiency of government predominance in maternal health care financing was evaluated with a severity score. Spearman correlation and linear regression analysis were used to analyze the relationship between the insufficiency of government predominance financing and MMR in the two municipalities. Results The severity score for the insufficiency of government predominance in maternal health care financing decreased from 3.58 in 2000 to 2.82 in 2017 in Beijing municipality; while in Shanghai the severity score decreased from 3.72 to 1.44. A significant correlation between the MMR and the severity score was observed in Shanghai municipality (r = 0.723, P < 0.01). Conclusion The government predominance in maternal health care financing increased during 2000 – 2017 in Beijing and Shanghai municipality and the government predominance financing has a more obvious influence on the reduction of maternal mortality ratio in Shanghai municipality.

ObjectiveTo analyze the extent of deficit in total financial investment in maternal health care (MHC), the changing trend of maternal mortality rate (MMR) and their regional disparities in Beijing and Shanghai municipality during the period from 2000 through 2017 and to explore suitable total financial investment in MHC. Methods We searched China National Knowledge Infrastructure (CNKI) and Web of Science for research literatures on financial investment in MHC in Beijing and Shanghai municipality published during 1995 – 2017. The information on deficit in total financial investment in MHC was extracted from 205 retrieved studies for calculation of a severity score to evaluate the deficit in total financial investment in MHC. Spearman correlation and linear regression analysis were used to analyze the relationship between the deficit in total financial investment in MHC and MMR. Results For Beijing municipality, the severity score for the deficit in total financial investment in MHC decreased from 3.54 in 2000 to 2.78 in 2017, while for Shanghai municipality, the score decreased from 3.94 to 1.41. Regression analysis on the correlation between the deficit severity score and MMR resulted in statistically significant regression equations for both Beijing (P < 0.05) and Shanghai (P < 0.01). Conclusion The total financial investment in maternal health care increased gradually over the years in both Beijing and Shanghai municipality during 2000 – 2017. The influence of total financial investment on maternal mortality rate is more obvious for Shanghai. The study verified the feasibility of quantitative assessment on total financial investment in maternal health care.

Background While the elderly are facing greater health risks, they also face more serious inequalities in utilization of medical services. The family doctor contracted service is the core policy of the Chinese government to cope with aging and to achieve the outcome that everyone has the right to primary health care. However, previous research has neither revealed the degree of inequality in the use of contracted services among the elderly in China, nor has it revealed what factors are related to the inequality in the use of services. Objective Assess and decompose the inequality in the use of family doctors contracted services in the elderly population in China. Methods A cross-sectional study of 1037 elderly people was conducted in Shandong Province, China. According to the first consultation rate of family doctors, the physical examination rate, the healthy lifestyle guidance rate and the chronic disease management rate, the situation of elderly people’s utilization of family doctor contracted service was investigated. The concentration index is used to measure the degree of inequality in the use of family doctors contracted services by the elderly. In order to test the contribution of different factors to the inequality of utilization of family doctors contracted services, the concentration index was also decomposed. Results The first consultation rate of family doctors for the elderly in Shandong Province was 24.6%, the physical examination rate was 65.8%, the healthy lifestyle guidance rate was 13.7%, and the chronic disease management rate was 52.2%. The horizontal inequality index of the healthy lifestyle guidance rate and the chronic disease management rate were 0.451 and 0.573, respectively, indicating that there is an inequality of pro-wealth. The concentration index of physical examination rate and chronic disease management rate is negative (− 0.260, − 0.518), which means inequality to the poor. Education level is the most important factor affecting the unequal utilization of health services for the elderly, followed by income. Conclusion The family doctor contracted service has had a positive impact on alleviating the health inequality in the utilization of basic medical and health services for the elderly. Although there is still inequality in terms of pro-wealth for the elderly, the utilization of family doctor contracted service has weakened the inequality of service utilization brought about by income. Enhancing the health literacy of the elderly, narrowing the gap between the rich and the poor, bridging the gap between urban and rural areas, and building a harmonious family relationship can promote the realization of basic medical and health care services for every elderly.

Objective To analyze the extent of deficit in total quantity of maternal health care (MHC) staff, the changing trend of maternal mortality rate (MMR) and their regional disparities in Beijing and Shanghai municipality during the period from 2000 through 2017 and to explore the suitable scale of MHC staff for the two regions. Methods We searched China National Knowledge Infrastructure (CNKI) and Web of Science for research literatures on human resource for MHC in Beijing and Shanghai municipality from 1995 to 2017. The information on the deficit in total quantity of MHC staff was extracted from 166 retrieved studies (79 in Beijing and 87 in Shanghai) for calculation of a severity score to evaluate the deficit. Spearman correlation and linear regression analysis were used to analyze the relationship between the deficit in total quantity of MHC staff and MMR. Results For Beijing municipality, the severity score for the deficit in total quantity of MHC staff decreased from 3.76 in 2000 to 3.40 in 2017, while for Shanghai municipality, the score decreased from 4.00 to 2.10. A significant correlation between MMR and the severity score was detected for Shanghai (r = 0.756, P Conclusion The suitability of maternal health care staff quantity increased gradually in both Beijing and Shanghai municipality during 2000 – 2017 and the impact of the increase in total quantity of the staff on maternal mortality rate is more obvious for Shanghai. The study verified the feasibility of quantitative assessment on the scale of maternal health care staff.

目的 分析2000-2017年京沪妇女保健人力资源适宜程度及孕产妇死亡率的变化趋势,明确两地差异,探讨妇女保健人力资源适宜程度.方法 收集1995-2017年涉及京沪妇女保健人员规模问题(166篇)、人员素质问题(312篇)、人员激励问题(115篇)文献,综合人员规模适宜程度、素质适宜程度、激励适宜程度等3个指标,计算妇女保健人力资源的适宜程度.运用Spearman相关、线性回归等分析妇女保健人力资源适宜程度与孕产妇死亡率的关系.结果 北京妇女保健人力资源适宜程度从2000年的26.20％升至2017年的39.00％,上海则由25.60％升至57.60％.上海孕产妇死亡率与妇女保健人力资源适宜程度回归方程有统计学意义(P＜0.01).结论 京沪两地妇女保健人力资源适宜程度逐年提高,上海妇女保健人力资源在孕产妇死亡率下降中影响更大,但妇女保健人员规模仍有待进一步优化;适宜的妇女保健体系应"规模适宜、能力胜任、激励有效";验证了量化妇女保健人力资源适宜程度的可行性.

目的 分析2000-2017年京沪妇女保健人员激励不足严重程度及孕产妇死亡率的变化趋势,明确两地差异,探讨妇女保健人员激励适宜程度.方法 收集1995-2017年所有涉及京沪妇女保健资源问题的文献,筛选所有涉及妇女保健人员激励主题的相关文献(上海纳入61篇,北京纳入54篇),摘录人力激励不足问题的相关表述,计算严重程度评分.运用Spearman相关、线性回归等分析妇女保健人员激励不足严重程度与孕产妇死亡率的关系.结果 北京妇女保健人员激励不足严重程度从2000年的3.79分降至2017年的2.61分,上海则由3.45分降至2.13分.上海孕产妇死亡率与妇女保健人员激励不足严重程度相关有统计学意义(r=0.542,P＜0.05).上海和北京的回归方程均有统计学意义(P＜0.05).结论 京沪两地妇女保健人员激励不断强化,上海妇女保健人员激励对孕产妇死亡率降低影响更大,但仍存在激励不够稳定的问题;适宜的妇女保健体系应"激励有效";验证了量化妇女保健人员激励的可行性.

目的 分析2000-2017年京沪妇女保健人员素质不足严重程度及孕产妇死亡率的变化趋势,明确两地差异,探讨妇女保健人员素质适宜程度.方法 收集1995-2017年所有涉及京沪妇女保健资源问题的文献,系统筛选涉及妇女保健人员素质主题的有关文献,进而计算妇女保健人员素质不足严重程度评分.上海纳入165篇文献,北京纳入147篇.运用Spearman相关、线性回归等方法分析妇女保健人员素质不足严重程度与孕产妇死亡率的关系.结果 北京妇女保健人员素质不足严重程度从2000年的3.53分降至2017年的3.12分,上海则由3.70分降至2.12分.上海孕产妇死亡率与妇女保健人员素质不足严重程度相关有统计学意义(r = 0.758,P<0.01).上海的回归方程有统计学意义(P<0.01).结论 京沪两地妇女保健人员素质不断提高,上海妇女保健人员素质在孕产妇死亡率降低中发挥更大作用,但人员专业能力仍需进一步提升;适宜的妇女保健体系应"人员能力胜任工作需要";验证了量化妇女保健人员素质的可行性.

Human brucellosis (HB) remains a serious public health concern owing to its resurgence across the globe and specifically in China. The timely detection of this disease is the key to its prevention and control. We sought to describe the differences in the demographics of high-risk populations with detected cases of HB contracted from active versus passive sources. We collected data from a large sample population from January to December 2018, in Jining City, China. We recruited patients that were at high-risk for brucellosis from three hospitals and Centers of Disease Control and Prevention (CDCs). These patients were classified into two groups: the active detection group was composed of individuals receiving brucellosis counseling at the CDCs; the passive detection group came from hospitals and high-risk HB groups. We tested a total of 2,247 subjects and 13.3% (299) presented as positive for HB. The positive rates for active and passive detection groups were 20.5% (256/1,249) and 4.3% (43/998), respectively ( p < 0.001). The detection rate of confirmed HB cases varied among all groups but was higher in the active detection group than in the passive detection group when controlled for age, sex, ethnicity, education, career, and contact history with sheep or cattle ( p < 0.05). Males, farmers, those with four types of contact history with sheep or cattle, and those presenting fever, hyperhidrosis and muscle pain were independent factors associated with confirmed HB cases in multivariate analysis of the active detection group. Active detection is the most common method used to detect brucellosis cases and should be applied to detect HB cases early and avoid misdiagnosis. We need to improve our understanding of brucellosis for high-risk populations. Passive HB detection can be supplemented with active detection when the cognitive changes resulting from brucellosis are low. It is important that healthcare providers understand and emphasis the timely diagnosis of HB.

Purpose This study aimed to explore factors affecting behavioral intention of receiving periodic health examinations (hereafter, BIE) among people aged 60 and over in rural China, namely, Shandong Province, using the extended health belief model (EHBM). Patients and Methods Participants were selected using stratified multi-stage random sampling. Three cities were selected based on economic level. Subsequently, three counties and three villages were selected from each sample city and county. Finally, 30 respondents were selected from each sample village. Face-to-face surveys were conducted using a structured questionnaire between March and September 2017. Multiple linear regression was conducted to investigate the association between BIE and eight dimensions of EHBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues to action, health knowledge, and social support. Results Of the 509 rural respondents aged 60 years and older, the average score of behavioral intention was 4.43±0.80. Multivariate linear regression analysis demonstrated poor BIE among participants who were men, were current smoker, were current drinker, were aged 70 years or over, had lower social support, and perceived lower self-efficacy, less benefits, and more barriers. Among them, barriers were found to have the strongest association with BIE (B’=−0.556; p<0.001). Qualitative interviews revealed that reasons for not receiving periodic health examinations (PHE) included pain, cost, difficulty in finding a health care provider, time and scheduling, potential lack of trust in the physician, and value of the PHE. Conclusion This study highlighted the importance of psychological variables in the acceptance of PHE among the elderly in rural China and provided insights for further intervention designs targeting identified groups and performed by general practitioners. Addressing medical mistrust, strengthening, and enhancing one’s social support network and health communication channels, such as bulletin boards, may serve to facilitate BIE.

目的 比较京沪妇女保健人员与其他行业从业人员的收入水平,明确两地差异,探讨妇女保健人员收人适宜程度.方法 通过文献(2000-2017年)和统计年鉴收集京沪妇女保健人员、医院工作人员、公务员等不同行业收入数据以及住宅销售价格并将其标化为2017年水平.运用Excel 2010进行数据整理,分析妇女保健人员收人适宜程度.结果 北京和上海妇女保健人员2017年的收入分别为105 422.4元和108 498.8元,两地的妇女保健人员收入适宜程度分别为:北京37.0％,上海37.6％.结论 两地妇女保健人员收入均偏低,北京收入适宜程度低于上海,妇女保健人员收入适宜程度可以量化评价.

Objectives: This study aimed to explore the current status of Chinese residents' health promotion lifestyle and its influencing factors, especially explore how health attitudes affect health promotion lifestyle, thus can make targeted recommendations for health promotion in China and similar areas. Study design: This study was based on a household survey of 1769 adults aged 18 and over from Shandong Province of China conducted in 2018. Methods: A cross-sectional, face-to-face survey design was used. The between-group measured data were compared by One-way ANOVA or t -tests. The correlation between the health attitude and health promotion lifestyle was examined by Pearson correlation. Logistic regression model was used to examine the related factors influencing Chinese residents’ health promotion lifestyle. Results: The health promotion lifestyle of residents in Chinese residents was not good. Significant differences existed in health promotion lifestyle among different genders, education levels, income levels, marital status, and health attitude ( Ps <0.001). Multivariable Logistic regression model found that gender, education level, annual family per capita income, affection and behavioral intention in health attitude were key factors influencing Chinese residents’ health promotion lifestyle ( Ps <0.001). Conclusions: Individual health responsibilities need to be further strengthened. More affective factors and operable measures should be added to enhance health affection and health behavioral intention, so as to enhance health promotion lifestyle.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的分析2000—2017年京沪妇女保健财力资源适宜程度及孕产妇死亡率的变化趋势,明确2地差异,探讨妇女保健财力资源适宜程度。方法收集1995—2017年涉及京沪妇女保健财力投入政府主导问题（202篇）、投入总量问题（205篇）和投入增长问题（122篇）文献,综合投入政府主导适宜程度、投入总量适宜程度、增长适宜程度等3个指标,计算财力资源的适宜程度。运用Spearman相关、线性回归等分析妇女保健财力资源适宜程度与孕产妇死亡率的关系。结果北京妇女保健财力资源适宜程度从2000年的28.40%升至2017年的42.60%,上海则由22.60%升至69.40%,北京和上海的回归方程均有统计学意义（上海P &lt;0.01,北京P &lt;0.05）。结论京沪2地妇女保健财力资源适宜程度逐年提高,上海财力资源在孕产妇死亡率下降中作用更大,但财力投入稳定增长仍是薄弱环节;适宜的妇女保健体系应"政府负责、投入适宜、稳定增长";验证了量化妇女保健财力资源适宜程度的可行性。</span>

《关于加强公立医院党的建设工作的意见》要求,加强公立医院党的建设.该文分析了公立医院党的建设的重要性,梳理了目前公立医院党建存在的问题和不足,并提出相应的政策建议.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的评价无细胞百白破疫苗（DTaP）替换全细胞百白破疫苗（DTwP）免疫策略的转换效果。方法收集山东省济南市1965—2016年百日咳报告发病率数据,应用中断时间序列（ITS）和间断线性回归分析（SRA）方法定量评价百日咳疫苗预防接种及DTaP替代DTwP的免疫策略转换对百日咳发病率影响的近期影响和长期效应。结果 1978年济南市DTwP大规模预防接种后,百日咳年均报告发病率较接种前的164.47/10万下降了145.77/10万（P=0.017）,但长期效应平均每年上升7.32/10万（P=0.004）;2002年开始DTaP作为二类苗接种并未对发病率产生近期影响和长期效应（均P&gt; 0.05）;2008年DTaP替代第4针DTwP、2009年DTaP替代第2～4针DTwP和2010年DTaP全面替代DTwP的3种免疫策略使百日咳报告发病率当年分别下降5.97/10万、7.39/10万和8.03/10万（均P &lt;0.01）,同时DTaP接种产生长期效应,使百日咳报告发病率每年上升0.29/10万、0.35/10万和0.39/10万（均P &lt;0.001）。结论 DTwP与DTaP组合免疫策略的效果可能优于单独接种DTwP;全程接种DTaP的短期效果优于DTwP,但DTaP诱导免疫的持续时间不理想,中国百日咳疫苗研发和免疫策略有待进一步研究。</span>

Introduction: Antibiotic consumption is associated with the development of antibiotic resistance. Our aim was to study the relationship between antibiotic consumption and carbapenem-resistant Klebsiella pneumoniae (CRKP) in three public general tertiary hospitals from 2011-2015 in the eastern, western and central regions of China. Methodology: Valid data were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). Bacterial resistance was reported as the percentage of resistant isolates among all tested isolates. Individual trends were calculated by linear regression, while possible correlations between antibiotic consumption and CRKP were evaluated by distributed lags time series analysis. Results: Over the 5-year period, an overall significant increasing trend (P < 0.1, R-2 > 0.3) of carbapenems consumption and the prevalence of CRKP was observed in all three hospitals. This correlated with the use of ceftazidime, cefoperazone/sulbactam, cefminox and meropenem at a hospital in eastern China, with the increased use of meropenem at a hospital in eentral China and with the increased use of doxycycline, ceftriaxone, ceftazidime, meropenem and biapenem at a hospital in western China. Conclusions: We report a high incidence of CRKP in all three hospitals and that an increase in carbapenem usage is associated with this. Further research is needed to elucidate which factors influence the increased consumption of carbapenems.

Objective: The aim of this study was to explore the effects of family doctor contract service on patients with hypertension. Methods: A total of 471 patients with hypertension were recruited. In the contract group, 252 patients received family doctor contract service. In the routine group, 219 patients received routine hypertension management service. Blood pressure and biochemical parameters, before and after intervention, were compared between the two groups, including TG, LDL-C, HDL-C, TC, life quality scores, and treatment compliance scores. Results: There were no significant differences in blood pressure before service (P>0.050). DBP and SBP of the contract group, after treatment, were significantly lower than those of the conventional group (P<0.001). DBP and SBP of the two groups, after treatment, were significantly lower than those before service (P<0.001). There were no significant differences in TG and TC between the two groups, before and after service (P>0.050). LDL-C of the contract group, after service, was lower than that of the conventional group and HDL-C was higher than that of the conventional group (P<0.001). TG, TC, and LDL-C of the two groups, after treatment, were significantly lower than those before service. HDL-C, after service, was higher than that before service (P<0.001). SF-36 scale and treatment compliance scores of the contract group were higher than those of the conventional group (P<0.001). Conclusion: Family doctor contract service can effectively improve blood pressure control of patients with hypertension, improving their quality of life. Therefore, it is worthy of clinical application.

BACKGROUND:China has a high rate of antibiotic use. The Chinese Ministry of Health (MOH) established the Center for Antibacterial Surveillance (CAS) to monitor the use of antibacterial agents in hospitals in 2005. The purpose of this study was to identify trends, pattern changes and regional differences in antibiotic consumption in 151 public general tertiary hospitals across China from 2011-2014. MATERIALS AND METHODS:Valid data for antibiotic use were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). We compared the patterns of antibiotic use in different classes and geographical clusters. RESULTS:Total antibiotic use significantly decreased (P = 0.018) from 75.86 DDD/100 ID in 2011 to 47.03 DDD/100 ID in 2014. The total consumption of flomoxef sodium and cefminox increased from 1.31 DDD/100 BD in 2011 to 8.6 DDD/100 BD in 2014. Cephalosporins were the most frequently used antibiotics in all regions. Third-generation cephalosporins accounted for more than 45% of the cephalosporins used. Carbapenem use substantially increased (P = 0.043). Penicillin combinations with inhibitors accounted for 50% of the penicillin used, and prescribed meropenem accounted for most of the carbapenems used in all regions in 2014. The subclasses in each antibiotic group were used differently between the seven regions, and the total hospital antibiotic use in 2014 differed significantly by region (P = 0.014). CONCLUSION:Although the volume and intensity of total antibiotic use decreased, the antibiotic use patterns were not optimal, and broad-spectrum antibiotics were still the main classes. The aggregate data obtained during the study period reveal similar antibiotic consumption patterns in different regions. These findings provide useful information for improving the rational use of antibiotics. More detailed data on antibiotics linked to inpatient diseases need to be collected in future studies.

Objective To understand the influencing factors of general practitioners' job satisfaction in Shandong Province. Methods A survey of job satisfaction was carried out among 837 general practitioners. Structural equation model analysis was conducted on job satisfaction of general practitioners in Shandong Province. Results According to the results of the structural equation model,the most influencial factor on job satisfaction of general practitioners was work return (β=0.87),followed by organization management(β=0.58),work environment(β=0.30),operating environment(β=0.28), doctor-patient relationship(β=0.19),and work itself(β=0.17). Conclusion Job satisfaction of general practitioners is at a general level in Shandong Province,which is mainly affected by work return and organization management. It is suggested to improve job satisfaction of general practitioners through attaching importance to general practitioners' work return, especially their material rewards,improving management level of administrative staff,and improving foresight and stability of policy making.

Objective To explore the macro-factors affecting the compensation mechanism of public hospitals,and to provide some references for some practice problems in current compensation mechanism.Methods PEST analysis was used to analyze the four factors which affect the development of public hospitals from policy,economic,society and technology environment,especially the factors that affect the compensation mechanism of public hospitals.Results The macro environment compensation mechanism of public hospital has political,economic,social,and technological superiority,but from the aspect of the country's reform and the level of information policy,it needs further development and improvement.Conclusion Based on macroscopic factors affecting the compensation mechanism of public hospitals,it is suggested that the reform of compensation mechanism in public hospitals should be started from three aspects,such as ensuring that government financial compensation,perfecting the system of medical insurance payment,setting scientific payment standards and optimizing methods of cost settlement,and making rational use of medical technology to improve the hospital information management service platform.