目的 基于2017年武汉市13个地区基层医疗卫生机构的横断面数据,分析武汉市基本公共卫生服务效率及其主要影响因素.方法 采用松弛测度(slack-based-measure,SBM)-超效率数据包络分析(data envelopment analysis,DEA)模型,对武汉市基本公共卫生服务效率进行测算,通过Tobit回归分析进一步探讨其影响因素.结果 2017年武汉市13个地区基本公共卫生服务的超效率、纯技术效率、规模效率几何均数分别为1.073、1.213、0.884.其中76.9％的地区为DEA有效,若非DEA有效地区能达到DEA有效,全市可少开办11家基层医疗卫生机构、减少1 451张病床、节省6 983万元基本公共卫生服务补助经费.60岁及以上老年人比例、平均期望寿命、每千人口卫生技术人员数、每千人口床位数对武汉市基本公共卫生服务效率的影响具有统计学意义.结论 武汉市基本公共卫生服务效率地区差异较大,规模效率是制约基本公共卫生服务效率的关键因素.60岁及以上老年人比例越高、平均期望寿命越长、每千人口卫生技术人员数越多,基本公共卫生服务效率越低;每千人口床位数越多,基本公共服务效率越高.针对这些因素,需提高老年人健康管理水平,优化机构人员配置,合理调整机构规模,重视基本公共卫生服务的公益性.

目的 采用德尔菲法构建武汉市二级以上医疗机构突发公共卫生事件应对能力评价指标体系.方法 通过文献检索和专家咨询,初步拟定武汉市二级以上医院突发公共卫生事件应对能力评价指标,对18名专家进行两轮德尔菲问卷调查.结果 两轮专家咨询的积极系数均为100％;平均权威系数为0.867;协调系数分别为0.328和0.439,差异均有统计学意义(P<0.001);最终筛选出包括7个一级指标、16个二级指标、25个三级指标的武汉市二级以上医院突发公共卫生事件应对能力评价指标体系.结论 所构建的武汉市二级以上医院突发公共卫生事件应对能力研究评价体系的专家积极性、权威性、协调性均较好,该评价体系可为卫生行政部门制定相关政策提供参考依据.

Objective This study aims to evaluate the operation efficiency of medical facilities in Wuhan. Methods The CCR model ,BCC model and Malmquist model of DEA was established by using the panel data of 2009 -2014 from medical facilities in Wuhan.Results In the study of 13 administrative districts ,there were 4 administrative districts of medical facilities at the constant returning to scale stage in 2014.The TFP and technology progress was impro-ving ,while those of technical efficiency ,pure technical efficiency ,and scale efficiency were decreasing. The TFP of suburbs was better than center area in Wuhan.Conclusion The total productivity of medical facility in Wuhan was unbalanced and showed a trend from decline to rise. The health administrative departments should overall planning for health resources ;actively explore structural reform of hospital management.

Objective To evaluate the efficiency of the implementation efficiency of basic public health service in grass-root health institutions in Wuhan. Methods The CCR model, BCC model of DEA was established by using the data of 2016 from primary-level medical institutions in Wuhan. Efficiency analysis were conducted on 2 input indexes, including the number of public health practitioner per 100000 residents and financial input, and 5 output indexes, including the number of hypertensive patients receiving standard management, the number of diabetic patients receiving standard management, the number of elders receiving standard management, the number of children under 6 receiving standard management, the number of the pregnant women receiving standard management. Results The average values of the comprehensive technological efficiency, pure technical efficiency and scale efficiency of the implementation of basic public health servers in Wuhan were 0.873、0.972、0.898 respectively. The comprehensive technological efficiency of 31.25% district was 1; the pure technological efficiency and scale efficiency of 25% district were all less than 1. Conclusion The comprehensive technological efficiency in basic public health was high in Wuhan, we must improve management level, increase the health resources and expand the scale of primary-level medical.

Objective To understand the effects of indoor particulate matters on childhood asthma.Methods With case-control study,82 children in urban of Wuhan were interviewed at home,and the particulate matter concentrations in children'living room were measured.Results Compared with the control group,the concentrations of PM10 in living rooms were significantly higher among the children with asthma (P＜0.05) with a dose-dependent manner.Adjusted by the covariates,PM10 significantly increased the risk of asthma,especially when the concentration exceeded 200 μg/m3 (OR=27.05,95％CI:1.52-482.94).Conclusion PM10 and PM2.5 in indoor air may increase childhood asthma,especially when it is in the higher level.

Objectives To evaluate the equilibrium of the allocation of resource among the governmental health management institutions and professionals,to provide references for improving public health resources alloca-tion.Methods 13 counties in Wuhan were involved.Descriptive statistical method and Lorenz curve and Gini Coeffi-cient were used to analyze the whole allocation of the 21 6 health management institutions and 729 profession-als.Theil index was used to evaluate the differences of interregional allocation.Results According to the ground of the service population and geography,the distributions of professionals were relatively unfair.The Gini coefficients were 0.467 and 0.580 respectively,the Theil index were 0.384 and 0.735 respectively.Based on the population and geographical distribution,the allocation of governmental health management institutions’was relatively equal because the Gini coefficients was 0.1 75 and the Theil index was 0.05 1.But its allocation was poorly balanced because the Gi-ni coefficients was 0.507 and the Theil index was 0.621 respectively.Basing on the area allocation,differences be-tween urban and rural was the main reason for resources disparity,with contributing rate of 54.29% and 83.89%respectively.Basing on the population allocation,the main reason exist in urban group and rural group respectively, with contributing rate of 92.32% and 84.62% respectively.Conclusions There are two main reasons which influ-ence the equilibrium of the allocation resource:one is the difference of the allocation between urban and rural area, another is the disproportionality which based on rural geographical area.It is necessary to improve the whole level of health management resource and distribution of rural area institution in Wuhan area,and enhance the service abilities of village clinics.

目的 对武汉市农村居民行为危险因素水平以及慢性病相关知识情况进行调查与分析,为开展农村居民慢性病预防与控制相关的健康管理和健康促进提供依据.方法 采用多阶段分层随机抽样方法,抽取武汉市农村地区18岁以上的常住居民8868人,采用问卷调查慢性病相关行为危险因素水平和慢性病相关的健康知识水平及获取情况.结果 武汉市农村居民现在吸烟率为19.8％,饮酒率为20.7％,57.6％的调查对象日均食盐摄入量在6 g及以上.对慢性病相关健康知识的知晓率普遍偏低(如食盐、食油和蔬菜摄入量,超重及肥胖标准),均在30％以下.对于慢性病危险因素的知晓率,除吸烟、超重或肥胖、高盐饮食外,知晓率均不足50％.主动获取健康知识的比例不高,有60.9％平常经常主动地获取保健知识.女性、文化程度低、老年人在健康知识掌握上比较差.结论 武汉市农村居民慢病危险因素水平处于较高水平,而对慢性病相关健康知识的知晓率普遍偏低,应积极针对重点人群(女性、文化程度低和老年人)开展健康管理工作,改变居民的不良生活方式,提高居民的健康保健意识.

目的 了解武汉市≥65岁老年人高血压患病率、知晓率和控制率的情况.方法 收集2012年武汉市≥65岁老年人免费体检数据368 870份(男171 529人,女197 341人),分析血压检测结果和调查问卷.按照年龄将老年人分为4个组,分别为65～＜70(149 840人)、70～＜75(106 724人)、75～＜80(72 403人)、≥80(39 903人)岁组.用方差分析、卡方检验与趋势卡方检验对数据进行分析.结果 高血压患病率为60.2％;城市高于农村(62.7％比57.7％,P＜0.05),女性高于男性(61.5％比58.6％,P＜0.05);高血压知晓率为57.4％,城市高于农村(65.1％比49.3％,P＜0.05),女性高于男性(59.5％比54.9％,P＜0.05);高血压控制率为20.3％,城市高于农村(25.0％比15.3％,P＜0.05),女性高于男性(20.6％比19.8％,P＜0.05);随年龄增长高血压患病率呈上升趋势,75～＜80岁组的知晓率与控制率高于其他组.结论 武汉市≥65岁老年人高血压患病率处于较高水平,知晓率和控制率相对落后,应加强科学管理,提高老年人高血压的知晓率与控制率.

Objective To provide guidance for health-policy making by investigating health service needs and utilization for elderly aged 60 and over in WuHan.Methods With stratified group randomly sampling,2 171 Wuhan residents,aged over 60 years and living in Wuhan for at least 1 year,were interviewed person to person by trained public health surveyors.Results Prevalence of chronic diseases in elderly aged 60 and over reached as high as 65.00%.The top three leading chronic diseases were hypertension,diabetes and coronary heart disease;24.60% of which were ill without consulting doctor in the past month,and 30% of which never had a physical examination.As for health knowledge,they need knowledge of common diseases most,and for health service,they need regular physical examination most.Conclusions Health service needs of the elderly are increasing,but the utilization of health services is not optimistic.Public health services should be provided with appropriate modes,which are:acceptable for the seniors,the services should based on the needs of the elderly,and can be adjusted according to their demand.

随着我国社会经济的进步,医疗卫生服务水平的提高,居民的健康观念、生活方式和行为习惯不断发生变化,居民疾病谱和死因谱也发生了显著变化,慢性病的发病率和死亡率呈逐年上升趋势[1,2],对居民的健康威胁日益凸显,成为重要的公共卫生问题[3].为了解武汉市居民慢性病防治知识的认知现状,为开展慢性病综合干预管理、制定慢性病防治策略和措施提供科学依据,在武汉市中心城区抽取18岁以上城市居民进行慢性病防治知识现状调查.

PurposeThis study aims to examine whether, in the opinion of patients selected in 13 hospitals of Hubei province, China, hospitals are smoke free. Patients were also asked whether their physicians had inquired about their smoking status.Design/methodology/approachPatients were recruited through an intercept method (i.e. stopped by the interviewer while in the hospital); data were collected through interviews, with a response rate of 96.1 percent.FindingsAmong the intercepted patients, 48.3 percent reported having seen people smoking in hospitals; 22.3 percent had seen a doctor and/or nurse smoking; 23.8 percent had smelled tobacco in hospitals; 68.4 percent reported having seen “no‐smoking” signs in hospital settings; 42.6 percent reported having been asked about smoking status in their latest visit to a doctor and 23.8 percent reported receiving tobacco cessation counseling. Compared to hospitals in large cities, patients from medium/small city hospitals reported significantly higher levels of cigarette smoking among physicians, and poorer implementation of regulations for a smoking‐free hospital, and less smoking cessation counseling by physicians.Originality/valueFindings of this study point to the need for greater efforts to be made in promoting a smoke free environment in hospitals, as well as encouraging physicians to provide more smoking cessation counseling to smoking patients, particularly physicians in small and medium hospitals.

Purpose - The paper seeks to report data on cigarette smoking, anti- smoking practices, physicians' receipt of anti-smoking training, and the association between receipt of the training and anti-smoking practice among physicians in Wuhan, China.Design/methodology/approach - Participants were selected through the stratified random sampling method. The questionnaires were completed by the sampled physicians and the response rate of the survey was 98.1 percent.Findings - Among the total sample, 11 percent were current smokers. Significantly more male physicians than female physicians were current smokers (31.6 vs 0.9 percent, p, 0.001). In total, 41 percent of physicians always or often asked patients about smoking habits, and 61 percent of them often advised patients to quit. Receiving anti-tobacco training significantly increased the likelihood for physicians to ask patients about smoking (odd ratio = 2.55, p, 0.001) and to advise patients against smoking (odd ratio = 4.05, p < 0.001) with and without controlling gender, age, education, type of hospital and medical services specialty.Practical implications - More effort should be devoted to training for physicians with focus on anti-smoking practice and smoking cessation counseling in addition to assist physicians themselves to quit smoking.Originality/value - The findings of this study update the data regarding cigarette smoking among physicians in Wuhan, China, and their practice of anti- tobacco counseling. It indicates that it is very important to provide the training regarding anti- smoking counseling among physicians.

Objective To understand the underreporting situation of death surveillance system among Wuhan residents as well as to evaluate the integrity and accuracy of this system.Methods A multi-stage stratified random cluster sampling survey from 13 administrative divisions was conducted at 104 community committees or natural villages from 26 streets or townships in Wuhan City.The underreporting rate was calculated by compared the mortality data from various means,except Wuhan death surveillance system,in sampling points and from death surveillance system in Wuhan in 2007 and 2008,and the reliability and coding quality of death cause surveillance was assessed by examining the death reporting card from death surveillance system in sampling points.Results The total underreporting rate in sampling points was 7.90%(2.11% in urban and 14.69% in rural)(χ2=170.913,P0.001),the overall integrity of death surveillance system data was good.The highest death diagnosis unit for the decedent reached to county-level medical institutions and above accounted for 78.70%,the rate of undiagnosed decedent was 7.10%,the reliability of death cause diagnosis was high,the rate of citywide coding inaccuracy was 8.48% and the rate of citywide coding errors was 4.12%,the coding quality was eligible.Conclusion The quality of death cause surveillance system in Wuhan was good and could reflect death cause pattern reasonably within the population of whole city.

Objective To understand the epidemic characteristics and disease burden of injury in the residents over 60 in urban areas of Wuhan. Methods A random cluster sampling study was conducted among 760 residents,and each of them completed a questionnaire about injuries incidence,disease burden and major factors during June to August in 2010. Results The incidence rate of injury over 60 was 2. 90% during the past year. Falling(1. 70%) ,strike(0. 40%) ,traffic accident(0. 30%) were the leading three injuries. The average costs from high to low was falling,traffic accident,strike,animal bite,Sharp stabbing or incision and heavy bound injury. Conclusion The incidence rate of injury over 60 in Wuhan was lower than other cities in China,but injury was seriously harmful to the residents in economic burden and social burden. According to the characteristics of injury in elderly people, comprehensive intervention measures should be carried out to decrease the incidence rate of injury.

Objective To understand and analyze the control and influencing factors of blood pressure in patients with essential hypertension.Methods By using self-designed questionnaire,the control and influencing factors of blood pressure in 1511 out-patients were investigated and analyzed.Results Blood pressure control rates among urban and village residents were 42.2%,30.0% respectively;the regular medicine.taking rate was 53.3%;Non-conditional logistic regression analysis showed that in urban and rural areas,the course of disease,age,sex,regular medicine-taking,reasonable diet,and emotion-control were the influencing factors for blood pressure control.Conclusions Blood pressure control in patients with essential hypertension can not just rely on drug treatment,it should be ascertained that medicine-taking should be regular,and at the same time,active comprehensive measures should be taken,such as:reasonable diet,physical exercise,health education and blood pressure self-test and other non-drug treatment.

Objective To understand the public awareness and attitude towards smoking and tobacco control policy in the restaurants and bars in Wuhan.Methods With interceptive sampling,two restaurant/bar-concentrated areas were selected,from which 40 restaurants/bars were taken for investigation.496 customers from 65 restaurants and 15 bars accepted face to face interview.Results The current smoking rate was 39.3%,61.1% in male which is much higher than 7.0% in female.Supporting rate for smoke-banned location was school 85.5%,hospital 85.3%,public transportation 82.9%,offices 55.6%,restaurant 28.6% and bars 21%.Conclusion The smoking ban in the public places is not promising in Wuhan,the educational training on hazards of smoking and passive smoking should be strengthened to create a comprehensive smoke-free environment.

Objective To study the prevalence of hypertension in rural adults in Wuhan,and to provide scientific basis for preventing hypertension and cerebrovascular diseases in rural area.Methods With stratified group randomly sampling,2257 Wuhan rural residents,aged over 18 and living in Wuhan for at least 1 year,were collected for this study.SPSS 13.0 software was used for statistical analysis.Results The prevalence rate of hypertension was 22.0%,and the standardized prevalence rate was 18.8%.With the increase of age,the prevalence rate went obviously upward,especially the prevalence rate for people aged ≥35 years was 29.6%.Conclusion The prevalence rate of hypertension in Wuhan rural area was at a relatively high leve1.Comprehensive lifestyle modifications,such as weight reduction,limitation of salt intake should be performed,so as to decrease the incidence of hypertension,and further prevent them from suffering hypertension,cardiovascular and cerebrovascular diseases.

[Objective] To investigate the epidemiologic characteristics of metabolic syndrome(MS)in the general pop-ulation of Wuhan.[Methods] 1 979 residents including 792 male and 1 187 female who lived in Wuhan at lest for 20 years were recruited from investigation on the chronic diseases and its related risk factors in Wuhan in 2006,the information about their fasting plasma glucose,blood lipids,and blood pressure were collected.The mean±standard deviation standardization at-tack rate of every factors of patients with MS were calculated,and single-factor and multiple factors logistic regression analysis were performed to analyze the risk factors of risk factors of MS.[Results] The standardized prevalence of patients with MS of Wuhan in 2006 was 18.37%(male for 16.25% and female for 20.26%),and it increased with age.Age,smoking,drinking,triglyceride,systolic pressure,diastolic pressure,blood sugar,BMI,and high waist circumference might be the risk factors of metabolic syndrome.[Conclusion] Metabolic syndrome has significant association with the unhealthy life style,and high TG,wide waist circumference and high hyperglycemia were the influencing factors for MS,moreover,people over the age of 40 years was also a risk factor for MS.Other influencing factors for MS included smoking,cardiovascular disease,and family his-tory of diabetes.

Objective To investigate the hazard of hypertension at initial diagnosis ages.Methods Using stratified cluster sampling,6 091 adults aged more than 18 years with/without hypertension were interviewed;meanwhile their blood pressures were measured.The hazard of hypertension at initial diagnosed age was analyzed with survival analysis.Results The prevalent rate of hypertension was 19.9%and the average initial diagnosed age of hypertension was 52.0±13.12)yrs.The hazard persistently increased with the age after 35 years old for male,and reached its peak of prevalent rate(26%)at the age of 75 years for female.Not significant difference of hazard existed between male and female.Conclusion Our data indicated that there is a close relationship between the risk of hypertension onset and the age,the hazard increasing with ages,especially for the population aged over 35 years old.Therefore,an early prevention of hypertension should be taken from adolescent period.

Objective To understand the prevalence of smoking,smoking cessation,and passive smoking among adults in Wuhan.Methods 9077 residents aged 18 and above were selected by cluster random sampling for the study.Standardized questionnaires were used to conduct inquery survey.Results The age-adjusted smoking rate was 25.6%,while city residents had a higher smoking rate than suburb residents.The smoking rates for males and females were 49.1% and 2.6% respectively.The age-adjusted smoking cessation rate was 3.5%,6.4% for males and 0.6% for females.The age-adjusted rate of passive smoking was 25.9%.The average age of smoking onset was 22.3(standard deviation SD=7.1).Conclusion Wuhan adult residents'ever-smoking rate and passive smoking rate were lower than the national average in 2002.Suburb residents' smoking rate was higher than those living in city and they consumed more cigerettes than city residents.City residents had a greater smoking cessation rate than those living in suburb areas.