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Malaria 疟疾
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0073
F. Baiden, K. Malm, F. Binka
Malaria is a subtropical and tropical protozoan infection that accounts for nearly half a million deaths each year. Most deaths occur in sub-Saharan Africa and are caused by Plasmodium falciparum. The least studied of the five Plasmodia species that cause malaria, P. knowlesi, along with P. vivax cause life-threatening disease, mostly in Southeast Asia. Children, pregnant women, and non-immune travellers to endemic countries are most vulnerable to severe malaria. Cerebral malaria and anaemia are complications that results in neurological deficit and death if treatment is delayed or inappropriately administered. Rapid diagnostic tests have emerged as accurate and reliable means to diagnosing malaria at point-of-care.
疟疾是一种亚热带和热带原生动物感染,每年造成近50万人死亡。大多数死亡发生在撒哈拉以南非洲,由恶性疟原虫引起。在导致疟疾的五种疟原虫中,诺氏疟原虫和间日疟原虫是研究最少的一种,它们会导致威胁生命的疾病,主要发生在东南亚。儿童、孕妇和前往疟疾流行国家的无免疫力旅行者最容易感染严重疟疾。脑型疟疾和贫血是并发症,如果治疗延迟或施用不当,可导致神经功能缺损和死亡。快速诊断测试已成为在医疗点诊断疟疾的准确和可靠手段。
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引用次数: 0
People with disabilities 残疾人士
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0090
A. Kavanagh, M. Shields, A. Devine
This chapter addresses the developing field of disability in public health. Disability is traditionally associated with morbidity and mortality as negative public health outcomes. Primary prevention activities addressing birth defects, developmental disabilities, injuries, and chronic illnesses associated with disabling conditions are the foundation of public health. Public health is developing rapidly in promoting the health and well-being of the population of people living with disabling conditions. This chapter outlines the essential public health functions of assessment, policy development, and assurance for this population across countries and age groups. The WHO’s International Classification of Functioning, Disability and Health (ICF) provides the framework for the conceptual and scientific issues. Finally, the chapter discusses directions for public health and disability to develop more closely. Recommendations are made for improving communication, cooperation, and coordination of activities between the public health and disability communities. The fundamental tenet of the chapter is that people with disabilities should be included in planning, development, and implementation of all public health activities.
本章论述公共卫生中发展中的残疾领域。传统上,残疾与发病率和死亡率有关,是负面的公共卫生结果。针对出生缺陷、发育性残疾、伤害和与残疾有关的慢性病的初级预防活动是公共卫生的基础。在促进残疾人的健康和福祉方面,公共卫生正在迅速发展。本章概述了评估、政策制定和保障对各国和各年龄组人口的基本公共卫生功能。世卫组织的国际功能、残疾和健康分类(ICF)为概念和科学问题提供了框架。最后,本章讨论了公共卫生与残疾更密切发展的方向。建议改善公共卫生界和残疾人界之间的交流、合作和活动协调。本章的基本原则是,应将残疾人纳入所有公共卫生活动的规划、发展和实施。
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引用次数: 0
Medical screening 医学排查
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0098
Tang Jin-ling, Li Li-ming
Screening is early detection and early treatment of increased risk of chronic disease with the ultimate goal of improving the health of the screened. Today, early detection and early treatment occur often ‘haphazardly’ in routine clinical practice and general health checks rather than in systematic screening programmes. The success of a screening programme depends on the characteristics of the disease, testing, and treatments of early diagnosed patients. Screening can be made more cost-effective by screening in high-risk people, choosing a relatively high specificity, screening less frequently, and high management standards. The ultimate evaluation of the benefits and harms of screening must be drawn from randomized controlled trials. Randomized trials of various screening programmes and health checks in the past 50 years showed disappointingly screening was often ineffective or barely effective. This re-emphasizes the urgency of strengthening the criteria for introduction of new technologies for early diagnosis of disease.
筛查是对慢性疾病风险增加的早期发现和早期治疗,最终目的是改善被筛查者的健康状况。今天,在常规临床实践和一般健康检查中,早期发现和早期治疗往往是“偶然的”,而不是在系统的筛查规划中。筛查计划的成功取决于疾病的特点、检测和早期诊断患者的治疗。在高危人群中进行筛查,选择相对高的特异性、较少的筛查频率和较高的管理标准,可以使筛查更具成本效益。对筛查的利弊的最终评估必须从随机对照试验中得出。过去50年对各种筛查项目和健康检查的随机试验表明,令人失望的是,筛查往往无效或几乎无效。这再次强调亟须加强采用早期诊断疾病的新技术的标准。
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引用次数: 0
Health promotion, health education, and the public’s health 健康促进、健康教育和公众健康
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0047
F. Baum
Health promotion is a complex, ambiguous concept and set of practices. While many have linked it, primarily, to a revolution in health education, its roots go much deeper into the history of public health. It had its contemporary beginnings in the throes of the backlash against bureaucratic and professional dominance exemplified by the new social movements of the 1970s and 1980s. At its heart, health promotion is centred on the values and principles of equity, participation, and empowerment. These concepts are embedded in health promotion’s founding document, the Ottawa Charter for Health Promotion. However, exactly how these values are articulated is often ambiguous. In this chapter, the authors contend that health promoters must intensify their reflection on these core values and principles; particularly in the light of the tendency to slip back into a comfortable paternalism, which reinforces existing power imbalances. We are specifically concerned with the precise interpretation of health equity in health promotion.
健康促进是一个复杂而模糊的概念和一套做法。虽然许多人将其主要与卫生教育的革命联系起来,但其根源要深得多,可以追溯到公共卫生的历史。它的当代开端是20世纪70年代和80年代新社会运动所体现的对官僚主义和专业统治的强烈反对。健康促进的核心是公平、参与和赋权的价值观和原则。这些概念都包含在促进健康的创始文件《渥太华促进健康宪章》中。然而,这些值究竟是如何表达的往往是模棱两可的。在本章中,作者认为健康促进者必须加强对这些核心价值观和原则的反思;尤其是考虑到人们倾向于重新回到舒适的家长式作风,这加剧了现有的权力不平衡。我们特别关心在促进健康方面对卫生公平的准确解释。
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引用次数: 0
Behavioural determinants of health and disease 健康和疾病的行为决定因素
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0015
L. Green, Kristin S Hoeft, R. Hiatt
This chapter reviews ways in which behaviour relates to the spectrum of health and disease determinants, from environmental to genetic, in shaping health outcomes. It builds on the previous chapters in recognizing the powerful influence of socioeconomic and cultural factors, especially poverty and discrimination, in influencing both behaviour and health. Many commentaries in the past four decades have attempted to correct the overemphasis on individual behavioural determinants of health by discounting and sometimes disparaging any focus on individual behaviour or personal responsibility in disease prevention and health promotion. This chapter seeks a middle ground, building on the growing understanding of the ecological and cultural context of the behaviour–health relationship. It seeks to integrate that knowledge in an approach to public health that acknowledges the reciprocal determinism of behavioural, environmental, and biological determinants rather than minimizing the importance of behaviour in these complex interactions.
本章回顾了行为在塑造健康结果方面与健康和疾病决定因素的范围有关的方式,从环境到遗传。它在前几章的基础上认识到社会经济和文化因素,特别是贫穷和歧视,在影响行为和健康方面的强大影响。在过去四十年中,许多评论试图纠正过分强调健康的个人行为决定因素的做法,对个人行为或个人在预防疾病和促进健康方面的责任不予重视,有时甚至是贬损。本章寻求一个中间立场,建立在对行为-健康关系的生态和文化背景的日益了解的基础上。它寻求将这些知识整合到一种公共卫生方法中,这种方法承认行为、环境和生物决定因素的相互决定性,而不是将行为在这些复杂相互作用中的重要性最小化。
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引用次数: 0
Health policy in developing countries 发展中国家的卫生政策
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0021
T. Htay, Yu Mon Saw, J. Levinson, S. M. Kadri, A. Brady, Cecilia S. Acquin, A. Htet
The purpose of this chapter is to underscore the role of an integrated stewardship process and decentralization of healthcare services through high standards of governance towards effective health policies in developing countries. Changing disease patterns and challenging health status in developing countries calls for a rigorous monitoring and evaluation of prevailing health systems so that their new health policies be able to tackle these emerging health needs. Three stages of health transition and globalization have highlighted their impacts on health problems and health policies. The optimal composition and interactions of actors in health policy have influenced the strategic directions and policy implementation. In implementing the global and national health policies within the context of health system strengthening, national policies will better assure that health priorities in local settings are addressed and country-led while international assistance supports the health sector priorities. With the creation of the Millennium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs), more attention is being given in these countries to policies and programmes which are results- and outcome-oriented. Possible strategies to improve health policy and the overall status of health in developing countries are recommended including Universal Health Coverage and the SDGs, among others.
本章的目的是强调综合管理进程和保健服务权力下放的作用,通过高标准的治理促进发展中国家有效的保健政策。发展中国家不断变化的疾病模式和具有挑战性的卫生状况要求对现行卫生系统进行严格的监测和评价,以便其新的卫生政策能够应对这些新出现的卫生需求。卫生转型和全球化的三个阶段突出了它们对卫生问题和卫生政策的影响。卫生政策行为者的最佳组成和相互作用影响了战略方向和政策执行。在加强卫生系统的背景下执行全球和国家卫生政策时,国家政策将更好地确保地方环境中的卫生优先事项得到处理并由国家主导,同时国际援助支持卫生部门的优先事项。随着千年发展目标(mdg)和现在的可持续发展目标(sdg)的创建,这些国家越来越重视以结果和成果为导向的政策和方案。建议采取可能的战略改善发展中国家的卫生政策和整体健康状况,包括全民健康覆盖和可持续发展目标等。
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引用次数: 0
Mathematical models of transmission and control of infectious agents 传染因子传播与控制的数学模型
Pub Date : 2021-11-01 DOI: 10.1093/MED/9780199661756.003.0121
A. Welte, B. Williams, Gavin Hitchcock
Indeed, the ‘heavy lifting’ of healthcare is in the care of patients, the development and distribution of vaccines, drugs and devices, and the conception and implementation of sensible systems and policies. However, in recent decades, spectacular increases in the availability of computational capacity have paved the way for mathematical modelling to play an ever-increasing role in many aspects of public health, by supporting formal analyses at various scales of the processes involved. This chapter explores a particular kind of ‘modelling’—and it is not the common (bio)statistical kind. We focus on what we would call ‘dynamical’ modelling (as opposed to ‘statistical’ modelling). This essentially entails the reduction, to mathematics, of key facts and principles inherent in the ‘processes’ or ‘mechanisms’ in an epidemiological situation. We can then manipulate these mathematical constructs, in search of insights that, while ultimately implied in the model construction, are not superficially apparent from our primary data and our intuition.
事实上,医疗保健的“重任”在于照顾病人,疫苗、药物和设备的开发和分发,以及合理系统和政策的构想和实施。然而,近几十年来,计算能力的显著增加为数学建模在公共卫生的许多方面发挥日益重要的作用铺平了道路,它支持对所涉进程的各种尺度进行正式分析。本章探讨了一种特殊的“建模”——它不是常见的(生物)统计类型。我们专注于所谓的“动态”建模(与“统计”建模相反)。这基本上需要将流行病学情况中的“过程”或“机制”中固有的关键事实和原则简化为数学。然后,我们可以操纵这些数学结构,以寻找见解,虽然最终隐含在模型结构中,但从我们的原始数据和直觉中并不明显。
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引用次数: 0
Public health priorities in countries undergoing economic transition 经济转型国家的公共卫生优先事项
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0004
Stephen M Tollman, Jessica Price
This chapter starts by reviewing the relationship between the economy and health, looking at changes in health outcome as income increases, demographic transitions related to economic growth, and the impact of urbanization on health outcomes. It then reviews major health challenges facing middle-income countries (MICs), including the triple burden of disease, multimorbidity, mental health across the life course, and the impacts of migration, climate change, and antimicrobial resistance. Finally, it discusses health system challenges and the importance of building resilient and ‘learning’ health systems with the agility to adapt to meet MICs’ evolving health needs. We discuss strategies to achieve universal health coverage in MICs and the importance of intersectoral collaboration in promoting health.
本章首先回顾了经济与健康之间的关系,考察了收入增加时健康结果的变化、与经济增长相关的人口结构转变以及城市化对健康结果的影响。然后,它回顾了中等收入国家面临的主要卫生挑战,包括疾病的三重负担、多病、整个生命过程中的精神健康,以及移民、气候变化和抗菌素耐药性的影响。最后,报告讨论了卫生系统面临的挑战,以及建立具有弹性和“学习型”卫生系统的重要性,该系统能够灵活地适应中等收入国家不断变化的卫生需求。我们讨论在中等收入国家实现全民健康覆盖的战略,以及部门间合作在促进健康方面的重要性。
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引用次数: 0
Interpersonal violence 人际暴力
Pub Date : 2021-11-01 DOI: 10.1037/e681442012-001
R. Jewkes
Interpersonal violence results in 404,000 deaths annually and substantial health and economic costs. Although there is an element of genetic susceptibility, its use largely a social construct and thus inherently preventable. Interpersonal violence encompasses child maltreatment, peer violence, youth violence, physical, sexual, emotional, and economic intimate partner violence, sexual violence, and elder abuse. While these appear as a disparate set of acts of violence, they are actually very closely interrelated and perpetrators of one form are at greater risk of perpetrating others, and may also have been victims. This chapter uses an ecological approach to understanding common risk factors and underlying causes and reveals the importance of individual-level, interpersonal- or relationship-level, community-level, and societal factors. Evidence of the preventability of interpersonal violence is demonstrated in the United States, where the prevalence of all forms has declined since 1990. This has not been convincingly attributed to any one intervention, and further suggests that a complex and multilevel programme of interpersonal violence prevention is required, targeting risk factors, and encompassing effective health responses to support victims.
人际暴力每年造成404,000人死亡,并造成巨大的健康和经济损失。虽然有遗传易感性的因素,但它的使用主要是一种社会结构,因此本质上是可以预防的。人际暴力包括虐待儿童、同伴暴力、青年暴力、身体、性、情感和经济上的亲密伴侣暴力、性暴力和虐待老年人。虽然这些看起来是不同的暴力行为,但它们实际上是非常密切相关的,一种形式的肇事者更有可能犯下其他行为,而且也可能是受害者。本章使用生态学方法来理解常见的风险因素和潜在原因,并揭示了个人层面、人际或关系层面、社区层面和社会因素的重要性。人际暴力可预防的证据在美国得到了证明,自1990年以来,各种形式的暴力的发生率都有所下降。这不能令人信服地归因于任何一项干预措施,并进一步表明,需要一项复杂和多层次的预防人际暴力方案,针对风险因素,并包括有效的保健对策,以支持受害者。
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引用次数: 0
Qualitative research imagination 定性研究想象
Pub Date : 2021-11-01 DOI: 10.1093/med/9780198816805.003.0031
J. Popay, F. Baum
In this chapter we will consider what the qualitative research imagination ‘is’—touching on key questions that should be addressed by all researchers regardless of their approach.) In the first part of the chapter we will consider the first two questions focusing on the type of ‘knowledge’ generated by qualitative research and in the second part on questions about the range of approaches that can be taken to data collection, analysis and interpretation, and the role of theory. The rest of this chapter is divided into three parts. First, we discuss the type of knowledge produced by qualitative research. We then discuss the potential for community/public involvement as ‘partners’ in qualitative research and finally consider key methodological issues in the conduct of qualitative research.
在本章中,我们将考虑什么是定性研究想象——触及所有研究人员都应该解决的关键问题,无论他们的方法如何。)在本章的第一部分,我们将考虑前两个问题,重点关注定性研究产生的“知识”类型,在第二部分,我们将考虑有关数据收集、分析和解释的方法范围以及理论的作用的问题。本章的其余部分分为三个部分。首先,我们讨论了由定性研究产生的知识类型。然后,我们讨论了社区/公众作为“合作伙伴”参与定性研究的潜力,最后考虑了定性研究过程中的关键方法论问题。
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引用次数: 0
期刊
Oxford Textbook of Global Public Health
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