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Firearm Injuries and Public Health 枪支伤害和公共健康
Pub Date : 2022-01-28 DOI: 10.1093/acrefore/9780190632366.013.298
L. Dahlberg, A. Butchart, J. Mercy, T. Simon
An important function of public health is to prevent injuries or to lessen their impact when they occur. An estimated 251,000 people worldwide die each year from a firearm-related death and many more suffer nonfatal injuries with consequences that can last a lifetime. Firearm injuries, which include those that are intentionally self-inflicted, unintentional, or from an act of interpersonal violence, are heavily concentrated in the Americas, driven largely by firearm homicides. Firearm-related deaths and injuries disproportionately impact males and younger populations and are associated with factors such as access, substance use, adverse childhood experiences, involvement in high-risk social networks, drug trafficking, density of alcohol outlets, and neighborhood and social disadvantage. While progress is being made to understand firearm injuries and how to effectively prevent them, much more needs to be done to improve the availability and timeliness of data; apply the knowledge that is generated to effectively reduce firearm-related injuries, deaths, and costs; strengthen the scientific infrastructure; and move countries closer to achieving the violence-related targets in the 2030 Sustainable Development Goals.
公共卫生的一项重要职能是预防伤害或在伤害发生时减轻其影响。据估计,全世界每年有251,000人死于与枪支有关的死亡,还有更多的人遭受非致命伤害,其后果可能持续一生。枪支伤害,包括那些故意造成的,无意的,或由人际暴力行为造成的,主要集中在美洲,主要是由枪支杀人造成的。与枪支有关的死亡和伤害对男性和较年轻人口的影响尤为严重,并与获取途径、药物使用、不良童年经历、参与高风险社会网络、贩毒、酒类销售点密度以及邻里和社会劣势等因素有关。虽然在了解火器伤害和如何有效预防火器伤害方面取得了进展,但在提高数据的可用性和及时性方面还需要做更多的工作;运用所产生的知识,有效减少与枪支有关的伤害、死亡和费用;加强科学基础设施建设;推动各国更接近实现《2030年可持续发展目标》中与暴力有关的具体目标。
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引用次数: 1
Monitoring Migrants’ Health Risk Factors for Noncommunicable Diseases 监测移徙者非传染性疾病健康风险因素
Pub Date : 2022-01-28 DOI: 10.1093/acrefore/9780190632366.013.14
S. Campostrini
Noncommunicable diseases (NCDs) have become the first cause of morbidity and mortality around the world. These have been targeted by most governments because they are associated with well-known risk factors and modifiable behaviors. Migrants present, as any population subgroup, peculiarities with regard to NCDs and, more relevantly, need specific information on associated risk factors to appropriately target policies and interventions. The country of origin, assimilation process, and many other migrant health aspects well studied in the literature can be related to migrants’ health risk factors. In most countries, existing sources of information are not sufficient or should be revised, and new sources of data should be found. Existing survey systems can meet organizational difficulties in changing their questionnaires; moreover, the number of changes in the adopted questionnaire should be limited for the sake of brevity to avoid excessive burden on respondents. Nevertheless, a limited number of additional variables can offer a lot of information on migrant health. Migrant status, country of origin, time of arrival should be included in any survey concerned about migrant health. These, along with information on other Social Determinants of Health and access to health services, can offer fundamental information to better understand migrants’ health and its evolution as they live in their host countries. Migrants are often characterized by a better health status, in comparison with the native population, which typically is lost over the years. Public health and health promotion could have a relevant role in modifying, for the better, this evolution, but this action must be supported by timely and reliable information.
非传染性疾病(NCDs)已成为世界各地发病率和死亡率的首要原因。这些已经成为大多数政府的目标,因为它们与众所周知的风险因素和可改变的行为有关。与任何人口亚群体一样,移徙者在非传染性疾病方面具有特殊性,更重要的是,他们需要有关相关风险因素的具体信息,以便适当地制定有针对性的政策和干预措施。原籍国、同化过程以及文献中研究的许多其他移民健康方面都可能与移民的健康危险因素有关。在大多数国家,现有的资料来源不够充分或应加以修订,并应寻找新的数据来源。现有的调查系统在更改问卷时可能遇到组织困难;此外,为了简洁起见,应限制所采用问卷的更改次数,避免给受访者带来过多的负担。然而,数量有限的其他变量可以提供关于移徙者健康的大量信息。任何有关移徙者健康的调查都应包括移徙者身份、原籍国、抵达时间。这些信息,以及关于健康的其他社会决定因素和获得卫生服务的信息,可以提供基本信息,以便更好地了解移民在东道国生活时的健康状况及其演变。与当地人口相比,移徙者的特点往往是健康状况较好,而当地人口通常是经过多年流失的。公共卫生和促进健康可以在改善这种演变方面发挥相关作用,但这一行动必须得到及时和可靠的信息的支持。
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引用次数: 0
Migration, Migrants, and Health in Latin America and the Caribbean 拉丁美洲和加勒比地区的移徙、移徙者和健康
Pub Date : 2021-12-22 DOI: 10.1093/acrefore/9780190632366.013.323
D. Ventura, Jameson Martins da Silva, L. Calderón, Itzel Eguiluz
The World Health Organization has recognized health as a right of migrants and refugees, who are entitled to responsive healthcare policies, due to their particular social determinants of health. Migrants’ and refugees’ health is not only related to transmissible diseases but also to mental health, sexual and reproductive health, and non-communicable diseases, such as diabetes. Historically, however, migration has been linked to the spread of diseases and has often artificially served as a scapegoat to local shortcomings, feeding on the xenophobic rhetoric of extremist groups and political leaders. This approach fosters the criminalization of migrants, which has led to unacceptable violations of human rights, as demonstrated by the massive incarceration and deportation policies in developed countries, for example, the United States under the Trump administration. In Latin America and the Caribbean, in particular, there have been legal developments, such as pioneering national legislation in Argentina in 2004 and Brazil in 2017, which suggest some progress in the direction of human rights, although in practice drawbacks abound in the form of countless barriers for migrants to access and benefit from healthcare services in the context of political turmoil and severe socioeconomic inequality. The COVID-19 pandemic has exposed and enhanced the effects of such inequality in the already frail health conditions of the most disenfranchised, including low-income migrants and refugees; it has both caused governments in Latin America to handle the crisis in a fragmented and unilateral fashion, ignoring opportunities to cooperate and shield the livelihoods of the most vulnerable, and served as a pretext to sharpen the restrictions to cross-border movement and, ultimately, undermine the obligation to protect the dignity of migrants, as the cases of Venezuela and the U.S.-Mexico border illustrate. Still, it could represent an opportunity to integrate the health of migrants to the public health agenda as well as restore cooperation mechanisms building on previous experiences and the existing framework of human rights organizations.
世界卫生组织承认,健康是移徙者和难民的一项权利,由于他们是影响健康的特殊社会决定因素,他们有权享受相应的保健政策。移徙者和难民的健康不仅与传染病有关,而且与心理健康、性健康和生殖健康以及糖尿病等非传染性疾病有关。然而,从历史上看,移徙与疾病的传播有关,而且往往人为地成为当地缺点的替罪羊,助长了极端主义团体和政治领导人的仇外言论。这种做法助长了对移民的刑事定罪,导致了不可接受的侵犯人权行为,发达国家(例如特朗普政府领导下的美国)的大规模监禁和驱逐政策就证明了这一点。特别是在拉丁美洲和加勒比地区,出现了一些法律发展,例如2004年阿根廷和2017年巴西开创性的国家立法,表明在人权方面取得了一些进展,尽管在实践中,在政治动荡和严重的社会经济不平等的背景下,移民在获得和受益医疗服务方面存在无数障碍。COVID-19大流行暴露并加剧了这种不平等对包括低收入移民和难民在内的最被剥夺权利者本已脆弱的健康状况的影响;它既导致拉丁美洲各国政府以分散和单方面的方式处理危机,忽视了合作和保护最弱势群体生计的机会,又成为加强对跨境流动限制的借口,并最终破坏了保护移民尊严的义务,正如委内瑞拉和美墨边境的案例所表明的那样。不过,这可能是一个机会,可以将移徙者的健康纳入公共卫生议程,并在以往经验和人权组织现有框架的基础上恢复合作机制。
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引用次数: 0
The Implications of Informal Settlement Upgrading Programs for Access to Water, Sanitation, and Public Health 非正式住区升级计划对获得水、卫生设施和公共健康的影响
Pub Date : 2021-12-22 DOI: 10.1093/acrefore/9780190632366.013.317
D. Satterthwaite, A. Sverdlik
Most cities in low- and middle-income countries have substantial proportions of their population living in informal settlements—sometimes up to 60% or more. These also house much of the city’s low-income workforce; many informal settlements also concentrate informal economic activities. These settlements usually lack good provision for water, sanitation, and other essential services. The conventional government responses were to bulldoze them or ignore them. But from the 1960s, another approach became common—upgrading settlements to provide missing infrastructure (e.g., water pipes, sewers, drains). In the last 20 years, community-driven upgrading has become increasingly common. Upgrading initiatives are very diverse. At their best, they produce high-quality and healthy living conditions and services that would be expected to greatly reduce illness, injury or disablement, and premature death. But at their worst, upgrading schemes provide a limited range of improvements do nothing to reduce the inhabitants’ exclusion from public services. There is surprisingly little research on upgrading’s impact on health. One reason is the very large number of health determinants at play. Another is the lack of data on informal settlement populations. Much of the innovation in upgrading is in partnerships between local governments and organizations formed by informal settlement residents, including slum/shack dweller federations that are active in over 30 nations. Community-driven processes can deal with issues that are more difficult for professionals to resolve—including mapping and enumerations. Meanwhile, local government can provide the connections to all-weather roads, water mains, sewers, and storm drains into which communities can connect.
低收入和中等收入国家的大多数城市有相当大比例的人口居住在非正式定居点,有时高达60%或更多。这些地方也容纳了该市大部分低收入劳动力;许多非正规住区也集中了非正规经济活动。这些定居点通常缺乏良好的供水、卫生设施和其他基本服务。政府的传统反应是将其推倒或忽略。但从20世纪60年代开始,另一种方法变得普遍——升级定居点,以提供缺失的基础设施(如水管、下水道、排水沟)。在过去的20年里,社区驱动的升级变得越来越普遍。升级计划非常多样化。在最好的情况下,它们提供高质量和健康的生活条件和服务,有望大大减少疾病、伤害或残疾以及过早死亡。但最糟糕的是,升级计划提供的改善范围有限,对减少居民被排除在公共服务之外毫无帮助。令人惊讶的是,关于升级对健康影响的研究很少。原因之一是有大量的健康决定因素在起作用。另一个问题是缺乏关于非正规住区人口的数据。升级改造方面的许多创新是地方政府与非正式住区居民组成的组织之间的伙伴关系,包括活跃在30多个国家的贫民窟/棚屋居民联合会。社区驱动的流程可以处理专业人员更难以解决的问题——包括映射和枚举。与此同时,当地政府可以为社区提供全天候道路、水管、下水道和雨水渠的连接。
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引用次数: 0
Drowning: Global Burden, Risk Factors, and Prevention Strategies 溺水:全球负担、风险因素和预防策略
Pub Date : 2021-12-22 DOI: 10.1093/acrefore/9780190632366.013.307
Aminur Rahman, A. Peden, Lamisa Ashraf, Dan Ryan, A. Bhuiyan, S. Beerman
Drowning has been described as a major global public health problem and has recently been acknowledged by a United Nations Declaration on Global Drowning Prevention. While drowning impacts countries of all income levels, the burden is overwhelmingly borne by low- and middle-income countries (LMICs) who account for 90% of the global death toll. In addition, there is scarce data collection on drowning in LMICs, so the magnitude of drowning may be far greater than is represented. A range of factors including sex, age, education, income, access to water, a lack of swimming skills, certain occupations like commercial fishing, geographically isolated and flood-prone locations, preexisting medical conditions, and unsafe water transport systems, influence the risk of drowning. Some behavioral factors, such as alcohol or drug consumption, not wearing life jackets, and engaging in risky behaviors such as swimming or boating alone, increase drowning risk. Geopolitical factors such as migration and armed conflict can also impact drowning risk. There is a growing body of evidence on drowning prevention strategies. These include pre-event interventions such as pool fencing, enhancing community education and awareness, providing swimming lessons, use of lifejackets, close supervision of children by adults, and boating regulations. Interventions to reduce harm from drowning include appropriate training for recognition of a drowning event, rescue, and resuscitation. An active and/or passive surveillance system for drowning, focusing on individual settings and targeting populations at risk, is required. Drowning requires coordinated multisectoral action to provide effective prevention, rescue, and treatment. Therefore, all countries should aim to develop a national water safety plan, as recommended in the WHO Global Report on Drowning. Further research is required on the epidemiology and treatment of drowning in LMICs as well as non-fatal and intentional drowning in both high-income countries (HICs) and LMICs. Effective and context-specific implementation of drowning prevention strategies, including pilot testing, scale up and evaluation, are likely to help reduce the burden of both fatal and non-fatal drowning in all countries.
溺水已被描述为一个重大的全球公共卫生问题,最近《联合国全球预防溺水宣言》也承认了这一点。虽然溺水影响所有收入水平的国家,但负担主要由低收入和中等收入国家承担,它们占全球死亡人数的90%。此外,关于中低收入国家溺水的数据收集很少,因此溺水的严重程度可能远远大于所代表的。一系列因素,包括性别、年龄、教育、收入、获得水的途径、缺乏游泳技能、商业捕鱼等某些职业、地理上孤立和洪水易发的地区、先前存在的医疗状况以及不安全的水上运输系统,都会影响溺水的风险。一些行为因素,如饮酒或吸毒,不穿救生衣,从事危险行为,如独自游泳或划船,会增加溺水的风险。移民和武装冲突等地缘政治因素也会影响溺水风险。关于预防溺水策略的证据越来越多。这些措施包括泳池围栏等事前干预措施、加强社区教育和意识、提供游泳课程、使用救生衣、成人对儿童的密切监督以及划船规定。减少溺水危害的干预措施包括对溺水事件的识别、救援和复苏进行适当的培训。需要建立一个主动和/或被动的溺水监测系统,以个人环境为重点,并以处于危险中的人群为目标。溺水需要采取协调的多部门行动,提供有效的预防、救援和治疗。因此,所有国家都应按照世卫组织《全球溺水报告》的建议,制定国家水上安全计划。需要进一步研究中低收入国家溺水的流行病学和治疗,以及高收入国家和中低收入国家的非致命性和故意溺水。有效和根据具体情况实施预防溺水战略,包括试点测试、推广和评估,可能有助于减轻所有国家致命和非致命溺水的负担。
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引用次数: 4
Climate Change Impacts on Diarrheal Disease, From Epidemiological Association Research to Social Vulnerability Exploration 气候变化对腹泻病的影响:从流行病学关联研究到社会脆弱性探索
Pub Date : 2021-11-29 DOI: 10.1093/acrefore/9780190632366.013.268
Junfeng Yu, Lianping Yang, H. Ho, Cunrui Huang
Climate change has resulted in rising global average temperatures and an increase in the frequency and intensity of extreme weather events, which already has and will yield serious public health consequences, including the risk of diarrheal diseases. Sufficient evidence in the literature has highlighted the association between different meteorological variables and diarrhea incidence. Both low and high temperatures can increase the incidence of diarrheal disease, and heavy rainfall has also been associated with increased diarrhea cases. Extreme precipitation events and floods are often followed by diarrhea outbreaks. Research has also concluded that drought can concentrate pathogens in water sources, which makes it possible for diarrhea pathogens to distribute broadly when the first heavy rain happens. Substantial evidence underscores the important role social, behavioral, and environmental factors may have for the climate-diarrhea relationship. Meteorological factors may further influence the social vulnerability of populations to diarrhea through a variety of social and behavioral factors. Future research should focus on social factors, population vulnerability, and further understanding of how climate change affects diarrhea to contribute to the development of targeted adaptation strategies.
气候变化导致全球平均气温上升,极端天气事件的频率和强度增加,这已经并将产生严重的公共卫生后果,包括腹泻病的风险。文献中有充分的证据强调了不同气象变量与腹泻发病率之间的关联。低温和高温都会增加腹泻病的发病率,强降雨也与腹泻病例的增加有关。极端降水事件和洪水之后往往会爆发腹泻。研究还得出结论,干旱可以将病原体集中在水源中,这使得腹泻病原体有可能在第一场大雨发生时广泛分布。大量证据强调了社会、行为和环境因素可能对气候-腹泻关系的重要作用。气象因素可能通过多种社会和行为因素进一步影响人口对腹泻的社会脆弱性。未来的研究应关注社会因素、人口脆弱性,并进一步了解气候变化如何影响腹泻,以有助于制定有针对性的适应策略。
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引用次数: 0
How Trust and Risk Perception Affect Household Water Use 信任和风险认知如何影响家庭用水
Pub Date : 2021-11-29 DOI: 10.1093/acrefore/9780190632366.013.164
R. Y. Wang, Xiaofeng Liu
Household water use accounts for an important portion of water consumption. Notably, different households may behave differently regarding how water is used in everyday life. Trust and risk perception are two significant psychological factors that influence water use behavior in households. Since trust and risk perception are malleable and subject to construction, they are useful for developing effective demand management strategies and water conservation policies. The concepts of trust and risk perception are multidimensional and interconnected. Risk perception varies across social groups and is often shaped by subjective feelings toward a variety of activities, events, and technologies. Risk perception is also mediated by trust, which involves a positive expectation of an individual, an organization, and/or an institution that derives from complex processes, characteristics, and competence. Likewise, different social groups’ trust in various entities involved in household water use is subject to the significant and far-reaching impact of risk perception. The complexity of the two notions poses challenges to the measurement and exploration of their effects on household water use. In many cases, risk perception and trust can influence people’s acceptance of water sources (e.g., tap water, bottled water, recycled water, and desalinated water) and their conservation behavior (e.g., installing water-saving technologies and reducing water consumption) in household water use. Trust can affect household water use indirectly through its influence on risk perception. Moreover, trust and risk perception in household water use are neither given nor fixed; rather, they are dynamically determined by external, internal, and informational factors. A coherent, stable, transparent, and fair social and institutional structure is conducive to building trust. However, trust and risk perception differ among groups with diverse household and/or individual demographic, economic, social, and cultural characteristics. Direct information from personal experiences and, more importantly, indirect information from one’s social network, as well as from mass media and social media, play an increasingly important role in the formation and evolution of trust and risk perception, bringing a profound impact on household water use in an era of information. Future directions lie in new dynamics of risk perception and trust in the era of information explosion, the coevolution mechanism of risk perception and trust in household water use, the nuanced impacts of different types of risks (e.g., controllable and uncontrollable) on household water use, and the interactive relations of risk perception and trust across geographical contexts.
家庭用水占用水量的重要组成部分。值得注意的是,不同的家庭在日常生活中使用水的方式可能不同。信任和风险感知是影响家庭用水行为的两个重要心理因素。由于信任和风险认知是可塑的,并受建设的影响,它们对制定有效的需求管理战略和节水政策是有用的。信任和风险感知的概念是多维的,相互关联的。风险感知因社会群体而异,通常由对各种活动、事件和技术的主观感受所塑造。风险感知也受信任的影响,信任涉及对个人、组织和/或机构的积极期望,这种期望源于复杂的过程、特征和能力。同样,不同社会群体对参与家庭用水的各种实体的信任也受到风险感知的显著而深远的影响。这两个概念的复杂性对测量和探索它们对家庭用水的影响提出了挑战。在许多情况下,风险认知和信任可以影响人们对水源(如自来水、瓶装水、循环水和淡化水)的接受程度及其在家庭用水中的节约行为(如安装节水技术和减少用水量)。信任可以通过对风险认知的影响间接影响家庭用水。此外,对家庭用水的信任和风险认知既不是给定的,也不是固定的;相反,它们是由外部、内部和信息因素动态决定的。一个连贯、稳定、透明、公平的社会和制度结构有利于建立信任。然而,信任和风险感知在不同家庭和/或个人人口、经济、社会和文化特征的群体中是不同的。来自个人经历的直接信息,更重要的是来自社会网络的间接信息,以及来自大众媒体和社交媒体的间接信息,在信任和风险认知的形成和演变中发挥着越来越重要的作用,对信息时代的家庭用水产生了深远的影响。信息爆炸时代风险感知与信任的新动态、家庭用水风险感知与信任的协同演化机制、不同类型风险(如可控风险与不可控风险)对家庭用水的细微影响、跨地域风险感知与信任的互动关系是未来研究的方向。
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引用次数: 0
Global Epidemiology of Induced Abortion 全球人工流产流行病学
Pub Date : 2021-11-29 DOI: 10.1093/acrefore/9780190632366.013.346
S. Bell, M. Shankar, C. Moreau
Induced abortion is a common reproductive experience, with more than 73 million abortions occurring each year globally. Worldwide, the annual abortion incidence decreased in the 1990s and the early decades of the 21st century, but this decline has been driven by high-resource settings, whereas abortion rates in low- and middle-resource countries have remained stable. Induced abortion is a very safe procedure when performed according to World Health Organization guidelines; however, legal restrictions, stigma, cost, lack of resources, and poor health system accountability limit the availability, accessibility, and use of quality abortion care services. Even as women’s use of safer self-managed medication abortion options becomes more common in some parts of the world, 45% of all abortions annually are unsafe, nearly all of which occur in low- and middle-resource settings, where unsafe abortion remains a primary cause of maternal death. Beyond country-level legal and health care system factors, significant disparities exist in women’s reliance on unsafe abortion. Even among women who receive a safe abortion, quality of care is often poor. Yet abortion’s precarious status as a health care service and its clandestine practice have precluded a systematic focus on quality monitoring and evaluation of service inputs. Improving abortion and postabortion care quality is essential to meeting this reproductive health need, as are efforts to prevent abortion-related mortality and morbidity more broadly. This requires a three-tier approach: primary prevention to reduce unintended pregnancy, secondary prevention to make abortion procedures safer, and tertiary prevention to reduce the negative sequelae of unsafe abortion procedures. Strategies include two complementary approaches: vulnerability reduction and harm reduction, the first focusing on the root causes of unsafe abortion by addressing the determinants of unwanted pregnancy and clandestine abortion, while the latter addresses the harmful consequences of clandestine abortion. Political commitments to extend service coverage of abortion and postabortion care need to be implemented through actions that build the public health system’s capacity. Beyond the model of receiving care exclusively in clinical settings, models of guided self-managed abortion are expanding the capacity of individuals to take evidence-based actions to terminate their pregnancies safely and without the threat of judgment. Research has strived to keep up with the changes in the abortion care landscape, but there remains a continuing need to improve methodologies to generate robust evidence to identify and address inequities in abortion care and its health consequences in a diversified landscape. Doing so will provide information for stakeholders to take actions toward a new era of health care reforms that repositions abortion as an integral component of sexual and reproductive health care.
人工流产是一种常见的生殖经历,全球每年发生7300多万例流产。在世界范围内,每年的堕胎发生率在20世纪90年代和21世纪头几十年有所下降,但这种下降是由高资源环境驱动的,而低资源和中等资源国家的堕胎率保持稳定。如果按照世界卫生组织的准则进行,人工流产是一种非常安全的程序;然而,法律限制、耻辱、成本、资源缺乏和卫生系统问责不力限制了高质量堕胎护理服务的可得性、可及性和使用。尽管妇女使用更安全的自我管理药物流产选择在世界某些地区变得更加普遍,但每年所有流产中仍有45%是不安全的,几乎所有这些流产都发生在低资源和中等资源环境中,在这些环境中,不安全流产仍然是孕产妇死亡的主要原因。除了国家一级的法律和卫生保健制度因素外,妇女对不安全堕胎的依赖也存在重大差异。即使在接受安全堕胎的妇女中,护理质量也往往很差。然而,堕胎作为一项保健服务的不稳定地位及其秘密做法妨碍了对服务投入的质量监测和评价的系统关注。改善堕胎和堕胎后护理质量对于满足这一生殖健康需求至关重要,更广泛地预防与堕胎有关的死亡率和发病率也是如此。这需要采取三层方法:一级预防减少意外怀孕,二级预防使堕胎程序更安全,三级预防减少不安全堕胎程序的负面后果。战略包括两种相辅相成的办法:减少脆弱性和减少伤害,前者侧重于不安全堕胎的根本原因,解决意外怀孕和秘密堕胎的决定因素,后者则解决秘密堕胎的有害后果。需要通过建设公共卫生系统能力的行动来落实扩大堕胎和堕胎后护理服务覆盖面的政治承诺。除了完全在临床环境中接受护理的模式之外,有指导的自我管理堕胎模式正在扩大个人采取循证行动安全终止妊娠的能力,而不会受到审判的威胁。研究努力跟上堕胎护理状况的变化,但仍然需要改进方法,以产生有力的证据,以确定和解决堕胎护理方面的不公平现象及其在多样化情况下对健康的影响。这样做将为利益攸关方提供信息,以便采取行动,迎接保健改革的新时代,将堕胎重新定位为性保健和生殖保健的一个组成部分。
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引用次数: 4
Health Inequities in Aging Adults from a Public Health Perspective 从公共卫生的角度看老年人的健康不平等
Pub Date : 2021-09-29 DOI: 10.1093/acrefore/9780190632366.013.274
S. Wallace
Inequities in the United States have gained renewed attention as a result of social movements such as Black Lives Matter (racism), Me Too (sexual abuse and gender), and immigrant rights. Yet despite the growing awareness of inequality across major social categories, there has been little or no public attention paid to the persistent inequities facing older adults. The news media in the 2020 presidential elections uncritically reported charges that one, or both, candidates were “too old” for the job or had some other liability tied primarily to their age. There is a whole field of “anti-aging” medicine that claims to slow the biological process of senescence (distinct from fighting specific diseases), even as the greatest challenges of growing older are rooted in social and political processes. This reflects the ageism in society that results in undervaluing older adults’ lives and often marginalizes them. In addition, there are serious inequities within the older population based on class, race, gender, and citizenship status. Health inequities involve conditions that are avoidable, are not the result of informed choice (e.g., injuries among extreme sports participants), and which differ by membership in groups that hold different levels of power and resources. As such, inequities also include an element of “unfairness” such that the disadvantage is in groups with less power and resources than others.
由于“黑人的命也是命”(种族主义)、“我也是”(性侵犯和性别)、移民权利等社会运动,美国的不平等问题再次受到关注。然而,尽管人们越来越意识到主要社会类别之间的不平等,但公众很少或根本没有关注老年人面临的持续不平等。在2020年总统大选中,新闻媒体不加批判地报道了一些指控,称其中一名或两名候选人“年龄太大”,不适合担任总统,或者有其他一些主要与年龄相关的责任。有一整个“抗衰老”医学领域声称可以减缓衰老的生物过程(与对抗特定疾病不同),尽管衰老的最大挑战根植于社会和政治进程。这反映了社会上的年龄歧视,这种歧视导致老年人的生活被低估,并经常被边缘化。此外,老年人口中存在着严重的阶级、种族、性别和公民身份不平等。卫生不平等涉及可避免的状况,不是知情选择的结果(例如,极限运动参与者受伤),并且因拥有不同权力和资源水平的群体成员而有所不同。因此,不平等还包括“不公平”的因素,即弱势群体的权力和资源比其他群体少。
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引用次数: 1
Sexual and Reproductive Health in China 中国的性与生殖健康
Pub Date : 2021-08-31 DOI: 10.1093/acrefore/9780190632366.013.224
Qianling Zhou, Chunyan Jin, Hai-jun Wang
Databases of PubMed, Scopus, and China National Knowledge Infrastructure (CNKI) were used to search relevant articles on sexual and reproductive health (SRH) in China published from 2005 to the present (2021), based on the World Health Organization’s (WHO) Operational Framework on Sexual Health and Its Linkages to Reproductive Health. The following results were found. (a) SRH education and information among the Chinese were insufficient, in particular regarding contraception, pregnancy, and sexually transmitted diseases (STDs). Adolescents, migrants, and the rural population had insufficient knowledge of SRH. (b) Fertility care services were mainly available in large cities, in urban areas, and for married couples. Services targeted for rural-to-urban migrants, rural residents, and the disabled and elderly are needed. (c) A total of 22.4% of youths aged 15–24 had premarital sexual intercourse, and the age of first sexual intercourse was decreasing. Risky sexual behaviors included multiple partners, casual and commercial sex, and having sex after drinking alcohol. (d) The contraceptive practice rate of women aged 15–49 in China was higher than the world’s corresponding figure. However, contraceptive use among young people was low (only 32.3% among unmarried women). (e) Unmarried pregnancy induced by low contraceptive practice is a critical issue in China. (f) Induced abortion was the major consequence of unmarried pregnancy. The rate of induced abortion among the general population in 2016 was 28.13‰, and the rate among unmarried women was increasing annually. (g) There were 958,000 HIV-infected cases in China as of October 2019. Sexual transmission was the major transmission route of HIV-AIDS. More men than women were infected. Men having sex with men comprised the high-risk group of sexual transmission of HIV-AIDS. (h) Gender-based violence including intimate partner violence (IPV), sexual violence, sexual coercion, and child sexual abuse (CSA) might be underreported in China, since many victims were afraid to seek help as well as due to limited services. Legal and regulatory measures should therefore be taken to prevent and reduce gender-based violence. For future perspectives of SRH in China, it is important to pay attention to SRH education and services. An up-to-date national survey on SRH is needed to reflect the current situation and to capture changes over the past decade. Most of the current research has been conducted among adolescents, and more studies are needed among other groups, such as the disabled, the elderly, and homosexual populations.
基于世界卫生组织(WHO)性健康及其与生殖健康联系的业务框架,使用PubMed、Scopus和中国知网数据库检索2005年至今(2021年)中国发表的性与生殖健康(SRH)相关文章。发现了以下结果。中国人的性健康教育和信息不足,特别是关于避孕、怀孕和性传播疾病的教育和信息不足。青少年、流动人口和农村人口对性健康和生殖健康的认识不足。(b)生育保健服务主要在大城市、城市地区和为已婚夫妇提供。需要有针对性地为农民工、农村居民、残疾人和老年人提供服务。(c) 15-24岁的青少年有婚前性行为的占22.4%,初次性行为的年龄呈下降趋势。危险性行为包括多个性伴侣、随意性行为和商业性行为以及酒后发生性行为。(d)中国15-49岁妇女的避孕药具使用率高于世界相应数字。然而,年轻人的避孕药具使用率很低(未婚妇女中只有32.3%)。(e)低避孕措施引起的未婚怀孕是中国的一个严重问题。(f)人工流产是未婚怀孕的主要后果。2016年总人口人工流产率为28.13‰,未婚女性人工流产率呈逐年上升趋势。(g)截至2019年10月,中国共有95.8万例艾滋病毒感染病例。性传播是艾滋病的主要传播途径。受感染的男性多于女性。男男性行为者是艾滋病毒/艾滋病性传播的高危人群。(h)基于性别的暴力,包括亲密伴侣暴力、性暴力、性胁迫和儿童性虐待,在中国可能没有得到充分报道,因为许多受害者不敢寻求帮助,而且服务有限。因此,应采取法律和规章措施,防止和减少基于性别的暴力。未来中国性健康与生殖健康的发展前景,关注性健康与生殖健康教育和服务是十分重要的。需要对性健康和生殖健康进行最新的全国调查,以反映目前的情况并捕捉过去十年的变化。目前的大多数研究都是在青少年中进行的,需要对其他群体进行更多的研究,如残疾人、老年人和同性恋人群。
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引用次数: 0
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Oxford Research Encyclopedia of Global Public Health
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