中国16省中小学校校医配备现状分析
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摘要
目的分析中国中小学校校医配备现状,为加强中小学校校医队伍建设提供参考。方法采用分层整群抽样方法,按照中国三大经济地带划分,分层选择调研省份,每个调研省份选择1～2个调研点,调研点内整群抽取全部中小学校进行问卷调查。共调查16个省、自治区、直辖市26个调研点的10 027所学校,选择学校规模大于600人或寄宿制学校共6 466所进行分析。结果校医配备率为33.1%(2 140/6 466),校医配备生医比为2 814.6∶1,满足600∶1的学校占5.0%(321/6 466)。多因素Logistic回归分析结果显示,经济地带、城乡、学段、学校规模、是否为寄宿学校均是校医配备的重要影响因素(P值均<0.05);在控制其他变量的情况下,东部学校配备校医概率是中部学校的3.30倍(95%CI=2.86～3.81);西部学校是中部学校的1.66倍(95%CI=1.40～1.96);随着学段的提高,校医配备概率亦提高,初中是小学的2.06倍(95%CI=1.79～2.36),高中是小学的7.93倍(95%CI=6.36～9.89);寄宿制学校是非寄宿制学校的1.34倍(95%CI=1.11～1.61);规模≥600人学校是规模<600人学校的1.72倍(95%CI=1.40～2.12);城市学校是农村学校的2.79倍(95%CI=2.39～3.25)。结论目前中国中小学校校医配备整体不足,不同经济发展地区和不同学段区别明显,中西部地区农村小学和小规模寄宿制学校的校医配备缺口较大。需要深入探索适宜政策,重视学校卫生立法,加强校医队伍建设。
Objective To analyze the status of school physicians in primary and secondary schools in China, and to provide possible reference for strengthening the school physician team in primary and secondary schools in China. Methods Investigated provinces were selected by stratified cluster sampling method according to China three major economic zones, 1 or 2 research centers were selected from each province above, all schools were surveyed in each research center. A total of 16 provinces, autonomous regions, and municipalities, 26 survey points and 10 027 primary and secondary schools were selected, and 6 466 schools which had a school size of more than 600 people or boarding schools were selected for analysis. Results For all schools, 33. 1%( 2 140/6 466) schools had at least one school physician, an average of 2 814.6 students shared 1 school physician and 5.0%( 321/6 466)schools with qualified number of school physicians. Multivariate logistic regression analysis showed that the equip rate of school physicians was affected by the economic zone, school type, school boarding system, school size, urban and rural factors( P < 0. 05).Compared with schools in the middle region, schools in the eastern region( OR = 3.30, 95%CI = 2.86-3.81) and west region( OR =1.66, 95%CI = 1.40-1.96) with a higher probability in school physician equipment. Compared with primary schools, middle schools( OR = 2.06, 95%CI = 1.79-2.36) and high schools( OR = 7.93, 95%CI = 6.36-9.89) with a higher probability in school physician equipment; Boarding schools had a higher probability in school physician equipment than non-boarding schools( OR = 1.34, 95%CI= 1.11-1.61); Schools with students higher = 600 had a higher probability in school physician equipment than schools with students<600( OR = 1.72, 95%CI = 1.40-2.12); Compared with rural schools, schools in urban areas( OR = 2.79, 95% CI = 2.39-3.25)had a higher probability in school physician equipment. Conclusion School physicians in primary and secondary schools in China are not enough; there are significant differences between different economic development zones and different school types. The gaps in rural primary schools and small-sized boarding schools in the central and western regions are particularly serious. It is necessary to explore appropriate policies and strengthen the construction of school physician team.
Objective To analyze the status of school physicians in primary and secondary schools in China, and to provide possible reference for strengthening the school physician team in primary and secondary schools in China. Methods Investigated provinces were selected by stratified cluster sampling method according to China three major economic zones, 1 or 2 research centers were selected from each province above, all schools were surveyed in each research center. A total of 16 provinces, autonomous regions, and municipalities, 26 survey points and 10 027 primary and secondary schools were selected, and 6 466 schools which had a school size of more than 600 people or boarding schools were selected for analysis. Results For all schools, 33. 1%( 2 140/6 466) schools had at least one school physician, an average of 2 814.6 students shared 1 school physician and 5.0%( 321/6 466)schools with qualified number of school physicians. Multivariate logistic regression analysis showed that the equip rate of school physicians was affected by the economic zone, school type, school boarding system, school size, urban and rural factors( P < 0. 05).Compared with schools in the middle region, schools in the eastern region( OR = 3.30, 95%CI = 2.86-3.81) and west region( OR =1.66, 95%CI = 1.40-1.96) with a higher probability in school physician equipment. Compared with primary schools, middle schools( OR = 2.06, 95%CI = 1.79-2.36) and high schools( OR = 7.93, 95%CI = 6.36-9.89) with a higher probability in school physician equipment; Boarding schools had a higher probability in school physician equipment than non-boarding schools( OR = 1.34, 95%CI= 1.11-1.61); Schools with students higher = 600 had a higher probability in school physician equipment than schools with students<600( OR = 1.72, 95%CI = 1.40-2.12); Compared with rural schools, schools in urban areas( OR = 2.79, 95% CI = 2.39-3.25)had a higher probability in school physician equipment. Conclusion School physicians in primary and secondary schools in China are not enough; there are significant differences between different economic development zones and different school types. The gaps in rural primary schools and small-sized boarding schools in the central and western regions are particularly serious. It is necessary to explore appropriate policies and strengthen the construction of school physician team.
引文
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[15]王烁,董彦会,王政和,等.1985—2014年中国7~18岁学生超重与肥胖流行趋势[J].中华预防医学杂志,2017,51(4):300-305.
[16]宋逸,胡佩瑾,董彦会,等.2014年全国各省、自治区、直辖市汉族学生视力不良现况分析[J].北京大学学报(医学版),2017,49(3):433-438.
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[2]马军.紧扣当前政策要点促进学校卫生工作发展[J].中国学校卫生,2017,38(2):161-163.
[3]李谡翊,李宏仁.对中小学校医队伍建设的思考和建议[J].中国学校卫生,2003,24(6):677-678.
[4]国家教委,卫生部.学校卫生工作条例[Z].1990-06-04.
[5]仇元营,余小鸣,张芯,等.我国中小学校专职校医配备现状[J].中国学校卫生,2014,35(11):1746-1748.
[6]尚大光.1994年全国学校卫生现状抽样调:2000年学校卫生发展战略目标与对策研究之一[J].中国校医,1997,11(6):405-408.
[7]赵海,段佳丽,滕立新,等.北京市中小学校校医和保健教师队伍现状调查[J].中国学校卫生,2015,36(3):466-468.
[8]杨艰萍,杨卓敏.上海市宝山区中小学校医现状调查[J].职业与健康,2002,18(12):95-96.
[9]周哲华.嘉兴市中小学校医及卫生室配置现况[J].中国学校卫生,2013,34(3):378-380.
[10]张萍,佟明菊.北京市朝阳区中小学校医和卫生教师现状调查[J].中国校医,2009,23(5):514-515.
[11]马迎华,胡芳,吕晓静.中小学学校卫生专业人员配备标准分析[J].中国学校卫生,2011,32(7):771-773.
[12]陶芳标.构建学校卫生金字塔[J].中国学校卫生,2017,38(1):2-4.
[13]中华人民共和国国家统计局.各级各类学历教育在校学生数[EB/OL].[2016-03-15].http://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0M0202&sj=2016.
[14]马军.当前学校卫生工作的机遇和挑战[J].中国学校卫生,2012,33(1):1-4.
[15]王烁,董彦会,王政和,等.1985—2014年中国7~18岁学生超重与肥胖流行趋势[J].中华预防医学杂志,2017,51(4):300-305.
[16]宋逸,胡佩瑾,董彦会,等.2014年全国各省、自治区、直辖市汉族学生视力不良现况分析[J].北京大学学报(医学版),2017,49(3):433-438.
[17]王海雪,朱广荣,温萌萌,等.中国中小学校卫生人员聘任模式现况[J].中国学校卫生,2017,38(3):475-477.
[18]林琼芬,王琦,郭仰峰,等.广州市中小学校校医配备现状[J].中国学校卫生,2017,38(8):1222-1224.
[19] BRENER N D,WHEELER L,WOLFE L C. Health education:results from the school health policies and programs study 2006[J]. J Sch Health,2007,77(8):464-485.