农村突发公共卫生事件应对脆弱性的循证研究
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摘要
目的通过己有文献资料、现况调查和数据统计分析对国内农村突发公共卫生事件危机管理系统建设现状进行研究,分析农村突发公共卫生事件危机管理的脆弱性与对策,为预防和控制农村突发公共卫生事件提供充分的科学依据。
方法本研究首先采用的研究方法是文献复习方法:应用国内外著名的电子文献数据库进行检索,包括MEDLINE、SpringerLINK全文电子期刊、OVID BP & Lippincott Williams & Wilkins (LWW) Total Access Collection、ProQuest博硕士论文数据库、Science Online及国内电子文献数据库检索如中国期刊全文数据库(CJFD)、维普中文科技期刊数据库、万方电子期刊数据库等,检索年限为2000年1月至2006年12月,运用主题词与/或关键词与/或自由词方法进行检索。另外采用Internet网络进行检索,检索方式同第一种方法,检索年限不限。其次,应用社区信息与流行病学技术循证研究(CIET)方法,即通过其中发现问题、分析已有资料、设计调查项目、开展预调查、现况调查、初步分析反馈等6个环节,做出农村突发公共卫生事件应对的脆弱性分析以及应对机制建议。其中,现况调查以农村居民、基层卫生专业技术人员、基层政府管理人员为研究对象,采用群组分层随机抽样方法,共调查农村居民2136人,卫生专业人员1113人,政府管理人员327人,采用面对面无记名自填方式调查;最后,应用Haddon概念模型,从“宿主-媒介(致病)因子-环境”三个环节及农村突发公共卫生事件发生的三个阶段,分析农村突发公共卫生事件的影响因素。
结果本研究表明:1、对相关农村突发公共卫生事件文献的循证研究,可以发现,我国在2000年1月至2006年12月期间发表的农村各类突发公共卫生事件文献报道分布情况,位居前三位的是:食源性疾病(21.4%)、传染病(18.9%)、环境卫生事件(18.1%);我国目前有关农村突发公共卫生事件的研究,以应对措施研究最多占发表文献比例的33.0%,其次为发生原因研究占25.2%,管理体系研究占24.1%,而应急机制、流行病学分析、控制效果等方面研究,仅占17.7%;2、对农村突发公共卫生事件应对能力实证研究表明,农村卫生专业人员、政府管理人员和居民对突发公共卫生事件总体风险认知率分别只有21.3%、14.0%和26.9%;在公共卫生知识水平中,农村居民对化学中毒、日常急救、食物中毒等知识知晓率仅为6.2%、11.8%、13.3%;政府管理人员对三种知识的知晓率为17.4%、28.1%、25.1%;而卫生专业人员对三种知识的知晓率也只有22.3%、33.6%、35.3%;在应急管理中,卫生专业人员、政府管理人员对于突发公共卫生事件预警机制的知晓率,仅分别为10.5%和24.8%;在应急技能中,农村卫生专业人员认为对化学性事故、意外创伤、放射性事故、不明原因传染病和食物中毒等应急救治技术能胜任的比例分别为13.0%、25.7%、6.6 %、4.7%和45.2%。通过统计学分析,农村突发公共卫生事件应急能力在农村居民、卫生专业人员和政府管理人员之间存在统计学差异(F=24.00,P=0.000<0.05),不同性别(F=16.42,P=0.000<0.05)、不同年龄(F=28.69,P=0.000<0.05)、不同婚姻状况(F=16.48,P=0.000<0.05)和不同文化程度(F=103.18,P=0.000<0.05)的农村居民、卫生专业人员和政府管理人员应对突发公共卫生事件能力均有统计学差异,不同工龄(F=16.82,P=0.000<0.05)的卫生专业人员和政府管理人员之间应对突发公共卫生事件能力有显著性统计学差异。农村居民与卫生专业人员应对突发公共卫生事件能力在公共卫生知识与风险认知维度无统计学差异(P=0.240>0.05),农村居民和政府管理人员在2维度上也无统计学差异(P=0.225>0.05),而卫生专业人员和政府管理人员(P=0.033<0.05)应对突发公共卫生事件能力在2个维度上有统计学差异。通过多因素分析,以不同人群应对突发公共卫生事件的能力为应变量,在分别以不同人群的人口学特征和应急水平维度因素为自变量,构建了三个人群的应对能力回归方程,表明了文化程度、单位性质、职业、职称、性别和婚姻状况等许多因素影响农村各级人员的突发公共卫生事件应急能力;3、从应对农村突发公共卫生事件的事件发生前、中、后三个阶段和宿主、媒介因子、物理基础环境和社会文化环境四个影响因子角度,结合文献循证,提出了Haddon模型应用于农村突发公共卫生事件的应对模型。
结论1、在文献归纳总结和循证分析的基础上,明确了我国农村突发公共卫生事件主要以研究食源性疾病、传染病、环境卫生事件较多,而缺乏脆弱性的实证研究;目前农村突发公共卫生事件应对存在的问题主要表现在基层政府、卫生机构应急体系建设薄弱、人员素质较低,应急知识普及以及健康教育(含心理)缺乏,应对部门之间协作能力差等,需要全面加强;2、通过对农村突发公共卫生事件应急能力的实证研究,发现农村居民、卫生专业人员和政府管理人员在突发公共卫生事件应急管理水平、风险意识、知识水平和应急技能方面存在明显不足,文化程度、单位性质、职业、职称、性别和婚姻状况等许多因素影响农村突发公共卫生事件应急能力的提高,需要进一步加强农村突发公共卫生事件应急能力建设;3、本文运用Haddon模型,结合循证,提出了农村突发公共卫生事件各个环节的应对模型。
Objective:Through the analysis research of the relevance literature materials,the cross-sectional study and data statistic, the present situation study for the crisis management system construction of public health emergency events for the domestic countryside was carried on,in order to analyze the vulnerability and countermeasure of the crisis management of public health emergency events in rural areas, to prevent and control pubilc health emergency events in rural areas.
Methods:To begin with, the literature review data was used,including the overseas and domestic famous electronic literature databases such as MEDLINE, SpringerLINK full text electron periodical, OVID BP & Lippincott Williams & Wilkins (LWW) Total Access Collection, Master ProQuest abundant paper database,Science Online in the overseas famous electronic literature databases and Chinese journal full text database (CJFD), CQVIP database, WANFANG database, the retrieval period was from Jan.2000 to Dec.2006. The ways of the keyword and/or the key word and/or the free word were carried on the retrieval.Moreover,the Internet network was carried on the retrieval, the retrieval way was in accord with the first method, the retrieval period was unlimited.What is more,Community Information and Epidemiological Technotogies (CIET) were applied,namely through finding the problems of preparedness and response for the rural public health mergencies,analyzing the previous study,designing investigation project,carrying out the pre-investigation,the cross- sectional study,responding to preliminary analysis,the vulnerability and mechanism of preparedness and response for the rural public health emergencies were worked out.Among them,the inhabitants,the health profession technical and government administrative personnels of the countryside were chosen as research objects,the method of the stratified chester random sampling was adopted, in total,2136 inhabitants,1113 health profession personnels and 327 government administrative personnels of the countryside were investigated,the investigation questionnaires were independently designed,the investigation methods of self-completed and face-to-face questionnaires was used through the anonymous way; Finally, Haddon conceptual model was applied for prevention of public health emergency events in rural areas, namely the concept of the host,the factors of medium (pathogenesis) and environment of the public health.
Results: The results could be summarized as follows:1、according to the evidence-based medicine study of the rural public health emergency events’literatures between Jan.2000 and Dec.2006,from the distribution of the rural public health emergency events’literatures reported,the three most papers among all ones published were the food-borne diseases(21.4%),the infectious diseases(18.9%) and the environmental hygiene events (18.1%). In addition , the studies of the rural public health emergency events on policies were the most among all papers published,accounting for 33.0% of the published data,secondly,the reasons researches accounting for 25.2%, the administrative system accounting for 24.1%, however,the study of the emergency mechanism,epidemiology aspect such as analysis of epidemiology, management effect and economics accounting for only 17.7%, especially the management effect(0.8%) and economics studies (0.4%);2、In view of the demonstration study of management capability to the rural public health emergency events,the risk recognition rates of public health emergency events for the inhabitants,the health profession technical and government administrative personnels of the countryside were 21.3%、14.0% and 26.9% respectively,the rates of knowing the chemistry toxicosis,daily first aid and food poisoning for the rural inhabitants only 6.2%,11.8% and 13.3% respectively,only 17.4%,28.1% and 25.1% for the rural government personnels,22.3%,33.6% and 35.3% for the rural hygiene professional staffs.In the emergency management,the knowing rates of the health profession and government personnels for the warning mechanism of public health emergency events were only 10.5% and 24.8% respectively.In the emergency technology,the competent rates of the health professional staffs for the emergency treatment technologies to the chemical accident,accidental injuries,radioactive accident,infectious diseases of unknown causes and food poisoning were 13.0%,25.7%,6.6%,4.7% and 45.2% respectively.Through the statistics analysis,the statistics difference existed in the public health emergency events management capability among the inhabitants,the health profession and government personnels of the countryside (F=24.00,P=0.000<0.05),the statistics differences among sex(F=16.42,P=0.000<0.05),the statistics differences among ages(F=28.69,P=0.000<0.05),the statistics differences among the different wedding status (F=16.48,P=0.000<0.05) and the statistics differences among the different education levels (F=103.18,P=0.000<0.05).The significant difference among the working years for the health profession technical and government administrative personnels of the countryside(F=16.82,P=0.000<0.05) existed in the public health emergency events management capability. No statistics differences existed in the dimensions of public health knowledge and risk cognition of the emergency capability between the inhabitants and government personnels(P=0.225>0.05) or health profession technical personnels (P=0.240>0.05)of the countryside,but there was the statistics difference on two dimensions of the emergency ability between the health profession personnels and government personnels of the countryside(P=0.033<0.05).The results showed that the emergency capability of the rural public health emergency events was affected by many factors,such as the level of education,the unit character,the occupation,professional title,sex and marital status,through the method of multi-factor analysis the response capacity regression equations of the three groups were established;3、The Haddon conceptual model combined with the evidence-based results of the rural public health emergency events’literatures,the Haddon conceptual model of the rural public health emergency events was built from the aspects of the different phases of the rural public health emergencies (preevent,event,and postevent) and the different influencing factors (host,agent/vehicle,physical environment,social enviro- nment).
Conclusion: 1、Accoding to the evidence-based medicine study and summarizing of the rural public health emergency events’literatures, it clearly indicated that the researches of the rural public health emergency events mainly studied the food-borne diseases,the infectious diseases,the environmental hygiene events,but the demonstration studies of the vulnerability were deficient.At present,it existed in some problems for the preparedness and response of the rural public health emergency events,for example,the weakness of the emergency system construction in the rural government and health organizations,the low-level of personnel quality,the deficiency of the popularity for emergency knowledge and health education (including psychology) and the low grade cooperation ability of the preparedness and response departments;2、The emergency management level,risk consciousness,public health knowledge level and emergency technology of the government,the inhabitant and health profession personnel in rural areas were obviously insufficient.The emergency capability of the rural public health emergency events was affected by many factors.The emergency capability construction of the rural public health emergency events was needed to strengthen further;3、According to Haddon conceptual model,the countermeasures of prevention,preparedness and response for public health emergency events in rural area were proposed.
方法本研究首先采用的研究方法是文献复习方法:应用国内外著名的电子文献数据库进行检索,包括MEDLINE、SpringerLINK全文电子期刊、OVID BP & Lippincott Williams & Wilkins (LWW) Total Access Collection、ProQuest博硕士论文数据库、Science Online及国内电子文献数据库检索如中国期刊全文数据库(CJFD)、维普中文科技期刊数据库、万方电子期刊数据库等,检索年限为2000年1月至2006年12月,运用主题词与/或关键词与/或自由词方法进行检索。另外采用Internet网络进行检索,检索方式同第一种方法,检索年限不限。其次,应用社区信息与流行病学技术循证研究(CIET)方法,即通过其中发现问题、分析已有资料、设计调查项目、开展预调查、现况调查、初步分析反馈等6个环节,做出农村突发公共卫生事件应对的脆弱性分析以及应对机制建议。其中,现况调查以农村居民、基层卫生专业技术人员、基层政府管理人员为研究对象,采用群组分层随机抽样方法,共调查农村居民2136人,卫生专业人员1113人,政府管理人员327人,采用面对面无记名自填方式调查;最后,应用Haddon概念模型,从“宿主-媒介(致病)因子-环境”三个环节及农村突发公共卫生事件发生的三个阶段,分析农村突发公共卫生事件的影响因素。
结果本研究表明:1、对相关农村突发公共卫生事件文献的循证研究,可以发现,我国在2000年1月至2006年12月期间发表的农村各类突发公共卫生事件文献报道分布情况,位居前三位的是:食源性疾病(21.4%)、传染病(18.9%)、环境卫生事件(18.1%);我国目前有关农村突发公共卫生事件的研究,以应对措施研究最多占发表文献比例的33.0%,其次为发生原因研究占25.2%,管理体系研究占24.1%,而应急机制、流行病学分析、控制效果等方面研究,仅占17.7%;2、对农村突发公共卫生事件应对能力实证研究表明,农村卫生专业人员、政府管理人员和居民对突发公共卫生事件总体风险认知率分别只有21.3%、14.0%和26.9%;在公共卫生知识水平中,农村居民对化学中毒、日常急救、食物中毒等知识知晓率仅为6.2%、11.8%、13.3%;政府管理人员对三种知识的知晓率为17.4%、28.1%、25.1%;而卫生专业人员对三种知识的知晓率也只有22.3%、33.6%、35.3%;在应急管理中,卫生专业人员、政府管理人员对于突发公共卫生事件预警机制的知晓率,仅分别为10.5%和24.8%;在应急技能中,农村卫生专业人员认为对化学性事故、意外创伤、放射性事故、不明原因传染病和食物中毒等应急救治技术能胜任的比例分别为13.0%、25.7%、6.6 %、4.7%和45.2%。通过统计学分析,农村突发公共卫生事件应急能力在农村居民、卫生专业人员和政府管理人员之间存在统计学差异(F=24.00,P=0.000<0.05),不同性别(F=16.42,P=0.000<0.05)、不同年龄(F=28.69,P=0.000<0.05)、不同婚姻状况(F=16.48,P=0.000<0.05)和不同文化程度(F=103.18,P=0.000<0.05)的农村居民、卫生专业人员和政府管理人员应对突发公共卫生事件能力均有统计学差异,不同工龄(F=16.82,P=0.000<0.05)的卫生专业人员和政府管理人员之间应对突发公共卫生事件能力有显著性统计学差异。农村居民与卫生专业人员应对突发公共卫生事件能力在公共卫生知识与风险认知维度无统计学差异(P=0.240>0.05),农村居民和政府管理人员在2维度上也无统计学差异(P=0.225>0.05),而卫生专业人员和政府管理人员(P=0.033<0.05)应对突发公共卫生事件能力在2个维度上有统计学差异。通过多因素分析,以不同人群应对突发公共卫生事件的能力为应变量,在分别以不同人群的人口学特征和应急水平维度因素为自变量,构建了三个人群的应对能力回归方程,表明了文化程度、单位性质、职业、职称、性别和婚姻状况等许多因素影响农村各级人员的突发公共卫生事件应急能力;3、从应对农村突发公共卫生事件的事件发生前、中、后三个阶段和宿主、媒介因子、物理基础环境和社会文化环境四个影响因子角度,结合文献循证,提出了Haddon模型应用于农村突发公共卫生事件的应对模型。
结论1、在文献归纳总结和循证分析的基础上,明确了我国农村突发公共卫生事件主要以研究食源性疾病、传染病、环境卫生事件较多,而缺乏脆弱性的实证研究;目前农村突发公共卫生事件应对存在的问题主要表现在基层政府、卫生机构应急体系建设薄弱、人员素质较低,应急知识普及以及健康教育(含心理)缺乏,应对部门之间协作能力差等,需要全面加强;2、通过对农村突发公共卫生事件应急能力的实证研究,发现农村居民、卫生专业人员和政府管理人员在突发公共卫生事件应急管理水平、风险意识、知识水平和应急技能方面存在明显不足,文化程度、单位性质、职业、职称、性别和婚姻状况等许多因素影响农村突发公共卫生事件应急能力的提高,需要进一步加强农村突发公共卫生事件应急能力建设;3、本文运用Haddon模型,结合循证,提出了农村突发公共卫生事件各个环节的应对模型。
Objective:Through the analysis research of the relevance literature materials,the cross-sectional study and data statistic, the present situation study for the crisis management system construction of public health emergency events for the domestic countryside was carried on,in order to analyze the vulnerability and countermeasure of the crisis management of public health emergency events in rural areas, to prevent and control pubilc health emergency events in rural areas.
Methods:To begin with, the literature review data was used,including the overseas and domestic famous electronic literature databases such as MEDLINE, SpringerLINK full text electron periodical, OVID BP & Lippincott Williams & Wilkins (LWW) Total Access Collection, Master ProQuest abundant paper database,Science Online in the overseas famous electronic literature databases and Chinese journal full text database (CJFD), CQVIP database, WANFANG database, the retrieval period was from Jan.2000 to Dec.2006. The ways of the keyword and/or the key word and/or the free word were carried on the retrieval.Moreover,the Internet network was carried on the retrieval, the retrieval way was in accord with the first method, the retrieval period was unlimited.What is more,Community Information and Epidemiological Technotogies (CIET) were applied,namely through finding the problems of preparedness and response for the rural public health mergencies,analyzing the previous study,designing investigation project,carrying out the pre-investigation,the cross- sectional study,responding to preliminary analysis,the vulnerability and mechanism of preparedness and response for the rural public health emergencies were worked out.Among them,the inhabitants,the health profession technical and government administrative personnels of the countryside were chosen as research objects,the method of the stratified chester random sampling was adopted, in total,2136 inhabitants,1113 health profession personnels and 327 government administrative personnels of the countryside were investigated,the investigation questionnaires were independently designed,the investigation methods of self-completed and face-to-face questionnaires was used through the anonymous way; Finally, Haddon conceptual model was applied for prevention of public health emergency events in rural areas, namely the concept of the host,the factors of medium (pathogenesis) and environment of the public health.
Results: The results could be summarized as follows:1、according to the evidence-based medicine study of the rural public health emergency events’literatures between Jan.2000 and Dec.2006,from the distribution of the rural public health emergency events’literatures reported,the three most papers among all ones published were the food-borne diseases(21.4%),the infectious diseases(18.9%) and the environmental hygiene events (18.1%). In addition , the studies of the rural public health emergency events on policies were the most among all papers published,accounting for 33.0% of the published data,secondly,the reasons researches accounting for 25.2%, the administrative system accounting for 24.1%, however,the study of the emergency mechanism,epidemiology aspect such as analysis of epidemiology, management effect and economics accounting for only 17.7%, especially the management effect(0.8%) and economics studies (0.4%);2、In view of the demonstration study of management capability to the rural public health emergency events,the risk recognition rates of public health emergency events for the inhabitants,the health profession technical and government administrative personnels of the countryside were 21.3%、14.0% and 26.9% respectively,the rates of knowing the chemistry toxicosis,daily first aid and food poisoning for the rural inhabitants only 6.2%,11.8% and 13.3% respectively,only 17.4%,28.1% and 25.1% for the rural government personnels,22.3%,33.6% and 35.3% for the rural hygiene professional staffs.In the emergency management,the knowing rates of the health profession and government personnels for the warning mechanism of public health emergency events were only 10.5% and 24.8% respectively.In the emergency technology,the competent rates of the health professional staffs for the emergency treatment technologies to the chemical accident,accidental injuries,radioactive accident,infectious diseases of unknown causes and food poisoning were 13.0%,25.7%,6.6%,4.7% and 45.2% respectively.Through the statistics analysis,the statistics difference existed in the public health emergency events management capability among the inhabitants,the health profession and government personnels of the countryside (F=24.00,P=0.000<0.05),the statistics differences among sex(F=16.42,P=0.000<0.05),the statistics differences among ages(F=28.69,P=0.000<0.05),the statistics differences among the different wedding status (F=16.48,P=0.000<0.05) and the statistics differences among the different education levels (F=103.18,P=0.000<0.05).The significant difference among the working years for the health profession technical and government administrative personnels of the countryside(F=16.82,P=0.000<0.05) existed in the public health emergency events management capability. No statistics differences existed in the dimensions of public health knowledge and risk cognition of the emergency capability between the inhabitants and government personnels(P=0.225>0.05) or health profession technical personnels (P=0.240>0.05)of the countryside,but there was the statistics difference on two dimensions of the emergency ability between the health profession personnels and government personnels of the countryside(P=0.033<0.05).The results showed that the emergency capability of the rural public health emergency events was affected by many factors,such as the level of education,the unit character,the occupation,professional title,sex and marital status,through the method of multi-factor analysis the response capacity regression equations of the three groups were established;3、The Haddon conceptual model combined with the evidence-based results of the rural public health emergency events’literatures,the Haddon conceptual model of the rural public health emergency events was built from the aspects of the different phases of the rural public health emergencies (preevent,event,and postevent) and the different influencing factors (host,agent/vehicle,physical environment,social enviro- nment).
Conclusion: 1、Accoding to the evidence-based medicine study and summarizing of the rural public health emergency events’literatures, it clearly indicated that the researches of the rural public health emergency events mainly studied the food-borne diseases,the infectious diseases,the environmental hygiene events,but the demonstration studies of the vulnerability were deficient.At present,it existed in some problems for the preparedness and response of the rural public health emergency events,for example,the weakness of the emergency system construction in the rural government and health organizations,the low-level of personnel quality,the deficiency of the popularity for emergency knowledge and health education (including psychology) and the low grade cooperation ability of the preparedness and response departments;2、The emergency management level,risk consciousness,public health knowledge level and emergency technology of the government,the inhabitant and health profession personnel in rural areas were obviously insufficient.The emergency capability of the rural public health emergency events was affected by many factors.The emergency capability construction of the rural public health emergency events was needed to strengthen further;3、According to Haddon conceptual model,the countermeasures of prevention,preparedness and response for public health emergency events in rural area were proposed.
引文
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