Kev txiav txim siab txog kev noj qab haus huv (SDOH) muaj kev cuam tshuam nrog ntau yam kev noj qab haus huv thiab nyiaj txiag.Kev xav yog qhov tseem ceeb rau kev kawm SDH.Txawm li cas los xij, tsuas yog ob peb daim ntawv tshaj tawm txheeb xyuas SDH cov kev pab cuam;feem ntau yog cov kev tshawb fawb hla ntu.Peb tau nrhiav los ua qhov kev ntsuam xyuas ntev ntawm SDH qhov kev pab cuam hauv kev kawm txog kev noj qab haus huv hauv zej zog (CBME) tau pib hauv xyoo 2018 raws li qib thiab cov ntsiab lus ntawm cov tub ntxhais kawm ntawv qhia txog kev xav txog SDH.
Kev tsim qauv kev tshawb fawb: Ib qho kev qhia dav dav rau kev txheeb xyuas cov ntaub ntawv zoo.Kev Kawm Txuj Ci: Kev xyaum ua haujlwm 4-lub lim tiam hauv kev kho mob dav dav thiab kev saib xyuas thawj zaug hauv University of Tsukuba School of Medicine, Nyiv, muaj rau txhua tus tub ntxhais kawm kho mob xyoo thib tsib thiab rau xyoo.Cov tub ntxhais kawm tau siv peb lub lis piam ua haujlwm ntawm cov chaw kho mob hauv zej zog thiab tsev kho mob hauv thaj chaw deb nroog thiab nyob deb nroog ntawm Ibaraki Prefecture.Tom qab thawj hnub ntawm SDH cov lus qhuab qhia, cov tub ntxhais kawm raug hais kom npaj cov ntaub ntawv qhia txog cov xwm txheej raws li cov xwm txheej tau ntsib hauv chav kawm.Hnub kawg, cov tub ntxhais kawm tau qhia lawv cov kev paub hauv pawg rooj sab laj thiab nthuav tawm ib daim ntawv ntawm SDH.Txoj kev pab cuam txuas ntxiv txhim kho thiab muab kev txhim kho tus kws qhia ntawv.Cov neeg koom nrog kev kawm: cov tub ntxhais kawm uas ua tiav qhov kev pab cuam thaum lub Kaum Hlis 2018 txog Lub Rau Hli 2021. Kev Ntsuam Xyuas: Qib ntawm kev xav tau raug cais raws li kev xav, tsom xam lossis piav qhia.Cov ntsiab lus raug tshuaj xyuas los ntawm kev siv Cov Lus Tseeb Tseeb.
Peb tau txheeb xyuas 118 tsab ntawv ceeb toom rau 2018-19, 101 tsab ntawv ceeb toom rau 2019-20 thiab 142 tsab ntawv ceeb toom rau 2020-21.Muaj 2 (1.7%), 6 (5.9%) thiab 7 (4.8%) cov ntaub ntawv qhia txog kev xav, 9 (7.6%), 24 (23.8%) thiab 52 (35.9%), 36 (30.5%) raws li, 48 (47.5%) thiab 79 (54.5%) piav qhia.Kuv yuav tsis tawm tswv yim txog qhov seem.Tus naj npawb ntawm Cov Txheej Txheem Txheej Txheem hauv daim ntawv tshaj tawm yog 2.0 ± 1.2, 2.6 ± 1.3, thiab 3.3 ± 1.4, feem.
Raws li SDH tej yaam num hauv CBME cov kev kawm tau ua kom zoo dua qub, cov tub ntxhais kawm kev nkag siab ntawm SDH txuas ntxiv mus ntxiv.Tej zaum qhov no tau txhawb nqa los ntawm kev txhim kho ntawm cov kws qhia ntawv.Kev nkag siab zoo txog SDH yuav xav tau kev txhim kho cov kws qhia ntawv ntxiv thiab kev kawm sib koom ua ke hauv social sciences thiab tshuaj.
Kev txiav txim siab txog kev noj qab haus huv (SDH) yog yam tsis yog kev kho mob uas cuam tshuam txog kev noj qab haus huv, suav nrog ib puag ncig uas tib neeg yug los, loj hlob, ua haujlwm, nyob thiab hnub nyoog [1].SDH muaj feem cuam tshuam rau tib neeg txoj kev noj qab haus huv, thiab kev cuam tshuam kev kho mob ib leeg tsis tuaj yeem hloov kho kev noj qab haus huv ntawm SDH [1,2,3].Cov kws kho mob yuav tsum paub txog SDH [4, 5] thiab pab txhawb rau zej zog raws li cov kws kho mob [6] kom txo tau qhov tsis zoo ntawm SDH [4,5,6].
Qhov tseem ceeb ntawm kev qhia SDH hauv kev kawm kho mob qib siab tau lees paub dav dav [4,5,7], tab sis kuj tseem muaj ntau yam teeb meem cuam tshuam nrog kev kawm SDH.Rau cov tub ntxhais kawm kho mob, qhov tseem ceeb tseem ceeb ntawm kev sib txuas SDH rau kab mob lom kab mob [8] tej zaum yuav paub ntau dua, tab sis kev sib txuas ntawm SDH kev kawm thiab kev cob qhia kho mob tseem yuav raug txwv.Raws li American Medical Association Alliance for Accelerating Change in Medical Education, ntau SDH kev kawm yog muab nyob rau hauv thawj thiab thib ob xyoo ntawm undergraduate kev kawm kho mob tshaj nyob rau hauv peb los yog plaub xyoo [7].Tsis yog txhua lub tsev kawm kho mob hauv Tebchaws Meskas qhia SDH ntawm qib kho mob [9], cov chav kawm sib txawv [10], thiab cov chav kawm feem ntau yog xaiv [5, 10].Vim tsis muaj kev pom zoo ntawm SDH kev txawj ntse, cov tswv yim ntsuam xyuas rau cov tub ntxhais kawm thiab cov kev pab cuam sib txawv [9].Txhawm rau txhawb SDH kev kawm hauv kev kawm kho mob hauv tsev kawm ntawv qib siab, nws yog ib qho tsim nyog yuav tsum ua raws li SDH cov phiaj xwm hauv xyoo kawg ntawm kev kawm kho mob qib siab thiab ua qhov kev ntsuam xyuas tsim nyog ntawm cov haujlwm [7, 8].Nyiv kuj tau lees paub qhov tseem ceeb ntawm SDH kev kawm hauv kev kawm kho mob.Hauv 2017, SDH kev kawm tau suav nrog hauv cov ntawv qhia tseem ceeb ntawm kev qhia kev kho mob, qhia meej cov hom phiaj kom ua tiav thaum kawm tiav hauv tsev kawm kho mob [11].Qhov no tau hais ntxiv nyob rau hauv 2022 hloov kho [12].Txawm li cas los xij, txoj hauv kev rau kev qhia thiab ntsuas SDH tseem tsis tau tsim nyob hauv Nyij Pooj.
Hauv peb txoj kev tshawb fawb yav dhau los, peb tau soj ntsuam cov theem ntawm kev xav hauv cov tub ntxhais kawm kho mob laus cov ntawv ceeb toom nrog rau lawv cov txheej txheem los ntawm kev ntsuam xyuas qhov kev ntsuam xyuas ntawm SDH qhov project hauv zej zog kev kawm kho mob (CBME) chav kawm [13] ntawm ib lub tsev kawm ntawv Nyij Pooj.Nkag siab SDH [14].Nkag siab SDH yuav tsum tau hloov pauv kev kawm [10].Kev tshawb fawb, suav nrog peb, tau tsom mus rau cov tub ntxhais kawm qhov kev xav txog kev ntsuas SDH cov haujlwm [10, 13].Hauv cov chav kawm thawj zaug uas peb tau muab, cov tub ntxhais kawm zoo li nkag siab qee yam ntawm SDH zoo dua li lwm tus, thiab lawv qib kev xav txog SDH kuj qis [13].Cov tub ntxhais kawm nkag siab tob txog lawv txoj kev nkag siab ntawm SDH los ntawm kev paub hauv zej zog thiab hloov lawv txoj kev xav ntawm tus qauv kho mob rau hauv lub neej qauv [14].Cov txiaj ntsig no muaj txiaj ntsig zoo thaum cov txheej txheem kev kawm rau SDH kev kawm thiab lawv qhov kev ntsuas thiab kev ntsuas tseem tsis tau tsim tiav [7].Txawm li cas los xij, kev ntsuam xyuas ntev ntawm kev kawm qib siab SDH tsis tshua muaj qhia.Yog tias peb tuaj yeem ua kom pom cov txheej txheem los txhim kho thiab ntsuas cov kev pab cuam SDH, nws yuav ua tus qauv rau kev tsim thiab kev ntsuam xyuas zoo dua ntawm SDH cov kev pab cuam, uas yuav pab tsim cov qauv thiab cov hauv kev rau undergraduate SDH.
Lub hom phiaj ntawm txoj kev tshawb no yog los ua kom pom cov txheej txheem ntawm kev txhim kho txuas ntxiv ntawm SDH kev kawm rau cov tub ntxhais kawm kho mob thiab ua qhov kev ntsuam xyuas ntev ntawm SDH kev kawm hauv chav kawm CBME los ntawm kev ntsuas qib ntawm kev xav hauv cov tub ntxhais kawm ntawv ceeb toom.
Txoj kev tshawb no tau siv ib txoj hauv kev inductive thiab ua qhov kev soj ntsuam zoo ntawm cov ntaub ntawv project txhua xyoo rau peb xyoos.Nws soj ntsuam SDH cov ntawv ceeb toom ntawm cov tub ntxhais kawm kho mob rau npe hauv SDH cov kev pab cuam hauv CBME cov ntaub ntawv kawm.General induction yog ib txheej txheem txheej txheem rau kev txheeb xyuas cov ntaub ntawv zoo uas qhov kev soj ntsuam tuaj yeem coj los ntawm cov hom phiaj kev ntsuas tshwj xeeb.Lub hom phiaj yog tso cai rau cov kev tshawb fawb tshawb pom los ntawm ntau zaus, tseem ceeb, lossis cov ntsiab lus tseem ceeb uas muaj nyob hauv cov ntaub ntawv nyoos es tsis yog cov txheej txheem ua ntej los ntawm txoj hauv kev [15].
Cov neeg koom nrog kev tshawb fawb yog cov tub ntxhais kawm kho mob thib tsib- thiab rau xyoo thib rau hauv University of Tsukuba Tsev Kawm Ntawv Tshuaj Kho Mob uas tau ua tiav qhov yuav tsum tau ua 4-lub lim tiam kev kho mob hauv chav kawm CBME thaum lub Cuaj Hlis 2018 thiab Tsib Hlis 2019 (2018-19).Lub Peb Hlis 2020 (2019-20) lossis Lub Kaum Hli 2020 thiab Lub Xya Hli 2021 (2020-21).
Cov qauv ntawm 4-lub lim tiam CBME chav kawm yog piv rau peb cov kev kawm yav dhau los [13, 14].Cov tub ntxhais kawm coj CBME hauv lawv lub xyoo thib tsib lossis rau xyoo uas yog ib feem ntawm Kev Taw Qhia rau Tshuaj Kho Mob, uas yog tsim los qhia kev paub hauv paus rau cov kws kho mob, suav nrog kev txhawb nqa kev noj qab haus huv, kev tshaj lij, thiab kev sib koom tes ua haujlwm.Lub hom phiaj ntawm CBME cov ntaub ntawv kawm yog nthuav tawm cov tub ntxhais kawm txog cov kev paub ntawm tsev neeg kws kho mob uas muab kev saib xyuas tsim nyog hauv ntau qhov chaw kho mob;qhia txog kev txhawj xeeb txog kev noj qab haus huv rau cov pej xeem, cov neeg mob, thiab cov tsev neeg hauv cheeb tsam kev noj qab haus huv;thiab txhim kho kev paub txog kev xav txog kev kho mob..Txhua 4 lub lis piam, 15-17 cov tub ntxhais kawm tau kawm.Kev sib hloov muaj xws li 1 lub lis piam hauv zej zog, 1-2 lub lis piam hauv tsev kho mob hauv zej zog lossis tsev kho mob me, mus txog 1 lub lis piam hauv tsev kho mob hauv zej zog, thiab 1 lub lis piam hauv tsev kho mob hauv tsev kho mob hauv tsev kho mob.Thawj hnub thiab hnub kawg, cov tub ntxhais kawm sib sau ua ke hauv tsev kawm ntawv mus koom kev qhuab qhia thiab kev sib tham hauv pab pawg.Thawj hnub, cov kws qhia ntawv piav qhia lub hom phiaj ntawm chav kawm rau cov tub ntxhais kawm.Cov tub ntxhais kawm ntawv yuav tsum xa ib daim ntawv qhia kawg ntsig txog cov hom phiaj ntawm chav kawm.Peb tus kws qhia ntawv tseem ceeb (AT, SO, thiab JH) npaj feem ntau ntawm CBME cov kev kawm thiab SDH cov haujlwm.Qhov kev zov me nyuam yog xa los ntawm cov kws qhia ntawv tseem ceeb thiab 10-12 tus kws qhia ntawv txuas ntxiv uas yog koom nrog hauv kev qhia ntawv qib siab hauv tsev kawm ntawv thaum xa CBME cov kev pab cuam raws li kev xyaum kws kho mob hauv tsev neeg lossis cov kws kho mob tsis yog kws kho mob paub txog CBME.
Tus qauv ntawm SDH qhov project hauv chav kawm CBME ua raws li cov qauv ntawm peb cov kev tshawb fawb yav dhau los [13, 14] thiab tau hloov kho tas li (Daim duab 1).Thawj hnub, cov tub ntxhais kawm tau koom tes nrog SDH cov lus qhuab qhia thiab ua tiav cov haujlwm SDH thaum lub sijhawm 4 lub lis piam hloov.Cov tub ntxhais kawm raug hais kom xaiv ib tus neeg lossis tsev neeg uas lawv tau ntsib thaum lawv ua haujlwm thiab sau cov ntaub ntawv los txiav txim siab txog yam uas yuav cuam tshuam rau lawv txoj kev noj qab haus huv.Lub Koom Haum Saib Xyuas Kev Noj Qab Haus Huv (World Health Organization) muab Cov Lus Tseeb Thib Ob Tshaj Tawm [15], SDH cov ntawv ua haujlwm, thiab cov qauv ua tiav cov ntawv ua tiav raws li cov ntaub ntawv siv.Hnub kawg, cov tub ntxhais kawm tau nthuav tawm lawv cov xwm txheej SDH hauv cov pab pawg me, txhua pab pawg muaj 4-5 tus tub ntxhais kawm thiab 1 tus kws qhia.Tom qab qhov kev nthuav qhia, cov tub ntxhais kawm tau ua haujlwm xa daim ntawv tshaj tawm kawg rau chav kawm CBME.Lawv raug hais kom piav qhia thiab hais txog lawv qhov kev paub dhau los thaum lub sijhawm 4 lub lis piam hloov;lawv tau hais kom piav qhia 1) qhov tseem ceeb ntawm cov kws kho mob nkag siab txog SDH thiab 2) lawv lub luag haujlwm los txhawb kev noj qab haus huv rau pej xeem lub luag haujlwm uas yuav tsum tau ua.Cov tub ntxhais kawm tau muab cov lus qhia rau kev sau daim ntawv tshaj tawm thiab cov ncauj lus kom ntxaws txog kev ntsuam xyuas tsab ntawv ceeb toom (cov khoom siv ntxiv).Rau kev ntsuam xyuas tub ntxhais kawm, kwv yees li 15 tus kws qhia ntawv (nrog rau cov kws qhia ntawv tseem ceeb) tau soj ntsuam cov ntawv ceeb toom tawm tsam cov kev ntsuas.
Kev nthuav qhia ntawm SDH qhov kev pab cuam hauv CBME cov ntaub ntawv kawm ntawm University of Tsukuba Kws Kho Mob hauv xyoo 2018-19, thiab cov txheej txheem ntawm SDH kev txhim kho thiab kev txhim kho cov kws qhia ntawv hauv 2019-20 thiab 2020-21 xyoo kawm ntawv.2018-19 yog hais txog txoj kev npaj txij lub Kaum Hli 2018 txog Lub Tsib Hlis 2019, 2019-20 yog hais txog txoj kev npaj txij lub Kaum Hli 2019 txog Lub Peb Hlis 2020, thiab 2020-21 yog hais txog txoj kev npaj txij lub Kaum Hli 2020 txog Lub Rau Hli 2021. SDH: Social Determinants of Health, COVID-19: Tus Kab Mob Coronavirus 2019
Txij li thaum nws pib xyoo 2018, peb tau hloov kho qhov kev pab cuam SDH txuas ntxiv thiab muab kev txhim kho cov kws qhia ntawv.Thaum lub phiaj xwm pib xyoo 2018, cov xibfwb qhia ntawv tseem ceeb uas tau tsim nws tau muab cov xibfwb qhia kev txhim kho rau lwm tus xibfwb uas yuav koom nrog SDH project.Thawj tus kws qhia ntawv txhim kho kev qhuab qhia tau tsom mus rau SDH thiab kev xav txog kev noj qab haus huv hauv chaw kho mob.
Tom qab ua tiav qhov project hauv xyoo kawm ntawv 2018-19, peb tau muaj lub rooj sib tham txhim kho tus kws qhia ntawv los sib tham thiab lees paub qhov project lub hom phiaj thiab hloov kho qhov project kom haum.Rau lub xyoo kawm ntawv 2019-20, uas tau pib txij lub Cuaj Hlis 2019 txog Lub Peb Hlis 2020, peb tau muab Cov Lus Qhia Txog Tus Kws Pab Tswv Yim, Daim Ntawv Teev Npe, thiab Cov Txheej Txheem rau Cov Kws Ua Haujlwm Pabcuam los ua SDH Cov Lus Qhia Pab Pawg rau hnub kawg.Tom qab txhua pab pawg nthuav qhia, peb muaj kev sib tham hauv pab pawg nrog tus kws qhia ntawv tus neeg saib xyuas kom xav txog qhov kev zov me nyuam.
Nyob rau xyoo thib peb ntawm txoj haujlwm, txij lub Cuaj Hlis 2020 txog rau Lub Rau Hli 2021, peb tau muaj cov rooj sib tham txog kev txhim kho cov kws qhia ntawv los tham txog cov hom phiaj ntawm SDH kev kawm uas siv daim ntawv tshaj tawm zaum kawg.Peb tau hloov pauv me me rau qhov kawg ntawm tsab ntawv tshaj tawm thiab cov txheej txheem ntsuas (cov khoom siv ntxiv).Peb kuj tau hloov cov hom ntawv thiab hnub kawg ntawm kev ua ntawv thov los ntawm tes thiab ua ntawv ua ntej hnub kawg rau kev xa ntawv hluav taws xob thiab ua ntawv tsis pub dhau 3 hnub ntawm rooj plaub.
Txhawm rau txheeb xyuas cov ntsiab lus tseem ceeb thiab cov ntsiab lus thoob plaws hauv tsab ntawv tshaj tawm, peb tau soj ntsuam qhov twg SDH cov lus piav qhia tau cuam tshuam thiab tshem tawm cov ntsiab lus muaj tseeb uas tau hais tseg.Vim hais tias yav dhau los kev tshuaj xyuas [10] tau txiav txim siab qhov kev xav ua ib daim ntawv ntawm kev kawm thiab kev ntsuam xyuas, peb tau txiav txim siab tias qib kev xav tau hauv kev ntsuam xyuas yuav raug siv los ntsuas cov kev pab cuam SDH.Muab qhov kev xav tau txhais txawv txawv hauv cov ntsiab lus sib txawv, peb txais yuav lub ntsiab lus ntawm kev xav hauv lub ntsiab lus ntawm kev kawm kho mob raws li "tus txheej txheem ntawm kev tshuaj xyuas, nug thiab rov tsim kho cov kev paub nrog rau kev ntsuam xyuas lawv rau kev kawm."/ lossis txhim kho kev xyaum, "raws li tau piav qhia los ntawm Aronson, raws li Mezirow lub ntsiab lus ntawm kev xav txog qhov tseem ceeb [16].Raws li peb txoj kev kawm yav dhau los [13], 4-xyoo lub sijhawm hauv 2018-19, 2019-20 thiab 2020-21.nyob rau hauv tsab ntawv ceeb toom zaum kawg, Zhou tau raug cais raws li kev piav qhia, kev txheeb xyuas, lossis kev xav.Qhov kev faib tawm no yog ua raws li kev kawm sau ntawv tau piav qhia los ntawm University of Reading [17].Txij li qee qhov kev tshawb fawb kev kawm tau soj ntsuam qib ntawm kev xav hauv ib txoj hauv kev zoo sib xws [18], peb tau txiav txim siab tias nws tsim nyog siv qhov kev faib tawm no los ntsuas qib ntawm kev xav hauv tsab ntawv tshawb fawb no.Ib daim ntawv qhia piav qhia yog ib daim ntawv qhia uas siv SDH lub moj khaum los piav txog ib rooj plaub, tab sis nyob rau hauv uas tsis muaj kev koom ua ke ntawm yam.Ib daim ntawv qhia kev soj ntsuam yog ib daim ntawv qhia uas integrates SDH yam.Reflection Cov ntaub ntawv qhia txog kev sib deev yog cov lus ceeb toom uas cov kws sau ntawv xav ntxiv txog lawv txoj kev xav txog SDH.Cov ntawv ceeb toom uas tsis poob rau hauv ib qho ntawm cov pawg no tau muab cais ua qhov tsis raug ntsuas.Peb tau siv cov ntsiab lus tsom xam raws li Cov Lus Tseeb Tseeb, version 2, los ntsuam xyuas SDH yam uas tau piav qhia hauv cov lus ceeb toom [19].Cov ntsiab lus ntawm tsab ntawv ceeb toom zaum kawg yog raws li lub hom phiaj ntawm txoj haujlwm.Cov tub ntxhais kawm raug nug kom xav txog lawv cov kev paub dhau los los piav qhia qhov tseem ceeb ntawm cov kws kho mob nkag siab txog SDH thiab lawv lub luag haujlwm.hauv zej zog.SO tau txheeb xyuas cov qib kev xav tau piav qhia hauv tsab ntawv ceeb toom.Tom qab txiav txim siab txog SDH yam, SO, JH, thiab AT tau sib tham thiab lees paub cov qauv hauv qeb.SO rov ua qhov kev ntsuam xyuas.SO, JH, thiab AT tau tham ntxiv txog kev txheeb xyuas cov ntawv ceeb toom uas xav tau kev hloov pauv hauv kev faib tawm.Lawv tau txais kev pom zoo zaum kawg ntawm kev tshuaj xyuas ntawm txhua daim ntawv tshaj tawm.
Tag nrho ntawm 118, 101 thiab 142 tus tub ntxhais kawm tau koom nrog SDH qhov kev pab cuam hauv 2018-19, 2019-20 thiab 2020-21 xyoo kawm ntawv.Muaj 35 (29.7%), 34 (33.7%) thiab 55 (37.9%) poj niam cov tub ntxhais kawm, feem.
Daim duab 2 qhia txog kev faib cov theem kev xav los ntawm lub xyoo piv rau peb txoj kev tshawb fawb yav dhau los, uas tau txheeb xyuas cov theem ntawm kev xav hauv cov ntaub ntawv sau los ntawm cov tub ntxhais kawm xyoo 2018-19 [13].Hauv 2018-2019, 36 (30.5%) cov ntaub ntawv tau muab faib ua cov lus piav qhia, hauv 2019-2020 - 48 (47.5%) cov lus ceeb toom, hauv 2020-2021 - 79 (54.5%) cov lus ceeb toom.Muaj 9 (7.6%) cov ntaub ntawv txheeb xyuas hauv 2018-19, 24 (23.8%) cov ntaub ntawv txheeb xyuas hauv 2019-20 thiab 52 (35.9%) hauv 2020-21.Muaj 2 (1.7%) cov ntaub ntawv qhia txog kev xav hauv 2018-19, 6 (5.9%) hauv 2019-20 thiab 7 (4.8%) hauv 2020-21.71 (60.2%) cov lus ceeb toom tau muab faib ua tsis raug ntsuas hauv 2018-2019, 23 (22.8%) tshaj tawm hauv 2019-2020.thiab 7 (4.8%) qhia hauv 2020-2021.Classified li tsis ntsuam xyuas.Table 1 muab piv txwv qhia rau txhua qib kev xav.
Qib ntawm kev xav hauv cov tub ntxhais kawm ntawv ceeb toom ntawm SDH tej yaam num muaj nyob rau hauv 2018-19, 2019-20 thiab 2020-21 xyoo kawm ntawv.2018-19 yog hais txog txoj kev npaj txij lub Kaum Hlis 2018 txog Lub Tsib Hlis 2019, 2019-20 yog hais txog txoj kev npaj txij lub Kaum Hli 2019 txog Lub Peb Hlis 2020, thiab 2020-21 yog hais txog txoj kev npaj txij lub Kaum Hli 2020 txog Lub Rau Hli 2021. SDH: Social Determinants of Health
Qhov feem pua ntawm SDH yam uas tau piav qhia hauv daim ntawv tshaj tawm yog qhia hauv daim duab 3. Qhov nruab nrab ntawm cov xwm txheej tau piav qhia hauv cov ntawv ceeb toom yog 2.0 ± 1.2 hauv 2018-19, 2.6 ± 1.3 hauv 2019-20.thiab 3.3 ± 1.4 hauv 2020-21.
Feem pua ntawm cov tub ntxhais kawm uas tau tshaj tawm hais txog txhua yam hauv Cov Txheej Txheem Txheej Txheem Txheej Txheem (2nd Edition) hauv 2018-19, 2019-20, thiab 2020-21 tsab ntawv ceeb toom.Lub sijhawm 2018-19 yog hais txog Lub Kaum Hli 2018 txog Lub Tsib Hlis 2019, 2019-20 hais txog Lub Kaum Hli 2019 txog Lub Peb Hlis 2020 thiab 2020-21 yog hais txog Lub Kaum Hli 2020 txog Lub Rau Hli 2021, cov no yog cov hnub npaj.Hauv 2018/19 xyoo kawm ntawv muaj 118 tus menyuam kawm ntawv, nyob rau hauv 2019/20 xyoo kawm ntawv - 101 cov tub ntxhais kawm, nyob rau hauv 2020/21 xyoo kawm ntawv - 142 cov tub ntxhais kawm.
Peb tau qhia txog SDH qhov kev kawm rau hauv chav kawm CBME uas xav tau rau cov tub ntxhais kawm kho mob kawm tiav thiab nthuav tawm cov txiaj ntsig ntawm kev ntsuas peb xyoos ntawm qhov kev pab cuam ntsuas qib ntawm SDH xav txog hauv cov tub ntxhais kawm ntawv ceeb toom.Tom qab 3 xyoos ntawm kev siv qhov project thiab txuas ntxiv txhim kho nws, feem ntau cov tub ntxhais kawm tuaj yeem piav qhia txog SDH thiab piav qhia qee yam ntawm SDH hauv daim ntawv tshaj tawm.Ntawm qhov tod tes, tsuas yog ob peb tus tub ntxhais kawm tuaj yeem sau cov lus ceeb toom ntawm SDH.
Piv nrog rau xyoo kawm ntawv 2018-19, 2019-20 thiab 2020-21 xyoo kawm ntawv tau pom ib qho kev nce qib ntawm cov ntaub ntawv txheeb xyuas thiab piav qhia, thaum qhov feem pua ntawm cov ntaub ntawv tsis raug ntsuas tau txo qis, uas tej zaum yuav yog vim kev txhim kho hauv program thiab kev txhim kho tus kws qhia ntawv.Kev txhim kho tus kws qhia ntawv tseem ceeb heev rau SDH cov kev kawm [4, 9].Peb muab kev txhim kho kev ua haujlwm tsis tu ncua rau cov kws qhia ntawv uas koom nrog hauv txoj haujlwm.Thaum qhov kev zov me nyuam tau pib xyoo 2018, Lub Koom Haum Saib Xyuas Kev Kho Mob Nyij Pooj, yog ib lub koom haum Nyij Pooj kev kawm tshuaj hauv tsev neeg thiab cov koom haum saib xyuas kev noj qab haus huv, nyuam qhuav luam tawm tsab ntawv tshaj tawm ntawm SDH rau cov kws kho mob hauv Nyij Pooj.Feem ntau cov kws qhia ntawv tsis paub lub sij hawm SDH.Los ntawm kev koom tes hauv cov haujlwm thiab kev cuam tshuam nrog cov tub ntxhais kawm los ntawm cov ntaub ntawv nthuav qhia, cov kws qhia ntawv maj mam nkag siab txog SDH.Tsis tas li ntawd, qhia meej cov hom phiaj ntawm SDH cov kev pab cuam los ntawm kev txhim kho tus kws qhia ntawv tsis tu ncua tuaj yeem pab txhim kho cov kws qhia ntawv tsim nyog.Ib qho kev xav tau yog tias qhov kev zov me nyuam tau txhim kho lub sijhawm.Cov kev npaj txhim kho zoo li no yuav xav tau sijhawm thiab siv zog ntau.Hais txog txoj kev npaj xyoo 2020–2021, qhov cuam tshuam ntawm COVID-19 muaj thoob qhov txhia chaw rau cov tub ntxhais kawm lub neej thiab kev kawm [20, 21, 22, 23] yuav ua rau cov tub ntxhais kawm saib SDH yog qhov teeb meem cuam tshuam rau lawv tus kheej lub neej thiab pab lawv xav txog SDH.
Txawm hais tias tus naj npawb ntawm SDH yam uas tau hais hauv tsab ntawv tshaj tawm tau nce, qhov xwm txheej ntawm ntau yam sib txawv, uas tej zaum yuav cuam tshuam nrog cov yam ntxwv ntawm ib puag ncig kev coj ua.Cov nqi siab ntawm kev txhawb nqa kev sib raug zoo tsis yog qhov xav tsis thoob vim muaj kev sib cuag nrog cov neeg mob uas twb tau txais kev kho mob.Kev thauj mus los kuj tau hais ntau zaus, uas tej zaum yuav yog vim qhov tseeb tias CBME qhov chaw nyob hauv thaj chaw deb nroog lossis thaj chaw nyob deb nroog uas cov tub ntxhais kawm tau ntsib kev thauj mus los tsis yooj yim thiab muaj lub sijhawm los cuam tshuam nrog cov neeg nyob hauv ib puag ncig zoo li no.Kuj tau hais txog kev ntxhov siab, kev sib cais, kev ua haujlwm thiab zaub mov, uas ntau tus tub ntxhais kawm yuav muaj kev xyaum ua.Ntawm qhov tod tes, qhov cuam tshuam ntawm kev tsis sib xws hauv zej zog thiab kev poob haujlwm ntawm kev noj qab haus huv yuav nyuaj rau kev nkag siab thaum lub sijhawm kawm luv luv no.SDH yam uas cov tub ntxhais kawm tau ntsib hauv kev xyaum kuj tseem nyob ntawm tus yam ntxwv ntawm thaj chaw xyaum.
Peb txoj kev kawm tseem ceeb heev vim tias peb pheej mus soj ntsuam SDH qhov kev pab cuam nyob rau hauv CBME qhov kev pab cuam peb muab rau cov tub ntxhais kawm ntawv kho mob los ntawm kev ntsuam xyuas theem ntawm kev xav hauv cov tub ntxhais kawm ntawv ceeb toom.Cov tub ntxhais kawm kho mob loj uas tau kawm tshuaj kho mob tau ntau xyoo muaj kev xav txog kev kho mob.Yog li, lawv muaj peev xwm kawm los ntawm kev hais txog kev sib raug zoo uas xav tau rau SDH cov kev pab cuam rau lawv tus kheej kev xav txog kev kho mob [14].Yog li ntawd, nws yog ib qho tseem ceeb heev los muab cov kev pab cuam SDH rau cov tub ntxhais kawm ntawv no.Nyob rau hauv txoj kev tshawb no, peb muaj peev xwm ua qhov kev ntsuam xyuas tsis tu ncua ntawm qhov kev pab cuam los ntawm kev ntsuam xyuas theem ntawm kev xav hauv cov tub ntxhais kawm ntawv ceeb toom.Campbell et al.Raws li tsab ntawv ceeb toom, US cov tsev kawm kho mob thiab cov kws kho mob cov kev pab cuam ntsuam xyuas cov kev pab cuam SDH los ntawm kev soj ntsuam, pab pawg tsom xam, lossis cov ntaub ntawv ntsuam xyuas nruab nrab ntawm pab pawg.Cov kev ntsuas feem ntau siv hauv kev ntsuam xyuas qhov project yog cov tub ntxhais kawm cov lus teb thiab kev txaus siab, kev paub txog tub ntxhais kawm, thiab cov tub ntxhais kawm tus cwj pwm [9], tab sis ib qho qauv thiab siv tau zoo rau kev ntsuam xyuas cov phiaj xwm kev kawm SDH tseem tsis tau tsim.Txoj kev tshawb no qhia txog cov kev hloov pauv mus ntev hauv kev ntsuam xyuas thiab kev txhim kho txuas ntxiv mus ntxiv thiab yuav pab txhawb rau kev txhim kho thiab kev ntsuam xyuas ntawm SDH cov kev pab cuam ntawm lwm lub tsev kawm ntawv.
Txawm hais tias cov tub ntxhais kawm qhov kev xav ntawm tag nrho cov kev xav tau nce ntxiv nyob rau lub sijhawm kawm, qhov feem pua ntawm cov tub ntxhais kawm sau cov lus ceeb toom tseem tsawg.Lwm txoj hauv kev sociological yuav tsum tau tsim los txhim kho ntxiv.Cov haujlwm hauv SDH xav kom cov tub ntxhais kawm koom nrog kev xav txog kev noj qab haus huv thiab kev kho mob, uas txawv ntawm qhov nyuaj piv rau cov qauv kho mob [14].Raws li peb tau hais los saum toj no, nws yog ib qho tseem ceeb los muab cov kev kawm SDH rau cov tub ntxhais kawm theem siab, tab sis kev npaj thiab txhim kho cov kev kawm pib thaum ntxov hauv kev kho mob, tsim kev xav txog kev noj qab haus huv thiab kev kho mob, thiab kev sib koom ua ke tuaj yeem ua tau zoo hauv kev txhawb nqa cov tub ntxhais kawm kev nce qib.'kev loj hlob.To taub SDH.Kev nthuav dav ntxiv ntawm cov kws qhia ntawv cov kev xav txog kev noj qab haus huv kuj tseem yuav pab txhawb cov tub ntxhais kawm xav txog.
Qhov kev cob qhia no muaj ntau yam kev txwv.Ua ntej, qhov chaw kawm tau txwv rau ib lub tsev kawm kho mob hauv Nyij Pooj, thiab CBME qhov chaw tau txwv rau ib cheeb tsam hauv nroog lossis nyob deb nroog Nyij Pooj, xws li hauv peb cov kev tshawb fawb yav dhau los [13, 14].Peb tau piav qhia txog keeb kwm ntawm qhov kev tshawb fawb no thiab cov kev tshawb fawb yav dhau los hauv kev nthuav dav.Txawm hais tias muaj cov kev txwv no, nws tsim nyog sau cia tias peb tau pom cov txiaj ntsig los ntawm SDH cov haujlwm hauv CBME cov haujlwm ntau xyoo.Qhov thib ob, raws li txoj kev tshawb fawb no ib leeg, nws nyuaj rau txiav txim siab qhov ua tau ntawm kev siv cov kev xav paub sab nraud ntawm SDH cov kev pab cuam.Kev tshawb fawb ntxiv yog xav tau los txhawb kev xav txog kev kawm ntawm SDH hauv kev kawm kho mob qib siab.Qhov thib peb, cov lus nug ntawm seb cov kws qhia ntawv txoj kev txhim kho puas muaj txiaj ntsig rau kev txhim kho txoj haujlwm yog dhau ntawm qhov kev xav ntawm qhov kev tshawb fawb no.Kev ua tau zoo ntawm pab pawg kws qhia ntawv xav tau kev kawm ntxiv thiab kev sim.
Peb tau ua qhov kev ntsuam xyuas ntev ntawm SDH kev kawm rau cov tub ntxhais kawm kho mob laus hauv CBME cov ntaub ntawv kawm.Peb qhia tias cov tub ntxhais kawm txoj kev nkag siab ntawm SDH txuas ntxiv mus tob zuj zus thaum txoj haujlwm loj hlob tuaj.Kev txhim kho SDH cov kev pab cuam yuav xav tau sijhawm thiab siv zog, tab sis kev txhim kho tus kws qhia ntawv txhawm rau txhim kho cov kws qhia paub txog SDH tuaj yeem ua tau zoo.Txhawm rau txhim kho cov tub ntxhais kawm txoj kev nkag siab ntawm SDH, cov chav kawm uas muaj kev koom ua ke ntau dua rau hauv social sciences thiab tshuaj yuav tsum tau tsim.
Tag nrho cov ntaub ntawv txheeb xyuas thaum lub sijhawm kawm tam sim no muaj los ntawm tus kws sau ntawv raws li kev thov tsim nyog.
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Post lub sij hawm: Oct-28-2023