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中国临床康复 2005年第28期9卷 24-26页

作者：谭斌向恩平何宇芬湖北民族学院医学院精神医学教研室湖北省恩施市445000 恩施市精神病医院一病区湖北省恩施市445000

目的:探讨社区管理防治精神分裂症患者疗效的影响,以及对患者经济因素的影响。方法:纳入2003-05/2004-06恩施市社区精神分裂症患者160例,随机分为社区观察组和对照组,每组80例,采用前瞻性对照观察,随访1年。社区观察组:均登记建卡纳入... 详细信息

目的:探讨社区管理防治精神分裂症患者疗效的影响,以及对患者经济因素的影响。方法:纳入2003-05/2004-06恩施市社区精神分裂症患者160例,随机分为社区观察组和对照组,每组80例,采用前瞻性对照观察,随访1年。社区观察组:均登记建卡纳入防治康复网络,制订康复方案,并成立社区治疗小组。具体措施有:①药物康复:给予肌注长效制剂或口服维持剂量的抗精神病药物,用药剂量折合成氯丙嗪效价为(238±9.67)mg/d。②实施家庭干预:对康复对象及家庭成员予以现场指导,包括集体家庭教育和个别家庭治疗。③职业康复:强调治疗的最终目的是恢复技能,重返社会。④进行追踪随访对患者每月的临床症状、用药情况、医疗费用支出、家庭经济收入等情况记录。对照组:发作期去医院治疗。患者住院期间接受常规药物治疗,药物治疗剂量折合成氯丙嗪效价为(242±10.53)mg/d。采用简明精神病评定量表、社会功能缺陷筛选量表进行疗效评定,分别于治疗前、中(6个月)、后(12个月)各评定1次。进行正态性检验、方差分析、χ2检验,比较1年前后临床症状变化、医疗费用及其他经济损失情况。结果:①1年末,社区观察组的简明精神病评定量表、社会功能缺陷筛选量表评分较入组前及对照组同期明显降低(25.01±12.17,32.42±13.69,31.69±12.33;3.61±2.17,7.41±3.12,10.31±2.49;t=2.12～7.93,P<0.05～0.01);且6个月末社区观察组社会功能缺陷筛选量表总分明显低于对照组(5.41±2.05,9.31±4.16,t=3.76,P<0.01)。②社区观察组患者药物治疗规则率由25例(31.0%)提高到73例(91.0%),而对照组药物治疗规则率仅维持在26例(33%)。社区观察组复发2例(3%),对照组复发14例(18%),两组比较差异有显著性意义(t=3.16,P<0.05)。③社区观察组患者的缺勤天数比对照组患者平均下降7.7d/个月,折合23l元/个月;患者家属缺勤天数平均下降2.3d/个月,折合59元/个月,平均每人减少间接费用290元/个月。对照组1年中有23人次住院治疗,合计住院费57271.70元,社区观察组无住院治疗人次,治疗费用显著低于对照组(t=2.86,P<0.01)。结论:精神分裂症患者经社区管理和规范防治,可改善临床症状,降低复发率,减少医疗费用支出,有利于患者的社会康复。

关键词：社区卫生服务/组织和管理社会经济因素精神卫生服务治疗结果

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Integrating oral health into primary health care - experiences in Bangladesh, Indonesia, Nepal and Tanzania

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INTERNATIONAL DENTAL JOURNAL 1999年第4期49卷 240-248页

作者： Helderman, WV Mikx, F Begum, A Adyatmaka, A Bajracharya, M Kikwilu, E Rugarabamu, P Nijmegen The Netherlands Dhaka Bangladesh Jakarta Indonesia Kathmandu Nepal Dar es Salaam Tanzania [*]WHO Collaborating Centre Dentistry 117 Postbus 9101 6500 HB Nijmegen The Netherlands

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

关键词：孟加拉国社区卫生服务/组织和管理卫生保健提供联合牙科医疗/分类牙科医疗/经济学牙科医疗/组织和管理牙科保健服务/组织和管理发展中国家/经济学财政支持健康教育牙科健康计划健康促进卫生资源/经济学卫生资源/组织和管理卫生服务易得程度/组织和管理印度尼西亚口腔疾病/预防和控制国家卫生规划/组织和管理尼泊尔口腔保健初级卫生保健/经济学初级卫生保健/组织和管理乡村卫生服务/组织和管理坦桑尼亚人类

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Evaluating the impact on public policy of foundation-sponsored programs in the health professions

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EVALUATION & THE HEALTH PROFESSIONS 1999年第3期22卷 342-357页

作者： Knott, JH Weissert, CS Henry, RC Univ Illinois Chicago IL 60680 USA Michigan State Univ E Lansing MI 48824 USA

The leaders of national philanthropic foundations have long been active in informing public policy makers about their organizations' accomplishments and lessons learned in health care and other issues. The public policy context also is seen increasingly as an important factor influencing changes in the health care market. This article outlines how public policy,cas monitored and evaluated in a recent initiative in health care by a prominent national foundation. The markers of policy change in the evaluation of this initiative represented a mixture of the initiative's efforts to inform policy makers, the success the participant projects had in making policy makers aware of the initiative's goals, and actual changes in policy outcomes. (C) 1999 Sage Publications, Inc.

关键词：卫生保健辅助人员/教育社区卫生服务/组织和管理财政支持基金会卫生服务研究方案评价/方法政府政策美国人类

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A community diabetes education and gardening project to improve diabetes care in a Northwest American Indian tribe

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DIABETES EDUCATOR 2000年第1期26卷 113-120页

作者： Armstrong, DL SUNY Albany Dept Epidemiol SPH Rensselaer NY 12144 USA

PURPOSE the purpose of this study was to design a culturally appropriate education program for a Northwest American Indian tribe. METHODS Needs assessment revealed that a community approach rather than clinic-based education would address multiple barriers to diabetes care. Both process and outcome information are described for community and individual level evaluations. RESULTS This intervention design consisted of community diabetes workshops called "How Healthy Am I?-Treating the Whole Person." The workshops represented a traditional view of health and included 4 specific themes: (1) taking care of the body, with an emphasis on diabetes care and physical activity;(2) mental health needs;(3) foods for healthy living;and (4) spirituality and healing the whole person. Workshops were designed to be social and informational, and involve all community members. A community garden was established to improve access to fresh produce and encourage exercise. CONCLUSIONS Prior to implementation of the community workshops and evaluations, the tribal government chose to discontinue receiving the federal funding for this project. Elements of a mutually respectful collaboration are outlined and discussed based on the experiences of this project.

关键词：农业健康态度/人种学社区卫生服务/组织和管理用户参与糖尿病/人种学糖尿病/预防和控制水果印第安人北美洲/教育印第安人北美洲/心理学需求估价美国西北部营养生理学/教育结果与过程评价(卫生保健) 方案评价蔬菜成年人老年人女(雌)性人类男(雄)性中年人

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Development of a community-based diabetes management Program for Pacific Islanders

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DIABETES EDUCATOR 1999年第5期25卷 738-746页

作者： Wang, CY Abbott, L Goodbody, AK Hui, WTY Rausch, C Univ Hawaii Dept Nursing Sch Nursing Honolulu HI 96822 USA

PURPOSE this study examined the perception of diabetes among a sample of Pacific Islanders in Honolulu, Hawaii. All 23 participants were diagnosed with type 2 diabetes, ranged in age from 22 to 70 years, and had glycosylated hemoglobin levels of 5.8% to 13.9%. METHODS Four focus groups were held in English and audiotaped. Outreach workers served as translators and comoderators. The content of transcripts was analyzed with Ethnograph software by investigators. The priority issues were confirmed by the comoderators and participants. RESULTS Participants perceived diabetes as full of complications, emotions, symptoms, and behavior changes. Responses to hyperglycemia were fear, frustration, and uncertainty. Barriers to staying on the prescribed diet were habit, cultural ritual, ideal body image, and limited budget. CONCLUSIONS Participants suggested that helpful activities would include walking/support group, cooking class, community healthy food store, translated material, and family participation. A community-based diabetes program has been developing as a result of the focus group findings.

关键词：健康态度/人种学社区卫生服务/组织和管理糖尿病 2型/血液糖尿病 2型/人种学糖尿病 2型/预防和控制集中研讨小组夏威夷健康知识态度实践需求估价护理方法学研究波利尼西亚/人种学规划制订/方法成年人老年人女(雌)性人类男(雄)性中年人

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Gender issues in the community-directed treatment with ivermectin (CDTI) of the African Programme for Onchocerciasis Control (APOC)

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ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002年第Sup1期96卷 59-74页

作者： Clemmons, L Amazigo, UV Bissek, AC Noma, M Oyene, U Ekpo, U Msuya-Mpanju, J Katenga, S Sékétéli, A African Programme Onchocerciasis Control Ouagadougou 01 Burkina Faso Univ Penn Dept Anthropol Philadelphia PA 19104 USA Univ Yaounde Dept Dermatol Yaounde Cameroon Minist Hlth Onchocerciasis Control Programme Unit Calabar Nigeria Univ Agr Dept Biol Sci Abeokuta Ogun State Nigeria World Bank Washington DC 20433 USA Minist Hlth Natl Onchocerciasis Control Programme Dar Es Salaam Tanzania

This paper reviews the issues relating to compliance and participation among the men and women of three countries within the remit of the African Programme for the Control of Onchocerciasis (APOC): Cameroon, Nigeria and Tanzania. Project-monitoring data from 109 focus-group discussions, 6069 household-survey respondents and 89 interviews with ivermectin distributors were analysed to gain an insight into the attitudes and behaviours of men and women in relation to ivermectin treatment and their participation in the programme. Although there are no statistically significant gender differences in coverages for ivermectin treatment, culturally prescribed gender relationships influence the ways in which men and women express and experience treatment-related behaviours. Gender roles also affect participation in the programme. Decision-making in communities on the selection of distributors tends to follow socio-cultural hierarchies based upon patriarchy and gerontocracy. Relatively few ivermectin distributors (21%) are women. Although they receive less support than their male counterparts, the female distributors are just as willing to continue ivermectin distribution in the community, and they perform as well or better than men in this regard. The terms 'community-directed', 'community participation, and even 'compliance' obfuscate important gender differences that are inherent in the implementation of onchocerciasis control. Development of strategies that recognize these gender differences will have important implications for long-term adherence to treatment and for the overall quality and sustainability, of the programme.

关键词：喀麦隆社区卫生服务/组织和管理抗丝虫药/治疗应用健康调查伊维菌素/治疗应用尼日利亚盘尾丝虫病眼/预防和控制病人依从/人种学性别因素坦桑尼亚女(雌)性人类男(雄)性

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Community-based service delivery in rehabilitation: The promise and the paradox

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DISABILITY AND REHABILITATION 2000年第10期22卷 435-445页

作者： Kendall, E Buys, N Larner, J Griffith Univ Ctr Human Serv Nathan Qld 4111 Australia

Purpose: According to many researchers, rehabilitation is being prevented from developing as a distinct profession due to two major problems. First, it has been claimed that rehabilitation is in need of a professional identity and a sense of cohesion if it is to emerge as a discipline. Second, it has been recognized that there is a need for a rehabilitation framework to challenge the restorative approach that continues to dominate rehabilitation, linking it back to the medical model from which it has attempted to escape. The model of community-based rehabilitation (CBR) is offered as a model that can provide the impetus for an attitudinal shift from the restorative tradition and unite rehabilitation workers through a cohesive framework. Method: Unfortunately, the implementation of community based rehabilitation in urban societies has been disappointing. The current paper is a conceptual discussion of community-based rehabilitation that explores some potential causes of this poor implementation. Results: To some extent, the implementation failure of community-based rehabilitation can be attributed to the paradoxes that are inherent in its fundamental constructs-empowerment and community inclusion. These paradoxes occur at a conceptual level, a practical level and a contextual level. Conclusions: Some solutions are offered to enable the paradigm to be implemented more fully. In particular, it is suggested that there is a need to develop useful working definitions of these constructs, favourable attitudes among rehabilitation workers and a focus on community development.

关键词：社区卫生服务/组织和管理卫生保健提供模型理论病人参与康复/组织和管理人类

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Strategies to increase enrollment in children's health insurance programs: A report of the New York Academy of Medicine

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JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE 1999年第2期76卷 247-279页

作者： Andrulis, DP Bauer, TA Hopkins, A New York Acad Med Off Urban Hlth Populat New York NY 10029 USA

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Dowling Oration 2000 - Dermatology patients: what do they really need?

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CLINICAL AND EXPERIMENTAL DERMATOLOGY 2000年第5期25卷 444-450页

作者： Finlay, AY Univ Wales Coll Med Dept Dermatol Cardiff CF14 4XN S Glam Wales

Dermatology services must be organized to meet the needs of patients. These needs change as society changes and medical knowledge increases. Considerable insight into the true needs of individual and groups of patients can be gained from the use of quality of life measures. Patients with widespread inflammatory skin disease are most severely handicapped by their skin disease and can be most helped by dermatology services. It is essential that such patients be given priority in the delivery of dermatological care. Where necessary, protected clinic time and specialist support services should be created to ensure that such patients are not adversely affected by pressures to review patients in other diagnostic groups.

关键词：社区卫生服务/组织和管理卫生服务需求病人依从病人满意度生活质量皮肤疾病/康复人类

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Community-based rehabilitation: the generalized model

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DISABILITY AND REHABILITATION 1999年第10-11期21卷 522-528页

作者： Mitchell, R Univ Sydney Dept Behav Sci Fac Hlth Sci Lidcombe NSW 2141 Australia

This article presents an overview of a generalized approach to rehabilitation services which have come to be known as community-based rehabilitation (CBR). The various administrative and government organizations that may be involved in the delivery of rehabilitation services are identified. Specific attention is given to the various forms of medical referral systems that might exist. In general, rehabilitation services an provided at the community level but more difficult cases. which require more sophisticated approaches, are referred to institutions more closely allied to a central government. This referral system also gives the disabled person access to more specialized personnel and services. The sources of information in this article consist of fundamental and formative primary references from documentation provided by the World Health Organization (WHO). These sources provide a valuable set of historical documents detailing the idealized concept of CBR.

关键词：社区卫生服务/组织和管理残疾儿童/康复残疾人/康复政府规划病人医疗小组初级卫生保健世界卫生组织儿童女(雌)性人类男(雄)性

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