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Sickle cell disease telemedicine network for rural outreach

JOURNAL OF TELEMEDICINE AND TELECARE 2000年第5期6卷 285-290页

作者： Woods, KF Johnson, JA Kutlar, A Daitch, L Stachura, ME Med Coll Georgia MCG Sickle Cell Ctr Dept Med Augusta GA 30912 USA Med Coll Georgia Telemed Ctr Dept Med Augusta GA 30912 USA

The Medical College of Georgia (MCG) Sickle Cell Center in Augusta, Georgia, USA, provides consultation and (in some cases) primary-care services to more than 1000 patients with sickle cell disease (SCD). Three SCD telemedicine clinic sites were established in rural areas of middle and southern Georgia, based on clinical need;a fourth site had been proposed. Over a 36-month study period, 77 telemedicine SCD clinics were held. There was a mean of 6.1 (SD 2.5) encounters per clinic and 466 total encounters among 128 SCD patients. By using telemedicine, the productivity of the MCG adult sickle cell clinic increased from 1413 to 1889 encounters a year, with an increase in rural outreach activity from 271 to 745 encounters a year. This was accomplished with the addition of a single physician assistant during the last 12 months of the study period;otherwise provider staffing was unchanged. A formal cost-benefit analysis now needs to be carried out.

关键词：贫血镰状细胞性/治疗社区卫生服务/组织和管理佐治亚门诊部医院/组织和管理病人接受卫生保健的程度病人满意度乡村卫生服务/组织和管理乡村卫生服务/标准远程医学青少年成年人女(雌)性人类男(雄)性中年人

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The prevalence of hospital health promotion and disease prevention services: Good news, bad news, and policy implications

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MILBANK QUARTERLY 2000年第1期78卷 115-+页

作者： Olden, PC Clement, DG Univ Scranton Panuska Coll Profess Studies Grad Hlth Adm Program Scranton PA 18510 USA Virginia Commonwealth Univ Richmond VA 23284 USA

In recent years, American health care has shifted toward an emphasis on population health in communities. National data from the American Hospital Association Annual Survey of Hospitals are used to describe the prevalence of 26 services provided by general hospitals that could contribute to health promotion and disease prevention (HPDP). Cross-sectional descriptive analyses, based on national data sources, linked HPDP services to hospital characteristics, and factor analysis identified significant categories of HPDP activities. The results showed that many specific HPDP services are offered by thousands of hospitals, but prevalence, distribution, and availability of the services are uneven across the size and ownership of hospitals and their communities. Policy initiatives could increase the prevalence of hospitals' health promotion and disease prevention services, thereby improving the health status of their communities.

关键词：美国医院协会社区卫生服务/组织和管理卫生政策健康促进/方法医院/统计学和数值数据预防卫生服务/统计学和数值数据美国人类

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Community-based early intervention: The Coimbra Project (Portugal)

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CHILD CARE HEALTH AND DEVELOPMENT 2000年第5期26卷 343-353页

作者： Boavida, J Espe-Sherwindt, M Borges, L Coimbra Childrens Hosp Child Dev Ctr Coimbra Portugal Family Child Learning Ctr Tallmadge Tallmadge OH 44278 USA

The Coimbra Early Intervention Project was undertaken to develop the first co-ordinated, multidisciplinary, interagency programme involving health care, education and social services, using existing resources in the community. The programme operates region wide and supports annually about 160 families and children with disabilities or at risk. Thirty-three per cent of the 601 children served so far had developmental delay, 22% belonged to high-risk families and 45% had risk factors and disabilities. In spite of difficulties, the programme success has increased awareness of the need to integrate and co-ordinate multiple community services and to develop legislation for the provision of early intervention services.

关键词：儿童保健服务/组织和管理儿童福利社区卫生服务/组织和管理发育障碍葡萄牙规划制订儿童人类

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Complementary therapy use: a survey of community- and hospital-based patients with advanced cancer

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PALLIATIVE MEDICINE 2000年第5期14卷 432-434页

作者： Oneschuk, D Hanson, J Bruera, E Grey Nuns Community Hosp Reg Palliat Care Program Edmonton AB T6L 5X8 Canada Cross Canc Inst Edmonton AB T6G 1Z2 Canada Univ Texas MD Anderson Canc Ctr Houston TX 77030 USA

Presents the results of a face-to-face survey dealing with complementary therapy use in consecutive advanced cancer patients in the community and in a tertiary palliative care unit. Use of complementary therapies; Reasons for use; Cost of the therapies; Presence of beneficial effects; Influence of involvement with health-care providers.

关键词：社区卫生服务/组织和管理补充疗法/利用住院/统计学和数值数据肿瘤/治疗姑息疗法/方法问卷调查老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Factors affecting home delivery in the Kathmandu valley, Nepal

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HEALTH POLICY AND PLANNING 1998年第2期13卷 152-158页

作者： Bolam, A Manandhar, DS Shrestha, P Ellis, M Malla, K Costello, AM Inst Child Hlth Ctr Int Child Hlth London WC1N 1EH England Matern Hosp MIRA Project Kathmandu Nepal

This nested case-control study compares the characteristics of mothers having home or institutional deliveries in Kathmandu, Nepal, and explores the reasons given by mothers for a home delivery. The delivery patterns of mothers were identified in a cross-sectional survey of two communities: an urban area of central Kathmandu (Kalimati) and a peri-urban area (Kirtipur and Panga) five kilometres from the city centre. 357 pregnant women were identified from a survey of 6130 households: 183 from 3663 households in Kirtipur and Panga, 174 from 2467 households in Kalimati. Methods involved a structured baseline household questionnaire and detailed follow-up of identified pregnant women with structured and semi-structured interviews in hospital and the community. The main outcome measures were social and economic household details of pregnant women;pregnancy and obstetric details;place of delivery;delivery attendant;and reasons given for home delivery. The delivery place of 334/357 (94%) of the pregnant women identified at the survey was determined. 272 (81%) had an institutional delivery and 62 (19%) delivered at home. In univariate analysis comparing home and institutional deliverers, maternal education, parity, and poverty indicators (income, size of house, ownership of house) were associated with place of delivery. After multivariate analysis, low maternal educational level (no education, OR 5.04 {95% CI 1.61-15.8}, class 1-10, OR 3.36 {1.04-10.8} compared to those with higher education) and multiparity (OR 3.1 {1.63-5.74} compared to primiparity) were significant risk factors for a home delivery. Of home deliverers, only 24% used a traditional birth attendant, and over half were unplanned due to precipitate labour or lack of transport. We conclude that poor education and multiparity rather than poverty per se increase the risk of a home delivery in Kathmandu. Training TBAs in this setting would probably not be cost-effective. Community-based midwife-run delivery units

关键词：病例对照研究社区卫生服务/组织和管理社区卫生服务/利用产房/标准产房/统计学和数值数据产房/利用人口统计学教育程度卫生保健调查家庭分娩/标准家庭分娩/统计学和数值数据家庭分娩/利用产妇死亡率助产学尼泊尔/流行病学病人接受卫生保健的程度/统计学和数值数据危险因素成年人女(雌)性人类妊娠

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Community-directed, ivermectin-treatment programmes for onchocerciasis control in Uganda: the selection and validation of indicators for monitoring sustainability at the district level

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ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 1999年第6期93卷 653-658页

作者： Katabarwa, MN Mutabazi, D Global 2000 River Blindness Program P.O. Box 12027 Uganda Global 2000 River Blindness Program P.O. Box 12027 Uganda

The selection and validation of indicators for predicting and monitoring sustainment in community-directed, ivermectin-treatment programmes (CDITP) at the community level in the Kabale, Kisoro and Rukungiri districts of Uganda have already been reported. The aim of the present study was to select and validate similar indicators at the district level, in the same districts over the same 4-year period. Three dependent-variable scales of programme sustainability (PS), PS1, PS2 and PS3, were compared by district. As at the community level, Rukungiri district clearly performed better than Kabale or Kisoro. Cost variables compiled at the district level and the ratios of numbers of community-based distributors (CBD) to community members were used as input variables in regression and correlation models, with PS1, PS2, and PS3 as outcome variables. In the regression model, cost of training CBD was found to be statistically significant (P = 0.0186). This variable also scored 100% on a scale for programme-indicator sensitivity and hence was selected as a helpful indicator. In the correlation model, cost of health education of community members had a weak relationship with PS1 (P = 0.0662). Cost of training CBD had a significant negative correlation with PS2 (P = 0.0186), indicating that reducing the cost of training would facilitate sustainability. PS3 showed weak negative correlations with cost of health education of community members (P = 0.0586) and cost/person treated in the district (P = 0.0584). Sustainment of CDITP might be better, therefore, if the costs per person could be reduced. As correlation relationships may not be linear, however, they were not considered particularly useful in the selection of helpful indicators.

关键词：社区卫生服务/组织和管理社区卫生服务/标准疾病管理抗丝虫药/治疗应用伊维菌素/治疗应用盘尾丝虫病/流行病学盘尾丝虫病/预防和控制方案评价乌干达/流行病学人类

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Integrated institution - community rehabilitation in developed countries: a proposal

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DISABILITY AND REHABILITATION 2000年第6期22卷 266-274页

作者： Eldar, R Loewenstein Hosp & Rehabil Ctr Fleischman Unit Study Disabil Rehabil Ctr IL-43000 Raanana Israel

Purpose: To propose a system for the provision of comprehensive, coordinated rehabilitation services that would meet all the needs of persons with disability in a timely and cost-effective manner. Methods: Study of the literature pertaining to features of settings available for the delivery of medical rehabilitation in developed countries;presentation of the evolution of a tertiary rehabilitation centre into an institution practicing community-oriented rehabilitation. Review of various issues and implications of integrating institutional-based and community-based rehabilitation. Results: Rehabilitation settings differ in skills and resources and consequently, in the treatment, care and concern they are able to offer. It is essential to find the balance between medical, nursing and social needs of persons with disability and their requirements for skills and resources at a given time, and to provide rehabilitation, support and guidance in the setting most appropriate to these requirements and needs at the lowest cost possible. Conclusion: The integration of the rehabilitation institution of a region with secondary and primary care of the region, into one functional entity for the purposes of providing the needed services, would enable finding the most appropriate setting, and facilitate addressing all needs, as well as increase the availability and accessibility of comprehensive rehabilitation at an affordable cost. This could be a viable way of providing rehabilitation in developed countries of Europe, where the need for it is expected to rise in excess of the population increase.

关键词：社区卫生服务/组织和管理病人医护连续性/组织和管理发达国家残疾人以色列康复/组织和管理人类

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Counseling: Implementing our knowledge in a hurried and complex world

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AMERICAN JOURNAL OF PREVENTIVE MEDICINE 1999年第4期17卷 295-298页

作者： Kottke, TE Edwards, BS Hagen, PT Mayo Clin & Mayo Fdn Dept Med Rochester MN 55905 USA

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Surgery and community participation in a community-based programme in war situations

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TROPICAL DOCTOR 2000年第1期30卷 20-23页

作者： Makender, E Qasim, S Meo, G Alpha Civil Hosp Com Collaboraz Med Billing Sudan

The paper presents the results and the experience gained from three 'mass surgical interventions' conducted in the Alpha Civil Hospital, Billing in south Sudan in the period between October 1996 and November 1997. The results showed that surgical services can be provided safely and economically even under most difficult conditions provided professional experience plus community commitment and participation are there. Such interventions lead to the development of strong community self-reliance and willingness which are fundamental if the programme is to be sustained.

关键词：社区卫生服务/组织和管理用户参与/方法用户参与/统计学和数值数据救灾计划/组织和管理方案评价苏丹外科手术/方法外科手术/统计学和数值数据战争人类

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The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain

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HEALTH POLICY AND PLANNING 1999年第1期14卷 49-58页

作者： Jamil, K Bhuiya, A Streatfield, K Chakrabarty, N USAID Bangladesh Amer Embassy Dhaka Bangladesh Johns Hopkins Univ Dept Populat Dynam Baltimore MD 21218 USA Int Ctr Diarrhoeal Dis Res Dhaka Bangladesh Populat Council Dhaka Bangladesh

The paper reviews the achievements in tetanus immunization coverage and child immunization in Bangladesh. It uses data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and non-programmatic factors that influence the coverage of tetanus (TT) immunization during pregnancy, and full immunization among children 12-23 months old in rural Bangladesh. The purpose of this analysis is to identify the areas that need further programme attention. The logistic regression results show that the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health/family planning fieldworkers and the proximity to outreach clinics had larger influences on TT coverage of poorer households compared to those better-off. The effect of distance to static clinics varied by regions. Among children, full immunization coverage (coverage of all of BCG, DPT1, DPT2, DPT3, Polio1 Polio2, Polio3) was significantly associated with distance to outreach clinics, the greater the distance to the clinics, the less the likelihood of immunization.

关键词：孟加拉国社区卫生服务/组织和管理发展中国家卫生服务研究免疫接种规划/组织和管理免疫接种规划/发展趋势免疫接种规划/利用 Logistic模型病人接受卫生保健的程度/统计学和数值数据产前保健/标准产前保健/统计学和数值数据方案评价农村人口社会经济因素破伤风类毒素/投药和剂量成年人儿童女(雌)性人类婴儿妊娠

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