创建促进青少年身心健康的社区护理服务体系的构想

青少年时期人的心理生理都处于不断变化的阶段,是人生的不稳定时期。青少年身心健康成长关系到整个社会的稳定和发展,因此青少年的身心健康问题应得到广泛的关注。欧美等一些国家已经建立了专门服务于青少年的医疗卫生服务体系例如美国的SBHCs组织,我国公共卫生服务体系还不十分完善,因此没有相关组织结构的建立,这个问题应该得到广大医疗卫生战线的人员来重视,相关问题还有待于探索研究。本文就关于创建提高青少年心理健康的社区护理服务体系的意义和如何创建提高青少年心理健康的社区护理服务体系的设想等问题发表了一些个人粗浅的见解。     

我国现行医疗卫生政策的相关问题分析

医疗卫生是构建和谐社会的重要因素之一,也是关乎百姓切身利益的重大问题之一,近年来,医疗体制的不断改革,医疗卫生的相关政策的不断出台,已经大大地改善了我国广大人民群众的“看病难,看病贵”等问题,增加了医保的覆盖人群,减轻了城市低收入人群及农村的医疗负担,但是,我们仍面临着巨大的挑战,新的问题也不断涌现,医疗卫生政策不适应现在的医疗需求发展、经济发展不均衡、不同层次群众的医疗需求有差异等,都是医疗卫生改革中面临的问题,医疗改革的不断推进势在必行。我国的医疗保障制度覆盖率已经达到95％,但是,现行的医疗保障制度的还不能从根本上解决人民群众的“就医难,治病贵”的问题,其他医疗保险不能与现行的医疗保障制度相适应,从而,影响了我国整体的医疗水平的提高。     

Reflections on the Surgeon General's Report on Mental Health,Culture, Race,and Ethnicity

The main goal of this paper is to evaluate the Supplement to the Surgeon General's Report on Mental Health, with an eye toward informing future efforts to prevent and treat mental illness among racial and ethnic minorities. I first briefly discuss the historical background of the Supplement. I then present its strengths, which include the authority and visibility of the Office of the Surgeon General, the organization of the report by racial/ethnic group, the examination of the social and historical context of each of the racial/ethnic groups, and the emphasis on science. Last, I identify three major tensions within the Supplement, focusing on groups versus cultural processes, situating culture within individuals or social worlds, and examining differences between minority groups and whites versus examining conceptually informed processes. The Supplement makes a significant contribution to advancing our understanding of the mental health of racial and ethnic minority groups. The actions that follow (or don't follow), however, will determine the import of this document.     

The Unknown Role of Mental Health in Global Development

In this paper, the author contrasts the substantial impact of mental health problems on global disability with the limited attention and resources these problems receive. The author discusses possible reasons for the disparity: Compared to physical disorders, mental health problems are considered less important, perhaps due to lower priority of disorders that primarily cause dysfunction rather than mortality, and skepticism that mental disorders are treatable in low-resource countries. He argues that achieving improved global health and development requires addressing problems causing disability, particularly mental health problems among populations in which the common mental disorders are frequent due to deprivation, war, and disasters. The author contends that services addressing the common mental disorders could be made widely and relatively cheaply accessible if provided by non-professional workers at the community level.     

公立医院纵向整合对医疗质量的影响研究

通过设定胃溃疡患者主诊断治疗效果和住院日的影响函数,利用样本整合前1年与整合后4年的相关数据,通过Logistic回归和多元线性回归分析了医院纵向整合对医疗质量的影响。结果发现,医院纵向整合对整合医院的治疗效果从整合后的第4年开始有显著性影响,对住院日没有显著性影响。     

The Impact of Therapeutic Riding for People with Disabilities on Variables Related to Mental Health

Substantial anecdotal evidence and some research indicate that therapeutic riding for people with disabilities has a positive impact on mental health. There is similar evidence showing that equine programs that include a psychotherapeutic component also have a positive impact. However, much of the existing research has many methodological problems, the most common being the absence of a comparison or control group. Therefore the present study investigated the mental health benefits of therapeutic riding for people with disabilities in comparison to therapeutic skiing for people with disabilities. The age range of participants was 16 to 70 years. They had a wide range of physical disabilities. In a quasi-experimental pre-test post-test design, all participants completed The Beck Depression Inventory, The Beck Anxiety Inventory, and The Rosenberg Self-Esteem Scale. They also completed an adjective checklist, consisting of 26 items that focused on mood, emotion, and sense of self. Open-ended interviews were conducted with a subset of riders. In addition, the riders completed the Pet Attitude Scale (PAS-M). Scores on the PAS-M were not related to the three psychometric measures. Both groups improved on the three psychometric measures during the course of their respective programs. Although the improvement was statistically significant, it was not clinically significant. Contrary to the hypothesis, there was no difference in improvement between riders and skiers on these measures. However, on the adjective checklist riders felt more positive regarding 21 of the 26 items, and of those 21, eight were statistically significant. The interview data suggest that the riding program improves motivation, relationship building, and self-esteem. Although these results must be interpreted with caution, due to the exploratory nature of the checklist and the interviews, they suggest that equine activities have a positive impact for people with disabilities and may have a greater impact than other activities for some aspects of mental health. However, the positive impact may be related to general wellbeing rather than psychopathology per se.     

我国少数民族孕产妇孕期保健及其健康现状综述

孕产妇孕期保健及孕产妇健康对促进安全分娩和优生优育起着十分重要的作用,随着我国孕产妇保健工作的进一步完善及国家二胎政策的实施,现代临床医学所倡导的优生优育的观念已逐渐被社会广泛认可。然而,我国少数民族地区多有经济落后、地理位置偏僻、思想观念陈旧等问题,导致我国少数民族孕产妇孕期保健水平还比较低下,孕产妇健康状况有待改善。为预防少数民族地区出生缺陷,降低出生缺陷率,提高优生率,提高少数民族地区出生人口素质,通过完善医疗制度,改善医疗环境,合理营养干预及加强家庭访视等相关健康教育促进孕期保健,提高孕前检查的依从性,实现优生,孕产期健康教育可以降低整个孕期出现的危险因素,本文对我国少数民族的孕产妇孕期保健及健康做一综述。     

Obesity and the Use of Health Care Services

Objective: This study investigated differences in the use of health care services and associated costs between obese and nonobese patients. Research Methods and Procedures: New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of medical services and related charges was monitored for 1 year. Data collected included sociodemographics, self‐reported health status using the Medical Outcomes Study Short Form‐36, evaluation for depression using the Beck Depression Index, and measured height and weight to calculate BMI. Results: Obese patients included a significantly higher percentage of women and had higher mean age, lower mean education, lower mean health status, and higher mean Beck Depression Index scores. Obese patients had a significantly higher mean number of visits to both primary care (p = 0.0005) and specialty care clinics (p = 0.0006), and a higher mean number of diagnostic services (p < 0.0001). Obese patients also had significantly higher primary care (p = 0.0058), specialty clinic (p = 0.0062), emergency department (p = 0.0484), hospitalization (p = 0.0485), diagnostic services (p = 0.0021), and total charges (p = 0.0033). Controlling for health status, depression, age, education, income, and sex, obesity was significantly related to the use of primary care (p = 0.0364) and diagnostic services (p = 0.0075). There was no statistically significant relationship between obesity and medical expenditures in any of the five categories or for total charges. Discussion: Obesity is a chronic condition requiring long‐term management, with an emphasis on prevention. If this critical health issue is not appropriately addressed, the prevalence of obesity and obesity‐related diseases will continue to grow, resulting in escalating use of health care services.     

Mental health in primary care for adolescent parents

Mental health care is important for everyone, especially teenagers. However, seeking mental health services may be challenging for teenagers, particularly when they are also parents. Offering mental health care in a safe, attractive and easily accessible manner, such as primary care, increases the chances that teenage parents will receive help. Comprehensive care models need to be established to address the many needs that at-risk young mothers and their children face. There are a number of programmes available to teenage mothers that either address healthcare and psychosocial needs or focus primarily on improvements in parenting skills; yet an integrated model that delivers medical, psychiatric and psychosocial care and facilitates positive parenting skills seems to be missing. Through a university–community partnership we have recently developed a model curriculum – the Mom Power (MP) group programme – at the University of Michigan which aims to close this gap in service delivery. We elaborate on core elements and key features of this 10-week group intervention programme for high-risk teenage mothers and their children, and present preliminary outcomes data. Analyses on the first 24 MP group graduates suggest that despite ongoing life trauma during the intervention period, teenage mothers show improvements in depression and post-traumatic stress disorder symptoms post intervention, and also self-rate as less guilty and shameful regarding their parenting skills after programme completion. Although preliminary, due to design and statistical limitations, these results show promise regarding feasibility and effectiveness of this integrated approach for teenage mothers with young children delivered through primary care.     

通过患者满意度调查评价护理质量

目的:通过患者满意度调查,进一步了解我院护理工作中的成效及存在问题,评价护理工作的质量,探索医院管理中护理科学管理方法。方法:①住院病人:采用问卷调查法;②出院病人:采用电话或上门随访方法;两种方法共对568例进行满意度调查,针对病人反馈的问题进行原因分析,提出改进措施并落实。结果:在疾病宣教及护理质量方面存在问题。结论:以医院管理年及创建优质护理服务为契机,以病人为中心,以质量为核心,逐步完善各项护理规章制度,加强护理安全管理,强化"三基三严"的训练,努力改善护理管理,提高护理服务质量。     

老年患者术后急性精神障碍临床观察与护理体会

目的：观察老年术后急性精神障碍发生的相关原因并总结护理要点。方法：回顾分析老年术后发生急性精神障碍的相关因素包括手术与麻醉时间、术前合并症和术后并发症等。结果：术后急性精神障碍与多种因素相关。与全身麻醉以及术后不良的环境因素密切相关,其他原因包括年龄、术前合并症以及术后并发症的发生等。术后必要的药物治疗以及术后的心理护理是护理工作的关键,患者信赖的医护人员以及亲友的安慰交流有防治效果。结论：老年病人术后精神障碍的发生对围手术期病人的治疗康复具有一定的负面影响,应当引起医护人员的重视并采取有效防治对策。     

爱心饲养对大熊猫心理健康及配种受孕率的影响

大熊猫在人工饲养条件下,单调、狭小的生存空间和伸手即来的食物使大熊猫的生活也变得单调而枯燥,不少饲养大熊猫的单位都存在较严重的种群健康下降问题.     

老年患者术后急性精神障碍临床观察与护理体会

目的:观察老年术后急性精神障碍发生的相关原因并总结护理要点。方法:回顾分析老年术后发生急性精神障碍的相关因素包括手术与麻醉时间、术前合并症和术后并发症等。结果:术后急性精神障碍与多种因素相关。与全身麻醉以及术后不良的环境因素密切相关,其他原因包括年龄、术前合并症以及术后并发症的发生等。术后必要的药物治疗以及术后的心理护理是护理工作的关键,患者信赖的医护人员以及亲友的安慰交流有防治效果。结论:老年病人术后精神障碍的发生对围手术期病人的治疗康复具有一定的负面影响,应当引起医护人员的重视并采取有效防治对策。     

神木“全民免费医疗”的可推广性探讨

神木模式是我国＂全民免费医疗＂的一次创造性探索,虽然它不是真正意义上的全民免费医疗制度,但对比目前新医改推广的＂全民医保＂制度而言,它在解决群众＂看病难、看病贵＂的问题上起到更积极的作用,对全国也起着一定的借鉴意义。     

Use of the Health and Activities Limitation Index as a Measure of Quality of Life in Obesity

Objective: Obesity reduces the quality of life (QOL); however, quantification of obesity's impact on QOL is cumbersome. Utility indices reduce QOL measurements to a single numerical value that can be used in the calculation of Quality‐Adjusted Life‐Years and the cost effectiveness for obesity treatment. The purpose of this investigation is to assess the sensitivity of the Health and Activities Limitation Index (HALex) utility index to obesity. Research Methods and Procedures: The answers to five questions regarding an individual's self‐perception of his or her health status and information about limitation in daily and work activities were collected from 32,440 adults in the 1998 National Health Information Survey. Answers to the questions were scored and converted to a utility index score ranging from 0 (near‐death state) to 1 (perfect health) with no limitations. Average values for indices corresponding to differing body mass indices were obtained and significance determined by ANOVA. Results: The utility index for normal weight males and females was 0.86 ± 0.19 and fell to 0.68 ± 0.27 for superobese males and 0.60 ± 0.28 in superobese females. Utility indices fell linearly with increasing body mass index and were lower for respondents having obesity‐related comorbid conditions known to reduce the quality of life. Discussion: There is a statistically significant decrease in the QOL with increasing obesity, slightly worse for women compared with men. The Health and Activities Limitation Index can quantitate the effect obesity and its complications have on quality of life.     

神木" 全民免费医疗" 的可推广性探讨

神木模式是我国"全民免费医疗"的一次创造性探索,虽然它不是真正意义上的全民免费医疗制度,但对比目前新医改推广的"全民医保"制度而言,它在解决群众"看病难、看病贵"的问题上起到更积极的作用,对全国也起着一定的借鉴意义。     

陆军青年军人心理素质与人格、心理健康的相关研究

目的：探讨陆军青年军人心理素质与人格、心理健康的关系。方法：整群抽取陆军青年官兵881名,采用军人心理素质量袁、艾森克人格问卷（EPQ）、症状自评量表（SCL-90）进行测评,进行方差分析和相关分析。结果：（1）陆军青年军人心理素质各因子分及总分与EPQ人格问卷中的E分呈显著正相关（p〈0．01）;与N分、P分呈显著负相关（p〈0．01）。高、中、低心理素质水平军人E、P、N得分比较有显著差异（p〈0．05）,表现为在E量表得分上高心理素质组〉中等心理素质组〉低心理素质组;而在P、N量表得分上则反之。（2）陆军青年军人心理素质各因子分及总分均与SCL-90各因子分和总均分呈显著负相关（p〈0．01）。高、中、低心理素质水平军人SCL-90各因子得分比较有显著差异（p〈0．05）,表现为低心理素质组〉中等心理素质组〉高心理素质组。结论：陆军青年军人心理素质与心理健康密切相关,心理素质越高,其心理健康水平也越高。     

The Relationship between Body Weight and Health Care among German Women

Objective: To investigate the relationship between body weight and the use of health care services among women from southern Germany. Research Methods and Procedures: Data were drawn from the 1994 to 1995 Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg survey, covering a population‐representative sample of women 25 to 74 years old (n = 2301). Logistic regression models were used to calculate odds ratios (ORs) for the use of medical services by women with overweight (BMI 25.0 to 29.9 kg/m²) or obesity (BMI ≥ 30 kg/m²) in comparison with normal‐weight women (BMI < 25.0 kg/m²). Results: In multivariable analysis, obese women 50 to 74 years old were more likely than normal‐weight women to delay cancer screening procedures, such as manual breast examination and Papanicolaou smear (OR 0.52, 95% confidence interval 0.37 to 0.74) in the previous 12 months. However, the relationship between obesity and cancer screening was not found to be significant in 25‐ to 49‐year‐old women (OR 0.92, 95% confidence interval 0.62 to 1.36). Neither in the 25‐ to 49‐year‐old age group nor in the 50‐ to 74‐year‐old age group were independent relationships between higher body weight and total physician visits, hospitalizations, or medication use observed. Discussion: Obese women tended to use medical services with greater frequency due to obesity‐related diseases. However, postmenopausal women with a BMI ≥ 30 kg/m² were more likely to delay routine cancer screening, putting them at a greater risk for death from breast, cervical, and endometrial cancer. Thus, obese postmenopausal women should be targeted for increased screening.