精神残疾人康复需求与康复服务发展状况研究

目的探讨精神残疾人康复需求现状、康复服务的获取及其影响因素,为精神残疾人康复服务发展提供支持。方法采用河南省2016年度全国残疾人基本服务状况和需求实名制专项调查数据,对精神残疾人康复需求现状及康复服务获取情况进行描述性统计分析。结果精神残疾人康复需求主要包括医疗康复、功能训练和辅助器具,其中医疗康复需求率最高(58.99%),功能训练需求率最低(10.08%)。不同年龄、性别、户口性质、残疾等级、受教育程度、就业情况、家庭收入状况、贫困与建档立卡状况的精神残疾人,康复需求存在非常高度显著性差异。精神残疾人的康复服务包括医疗康复服务、功能训练服务、辅助器具服务,其中医疗康复服务获取率最高(25.82%),辅助器具服务获取率最低(3.06%)。精神残疾人康复服务获取受其户口性质、残疾等级、受教育程度、就业情况、家庭收入状况、贫困与建档立卡状况等因素的影响;"家庭经济困难"、"不了解相关知识"、"交通不便"和"其他原因"也对精神残疾人获得康复服务有重要影响。结论精神残疾人康复需求量大,对医疗康复服务需求率最高;康复需求受性别、户口性质、残疾等级等因素影响。精神残疾人康复服务获取率总体较低,医疗康复服务获取率相对较高。精神残疾人康复服务情况受家庭经济状况和交通等其他因素影响。精神残疾人康复需求报告率、康复服务覆盖率、康复服务质量和效率有待提高。     

江西省残疾人康复医疗服务和救助需求调查

目的:对江西省残疾人康复过程中医疗服务需求及其影响因素进行计量分析,试图找到对医疗服务有迫切需求的残疾人群的特征,从而使有限的扶残助残资源能够得到有效的利用。方法:抽取24个县(市、区)5310例残疾人进行调查,利用SPSS统计软件进行分析。结果:曾接受过各种医疗服务、领取救济金、女性、中老年、无工作残疾人及精神与视力残疾者医疗服务需求程度相对较高,残疾人所在社区(村、居委会)没有康复站、拥有残疾人专职委员会或残疾人协会/小组等残疾人组织的需求程度较高。结论:应该增加政府投入,建立健全残疾人组织,扩大康复医疗服务的宣传教育,提高康复医疗服务提供的公平性,并将康复医疗服务重点向女性、中老年、无工作者等相对弱势群体和群众关心的精神残疾等人群倾斜。     

重庆市智力残疾人康复情况分析

目的：了解重庆市智力残疾人的康复状况及其主要需求。方法：以重庆市第二次全国残疾人抽样调查确定的401例智力残疾人为研究对象,按智力残疾的分级进行评定,包括残疾人基本情况、致残原因、康复形式、康复内容、曾接受服务及主要需求等。结果：智力残疾人主要康复形式为社区和家庭服务,主要康复内容为康复训练与服务;主要需求是贫困救助与扶持。结论：加强社区医疗机构建设,提高社区医疗机构的医疗质量及康复训练与服务,是改善智力残疾人生存质量、减少残疾人数的重要手段。     

智力残疾人康复需求与康复服务发展状况研究

目的探讨智力残疾人的康复需求与康复服务发展状况,为开展智力残疾人精准康复服务工作提供支持。方法采用河南省2016年度全国残疾人基本服务状况和需求实名制专项调查数据,对其中167,872名智力残疾人,从医疗服务与救助、辅助器具和康复训练3个方面进行分析。结果 56.4%智力残疾人有康复需求,且不同年龄、户口性质和残疾等级的智力残疾人,康复需求有非常高度显著差异(χ2 976.42, P 0.001)。受人口统计学变量、家庭经济状况、交通状况、对相关知识和信息的了解等因素影响,仅有19.0%智力残疾人获得康复服务。结论智力残疾人康复服务需求大,康复服务覆盖率低。要加大对智力残疾人康复服务的供给,制定精准康复服务实施方案,提高智力残疾人康复服务质量。     

重庆市残疾人家庭医生签约康复服务能力现状分析

目的:了解重庆市残疾人家庭医生团队的康复服务能力现状,为残疾人家庭医生团队康复服务能力的提升提供可行性建议。方法:基于世界卫生组织(WHO)《健康服务体系中的康复：行动指南》配套工具“康复现状系统评估配套工具-康复信息收集模板”,按照重庆市残疾人联合会的相关要求,对重庆市11个区县的187位家庭医生团队成员进行问卷调查,对数据进行描述性分析。结果:参与调查的家庭医生团队成员中,团队内有护理人员(93.05%)、全科医生(84.49%)、公卫医生(82.35%)和乡村医生(74.87%)的占比较高,有康复医生(29.95%)和康复治疗师(16.58%)的较少;从年龄段看,18～30岁(34.48%)和31～40岁(37.97%)人数较多;从学历看,本科生最多占比高达60.96%。从有效收回的172份问卷分析来看,各残疾类别开展较多的为支持性服务中的康复知识培训、心理辅导、康复咨询,其中盲人和低视力分别为40.70%和52.33%、精神残疾为53.49%、智力残疾为60.47%、听力残疾为33.72%,肢体残疾为50%;且未开展任何服务的比例也较高,其中视力残疾为35.47%、精神残疾为3...     

广东省残疾人社会参与状况与康复需求的关系

目的对广东省各类残疾人的社会参与状况与康复需求的调查数据进行分析,探讨各类残疾人不同程度社会参与状况与康复需求的关系,并提出相应的康复对策。 方法采用广东省第2次全国残疾人抽样调查中残疾人社会参与评定的分项目,以及个人主要需求的调查数据进行等级资料比较的统计处理。 结果听力、视力、肢体、智力残疾人不同社会参与状况在本人主要需求上的构成比差异有统计学意义,而言语、精神残疾人不同社会参与状况在本人主要需求的构成比差异无统计学意义。各类残疾人不同社会参与状况相对应的康复需求以医疗服务及救助、辅助器具配送和康复功能训练及服务为主。 结论各类残疾人不同社会参与状况与康复需求的差异不尽相同,主要集中在医疗服务及救助、辅助器具配送和康复功能训练及服务等基本医疗和社会的需求方面,可为采取相应的康复对策提供依据。     

残疾人职业满意度调查

目的调查研究残疾人工作满意度的现状及影响因素,了解残疾人的就业质量。方法采用明尼苏达满意度问卷随机对湖南省某公司各个车间及岗位的79名残疾员工进行调查。结果残疾人的总体满意度得分是67.78,最不满意的地方是工作的灵活变化性和工作条件。性别、年龄、工龄、残疾种类对工作满意度影响的差异有统计学意义(P<0.05)。影响残疾人工作满意度的主要因素除性别、年龄、残疾种类外,还有工资。结论工作满意度调查可为残疾人尤其是高危人群的职业康复提供更有针对性的干预措施。     

南皮县残疾人康复需求调查的实施与结果分析

康复需求调查是为广大残疾人提供有针对性社区康复服务的基础和前提。河北省南皮县残联在国际合作项目的帮助下，由县残联牵头，协调卫生等部门，对参加调查的人员进行培训，使他们掌握入户调查的内容、表格填写和统计汇总等方面的知识和方法；组织村医登门入户，到残疾人家中进行康复需求调查，掌握残疾类别、残疾程度和康复需求等情况，用半年时间完成了全县农村残疾人康复需求调查。     

广东省不同等级残疾人的康复需求分析

目的分析不同残疾等级残疾人的康复需求状况,为制定合理的康复与社会辅助对策提供依据。方法对广东省第二次全国残疾人抽样调查中不同残疾类型不同残疾等级人士间的康复需求分项目进行等级资料分析。结果不同等级视力、听力、肢体、智力残疾人间康复需求的构成差别有统计学意义（P〈0.05）,而不同等级言语、精神残疾人间康复需求的构成差别没有统计学意义（P〉0.05）。结论残疾程度越重对医疗服务与救助的需求越高,而对其他康复需求较低甚至没有。     

2006年北京市残疾人抽样调查流行病学特征分析*

目的：了解北京市残疾人现状及流行病学特征。方法：对第二次全国残疾人抽样调查中北京市的调查数据进行现状描述及流行病学特征分析。结果：北京市残疾现患率为6.49%,肢体残疾现患率最高,为2.31%;言语残疾最低,为0.04%。一级、二级残疾人分别占残疾人总数的15.95%和10.49%;三级、四级残疾人分别占28.09%和45.47%。75岁及以上人群残疾现患率最高,为39.98%。残疾年龄别现患率呈现随着年龄增加而增加的趋势。男性视力、精神残疾现患率低于女性,而听力、智力残疾现患率高于女性。农村残疾现患率高     

Mental health policy and integrated care: global perspectives

Although omitted from the World Health Organization's eight Millennium Development Goals, mental illness ranks fourth of the 10 leading causes of disability in the world and is expected to approach second place by 2020. Scarce resources challenge responses to mental health needs. Effective approaches must consider existing healthcare delivery networks, nurses as care providers, as well as social, cultural, political and historical contexts. This paper reviews policy development and care approaches to address mental health needs around the world. Challenges, successes and further needs are discussed. Selected articles were reviewed to represent varied approaches to address mental health needs in countries with diverse resources and infrastructures. Integrated systems offer one model for addressing mental health needs along with physical health needs within a population. While potentially an efficient strategy, caution is advised to ensure services are integrated and not merely added on top of an already overburdened system. As the largest group of healthcare professionals worldwide, nurses play a key role in the delivery of mental health services. Nurses have an opportunity, if not a responsibility, to collaborate across borders sharing education and innovative approaches to care delivery.     

Exploring the meaning of recovery‐oriented care: An action‐research study

The present study describes participants' perspectives of the meaning of recovery‐oriented care in developing services for people with psychosocial disability associated with mental illness. Participants were involved in a 12‐month cooperative inquiry action‐research group from August 2012 to July 2013, with six consumers, four clinicians, and a carer. A major finding was the importance of the facilitation of dialogue that acknowledged the asymmetrical power differences between participants. Thematically‐analysed data identified an overarching global theme: ‘I want services to hear me’. The theme reflected a shared view that participation is important in service development. Actions included mapping the integration of consumer participation within a mental health service and developing workshops to support change. Addressing the asymmetrical power relationship inherent in traditional mental health design is important. Using participatory processes, structural discrimination is revealed, and tensions associated with clinical mental health services and psychiatric practice can be discussed. A partnership approach to service development enables the social determinants of health to be addressed more effectively, as well as supporting individual recovery. These approaches create the potential for genuine transformational change. Approaches that support coproduction and codesign have the potential to enable solutions.     

“What is the work of Recovery Oriented Practice? A systematic literature review”

Concepts of personal and social recovery in mental illness are constantly evolving because the journey is fluid and subject to change over time. Dynamic interactions between the complexities of human nature and mental illness create ever‐altering landscapes of perplexity. The acknowledged ebb and flow of recovery in the presence of chronic and serious mental illness requires health professionals to provide a flexible suite of care, delivered through skills and methods that are responsive and meaningful to the recipient. We conducted a systematic search for qualitative literature that articulated the work of personally‐supportive recovery‐oriented practice (ROP) to determine the specific components of recovery‐supportive work. Twenty‐one articles were identified as meeting the inclusion criteria and were synthesized using a coding framework derived from Normalization Process Theory. We identified three kinds of recovery‐supportive work required from health professionals: alleviating stigma, delivering effective recovery‐supportive responses in the presence of complex health and social situations and managing challenges associated with the work of ROP. We discuss the resources needed for ROP and the barriers that inhibit health professionals' engagement in this work. By elucidating the work of ROP, we highlighted a disparity between health professionals' aspirations and achievements. These revelations could inform service delivery in order to better support consumer recovery in serious mental illness.     

Clinical review: Allocating ventilators during large-scale disasters – problems, planning, and process

Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible should be used to allocate ventilators. The process and decision tools should be codified pre-event by the local and regional healthcare entities, public health agencies, and the community. A proposed decision tool uses predictive scoring systems, disease-specific prognostic factors, response to current mechanical ventilation, duration of current and expected therapies, and underlying disease states to guide decisions about which patients will receive mechanical ventilation. Although research in the specifics of the decision tools remains nascent, critical care physicians are urged to work with their health care facilities, public health agencies, and communities to ensure that a just and clinically sound systematic approach to these situations is in place prior to their occurrence.     

Clinical review: allocating ventilators during large-scale disasters--problems, planning, and process

Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly as possible. If inadequate resources are available despite optimal incident management, a process that is evidence-based and as objective as possible should be used to allocate ventilators. The process and decision tools should be codified pre-event by the local and regional healthcare entities, public health agencies, and the community. A proposed decision tool uses predictive scoring systems, disease-specific prognostic factors, response to current mechanical ventilation, duration of current and expected therapies, and underlying disease states to guide decisions about which patients will receive mechanical ventilation. Although research in the specifics of the decision tools remains nascent, critical care physicians are urged to work with their health care facilities, public health agencies, and communities to ensure that a just and clinically sound systematic approach to these situations is in place prior to their occurrence.     

老年人长期护理需求及其影响因素的实证分析

伴随着我国人口的老龄化,老年人的长期护理需求将会增加。本文以北京市为例,采用2006年北京市城乡老年人口调查数据,统计分析了老年人的失能水平与健康状况,分析了失能的影响因素,测量了老年人的长期护理需求。研究发现除了年龄增长加重失能的风险外,教育水平越高,失能的风险越低。最后本文指出目前家庭已不能维持长期护理服务功能,农村比城市的情况更严重,社会提供的长期护理优质资源不足,亟待发展能满足老年人长期护理需求的护理机构。     

智力残疾的致残病因调查分析

目的：调查和分析智力残疾的致残原因,提高国民的保健意识,减少相关疾病的发病率及致残率。方法：以湖北省第2次全国残疾人抽样调查的资料为依据,对52例智力残疾患者进行病因分析;并比较不同等级及不同地区（城市和农村）导致智力残疾的主要疾病。结果：在已明确的智力残疾原因中染色体异常性疾病致残率最高（19．1％）;脑炎其次（18．0％）,这两类病因的比重明显高于其他病因的比重（P〈0．01）。农村患者中原因不明、染色体异常性疾病、其他外伤、发育畸形所占比重比城市高（P＜0．01）;而脑炎、新生儿窒息、早产、低体重和过期产所占比重城市高于农村（P〈0．01）。结论：在智力残疾的致残疾病中染色体异常性疾病和脑炎为首要病因。防治智力残疾的重点是建立健全医疗保健体制,注重围产期的检查及少年儿童的预防保健工作等。