珠海市社区双向转诊病人满意度与需求现状调查

[目的]了解珠海市社区双向转诊病人的满意度和需求情况。[方法]随机抽取珠海市各社区卫生机构上转到医院就诊的982例病人进行病人满意度与需求状况问卷调查。[结果]双向转诊病人对社区卫生机构最满意、最不满意及最希望改进的分别是服务态度、医疗设备、优化转诊流程;而对上转医院最满意、最不满意及最希望改进的分别是就医环境、就诊等候时间、排队等候问题。[结论]应针对社区双向转诊病人需求及满意度,提高社区卫生服务机构医疗水平和医疗服务质量,简化双向转诊流程,切实开展综合医院分时段预约诊疗服务,真正满足病人的需求和提高其满意度。     

肢残人群的心理腱康状况调查及分析

目的了解社区肢体残疾人群的心理健康状况。方法对上海市曹家渡街道14个居委的常住且具有残疾证的肢体残疾人运用《杜克OARS日常活动能力量表》进行问卷调查，重点包括精神生活满意情况、心理自我功能评估、服用精神类药物状况、接受医学心理干预情况等做统计分析。结果在精神生活满意度方面，感到生活无乐趣的人最多，大部分人的心理自我评估为普通。只有小部分人群曾得到过医学心理干预，在未接受过心理服务的人群中，有1／3的人希望今后能得到医学心理服务。结论关注社区肢残人群的心理健康问题将是今后开展肢残人群医学照顾工作的重点。     

澳大利亚社区康复对我国的启示

社区康复概念由WHO提出至今已有30年历史，目前全球已有84个国家在社区层次开展了康复服务，其中有初级卫生保健组织参与社区康复的共有55个国家。澳大利亚的康复医学体系基本沿袭英美国家的模式，由于人口老化、医疗模式转变及人们健康意识的提高，不同年龄的人对医疗服务的消费均有增加，致使澳大利亚人均医疗开支持续上升。从1993年起，澳大利亚政府及时调整政策，推行家庭及社区照顾计划以及精神健康护理计划，使老年人及残疾人可在家中接受医疗服务而无需住院，省及地方政府亦投入大量财力提供社区及公共医疗服务。笔者参观访问了位于悉尼东南部的～家养老院（Uniting Care）、Bankstown医院的老年康复科、悉尼北部的皇家康复中心、悉尼西部的Hills社区卫生服务中心，对澳大利亚的康复医学体系及社区康复有了一个初步印象，感觉澳大利亚的社区康复有许多值得国内同行借鉴之处。     

广州市社区卫生服务中心康复人员配备及工作情况分析

目的了解广州市社区卫生服务中心康复人员配备及工作情况。方法问卷调查社区康复专责员的基本资料,及其开展残疾人社区康复工作情况、存在问题、今后工作的方向。结果共调查154人。社区康复专责员大专以上学历143人（92.86%）,从事康复工作3年以上38人（24.68%）;过去1年开展的残疾人社区康复的工作,除为辖区内的居民（包括残疾人）提供康复医疗服务做得较好外,其他残疾人社区康复工作只在部分社区卫生服务中心开展;遇到的困难主要是经费不足、人员缺乏、专业水平较低等。今后工作83.77%表示,将按《广州市社区基本公共卫生服务项目工作规范（试行）》的要求执行。结论现在配备的社区康复专责员学历和素质较前有所提高。由于缺乏统一的工作规范,社区卫生服务中心的工作缺乏规范性,开展服务的内容、项目不统一,完成的目标也不统一。建议政府继续重视残疾人康复工作,加大经费投入,将残疾人康复纳入《国家基本公共卫生服务项目》;按照《广州市社区基本公共卫生服务项目工作规范（试行）》的要求组建社区康复队伍,配备康复训练场地和器材,加强专业培训,按工作目标和要求为残疾人提供有效的康复服务。     

北京大兴区社区卫生人员培训体会

全科医学人才的数量与质量极大地制约着社区卫生服务的发展。要解决这个问题，当务之急是对现有在岗从事社区卫生服务的医师进行培训。据报道，现在的综合医院门诊病人有64．8％可以在社区或基层解决，住院慢性病人有76％可以在社区或接受家庭卫生服务照顾，慢性病有76％的病人可以在社区解决。WHO也认为，80％门诊患者应先在社区卫生服务机构得到照顾，如能实现病人的合理分流，则可以节省40％的医疗费用。发展社区卫生事业是我国卫生工作改革的重要任务。近5年来，大兴区医学教育培训中心按照卫生部和北京市卫生局社区医师岗位培训大纲，组织对社区医生岗位培训及全科医学资格考试辅导，举办各种专题培训班，先后为社区乡镇培训社区卫生人员6002人次，对大兴区社区卫生事业起到推动作用。     

京津冀地区老年人社区医疗护理服务满意度及其影响因素分析

目的:探讨老年人的社区医疗护理服务满意度现状及其影响因素。方法:采用自行设计的一般情况调查表和社区医疗护理服务满意度调查表对京津冀三地的2 046例老年人进行调查,采用多元线性回归分析老年人社区医疗护理服务满意度的影响因素。结果:京津冀地区的老年人对社区医疗护理服务满意度一般,其中接近或超过40%的老年人对社区医疗护理服务表示不满意,超过40%的老年人对社区医疗护理服务满意度为一般,仅有不足20%的老年人对社区护理服务表示满意。多元线性回归分析发现,医疗费用承担程度、文化程度和身体健康状况是对京津冀地区老年人的社区医疗护理服务满意度差异有统计学意义(P0.05)。结论:京津冀地区的老年人对社区医疗护理服务的满意度较低,社区工作者应重视并改善社区医疗卫生服务存在的问题,提高老年人的社区医疗护理服务满意度。     

手术后出院患者对社区卫生服务利用情况的调查

目的了解手术后出院患者对社区卫生服务利用情况,为建立健全社区卫生服务网络提供依据。方法采用整群分层抽样方法,对某综合性三甲医院328例手术患者出院1周时进行电话随访,了解手术后出院患者对社区卫生服务利用情况。结果43．6％的患者并未寻求社区卫生医疗机构的帮助。其主要原因为：39．0％不信任社区卫生服务的医疗水平;29．3％不了解社区卫生服务;9．8％社区不能提供所需的服务。文化程度越高、曾经接受过社区卫生服务、有意愿建立社区卫生医疗服务网络的患者也更容易寻求社区的帮助（P〈0．05）。结论出院后社区卫生利用率不高。积极开展社区医疗服务,拓展服务内容,丰富服务方式,提高社区医疗的参与度,对促进患者康复与健康具有重要意义。     

武汉市居民社区卫生服务利用情况及其影响因素分析

[目的]了解武汉市居民社区卫生服务利用情况及其影响因素。[方法]自行设计《武汉市社区卫生服务需求调查表》,采取分层随机整群抽样的方法,抽取武汉市10个社区,2 026人进行调查。[结果]调查中有73.1%的居民愿意接受社区卫生服务,居民慢性病患病率为41.6%,就诊率为64.4%,56.1%居民首选的就诊机构为社区卫生服务机构。[结论]社区卫生服务中心因其服务态度好、方便居民就诊、价格合理,是社区居民首选就诊的医疗机构。社区卫生服务中心应对患病后自我医疗和不医疗的危害进行健康教育,提高患病居民的就医率。     

杭州市余杭区农村社区卫生服务试点的现状研究

目的了解余杭区农村社区卫生服务基本情况、管理者与职工对开展农村社区卫生服务的认识、服务区内农村居民的满意情况；为推动农村社区卫生服务和全科医疗的开展提供依据。方法调查6个社区卫生服务试点站点的基本情况、服务开展、经济运营、管理制度、服务人员对开展社区卫生服务的看法、居民就医状况及满意度等七方面情况。结果和结论农村社区卫生服务是主动适应经济发展和医学模式转变的具有战略性、方向性的重大改革，是一条既符合余杭区情又遵循低成本-高效益原则的卫生事业发展之路。社区卫生服务在农村大有可为。     

成都地区不同人群对社区卫生服务各不满意项关注程度分析

目的：调查成都地区人群对社区卫生服务各不满意项的关注程度。方法：通过发放调查表的方式调查成都地区不同学历、不同职业人群对社区卫生服务10个主要不满意项的关注程度,比较对各不满意项关注程度的差异。结果：医疗技术、服务态度、诊疗认真程度和候诊时间等是成都地区社区卫生服务最受关注的内容（平均关注指数分别达到4．342、3．696、1．888和1．521,与平均值1．364相比P〈0．05）;而医生看病时接电话和检查、检验等报告时间长则较容易得到理解,平均关注指数明显低于平均值（P〈0．05）;部分不满意项受关注程度与学历和职业有一定关系。结论：成都地区对社区卫生服务各不满意项的关注程度差异有显著性,对部分不满意项的关注程度与被调查者的学历和职业上有明显关系。     

Management of severely handicapped patients using a modified electric wheelchair

For a disabled person to be able to realize his potential for rehabilitation to the fullest extent possible, individualized provision of technical aids may be necessary along with the medical and therapeutic services needed. The present report describes the modifications and additional devices incorporated in an electric wheelchair to answer the specific needs of our severely handicapped client.     

Socio-demographical examinations on disability prevalence and rehabilitation status in southwest of Turkey

PURPOSE: Disability is one of the most important social issues in the community. In contrast to the developed countries, Turkey has, unfortunately, no goods records on the current issues of disability such as the number of disabled and handicapped, and their socio-demographic properties due to the lack of sufficient studies in the specified area. The present study was, therefore, aimed to determine the status of disabled in the entire region of Isparta and to establish relationships between the distinctive disability properties in order for a better understanding of its important aspects. MATERIALS AND METHODS: Data were collected in 2002 from 3500 people residing throughout the region by the gradual sampling method according to the evaluation criteria of International Classification of Impairments, Disabilities and Handicaps (ICIDH) by WHO. RESULTS: The disability prevalence in the studied group was found to be 5.3%, and 4.8% of the disabled were previously rehabilitated. Forty one percent of the disabled were found to have two types of disability. In the study, it was shown that the disability prevalence significantly increased by the age. The disabled were shown to be under-educated and not benefit from the rehabilitation services in one hand, and there were insufficient activities of rehabilitation established in the region in other hand. CONCLUSIONS: We concluded that the medical and social rehabilitation services must be initiated and freely provided to these local people, particularly to those young disables whose life will greatly change to a better living standard.     

产科医护人员亚健康状况调查

目的 了解医护人员亚健康状况.方法 对我院产科工作的医护人员的亚健康情况作了问卷调查.结果 137名医护人员中,存在亚健康的人员占64.2%,亚健康与医生或护士的工种无关,亚健康与对生活的满意度、亚健康与有无倾诉对象有关.结论 医务工作者的亚健康问题应给予关注,积极应对与消除亚健康状态.     

On the problem complex of the new act on the severely handicapped with respect to the workshop for the disabled (author's transl)]

One group of the disabled, i.e., the most severely handicapped, will not be able to benefit from the improvements brought about by the new Act on the Severely Handicapped, if the statutory orders of the Federal Government and the provisions of the Federal Employment Office are implemented as planned. In this event it would become extremely difficult for the severely physically handicapped to participate in the life of the community. The article demonstrates how a sheltered workshop for the disabled which, in part, looks after the most severely handicapped needing special care: - will not achieve recognition under 55 of the Act on the Severely Handicapped, - will not benefit from either institutional or individual support provided by the organisations of - the labour administration, - will not obtain contracts from either industrial or public enterprises because the orders cannot be set off against the equalisation payment, - cannot help their disabled employees to become eligible for social security benefits. This development which for the most severely handicapped represents a step backwards must be removed from those who are the most afflicted. It must not happen that efforts made at school to promote and integrate the disabled terminate in segregated facilities (nursing homes), which are run under different subsidy regulations. What is needed is a concept for appropriate care and support of the most severely handicapped and their integration into suitably equipped small groups within workshops for the disabled.     

Coping with the sexuality of the disabled: a comparison of the physically disabled and the mentally retarded

Taking as a starting point, papers on sexuality of disabled people and papers on attitudes and representations toward their sexuality, we have demonstrated that the coping of those people is directed by an ideology of rationalisation of sexuality. This ideology is expressed in different ways, with physically disabled and mentally retarded people. This fact makes clear the importance of the handicapped referent over the coping. Procreation is strongly supported for the physically disabled people (paraplegics). Mentally retarded people are strictly forbidden to procreate: this appears especially with the sterilisation of mentally retarded women.     

Independence: the ultimate goal of rehabilitation for spinal cord-injured persons

During the late 1960s and early 1970s, a new concept related to rehabilitation and improvements in quality of life began to emerge and be expressed by people with spinal cord injuries and other disabilities. This concept, independent living, is the foundation of the independent living movement, which has helped to overcome the barriers to a higher quality of life for disabled people. Of the many organizations and programs set up to provide support for disabled people living in the community, the independent living program seems to be comparatively successful at facilitating independence by people with spinal cord injuries. Independent living programs provide the kind of community-based support services necessary to expand the range of living options for disabled people beyond those traditionally available in most communities. The role of occupational therapists in the independent living stage of the rehabilitation process can be similar in some respects to their role during earlier phases of medical rehabilitation. However, the definition of independence as a "mind process" leads to considerable expansion of the therapist's role beyond the focus on physical skills, which are usually key priorities during medical rehabilitation. Occupational therapists typically possess knowledge and skills that equip them well for assisting clients in the independent living stage of the rehabilitation process.     

意大利政府对残疾人的优惠政策及工法架构(英文)

The most important reference in Italian legislation concerning interventions in favour of people with disabilities came about with Law 104 from February 5th 1992 in which the most important rights for disabled people were established. This law led to a new vision,the person with disabilities is no longer seen only a subject needing help but as a person who has the right to live his life in the best possible way that his condition allows him to and thus,it is society’s duty and that of the Government,to do everything possible to remove invalidating causes,to promote a disabled person’s autonomy and to realise his best social integration possible. To implement what is foreseen by this law it was necessary to activate different important interventions,two of which are very significant:the realisation of Guidelines from the Ministry of Health on rehabilitation activities in which the aims are defined on how rehabilitation should be implemented and how it should be organised on a national level and at a community level. Law 68 from March 12th 1999 decreed the full rights of people with disability to be integrated into the workplace. In the article we will also report some significant data concerning the results of the applications of the law.     

Environmental access to a rehabilitation center as a determinant of attitude to handicapped persons? A comparative empirical study of assumptions of the "contact hypothesis"]

A total of 263 respondents were interviewed relative to their attitudes towards disabled persons, using a standardized questionnaire. Of these 263 subjects, 144 lived in a community without any facility for disabled persons in the vicinity, 119 subjects lived close by a physically disabled persons centre. The "attitudinal climate" among all interviewees on the whole more on the positive side, it was found that those living in the vicinity of a physically disabled persons centre, though expressing less contact uneasiness when meeting physically handicapped children and young people, did however not give more positive--but neither more negative--opinions in other respects than those subjects not living near a facility for the disabled. The results obtained were further analyzed on the variables of age, sex, and closer contacts with disabled people among friends. It has, once again, been confirmed that attitudes toward disabled persons constitute a multidimensional construct that, to varying degrees, is influenced by a number of factors. Some consequences and considerations in terms of educational implementation possibilities of the findings are outlined in conclusion.     

The right work for every disabled person: the ERTOMIS ability and requirement profiles for the appropriate determination of a workplace

In close accordance with the "International Classification of Impairments, Disabilities and Handicaps" issued by the World Health Organisation in 1980, and in cooperation with medical doctors, psychologists, and vocational teachers a reintegration of disabled adults. Instead of only attesting to the rehabilitated person his disabilities this system allows qualified persons to assess by means of a set of 64 evaluation criteria in an "Ability Profile" the abilities available to the disabled after rehabilitation; likewise, using the same 64 criteria it allows one to determine in a "Requirement Profile" those requirements a particular job poses to the corresponding person. The two profiles can be compared, thus providing an easy match between the person's abilities and the abilities necessary to perform the job. The various criteria reflect "elementary abilities" or correspondingly "elementary requirements". By comparison of the two profiles it is possible--in a first rough approach based on correspondingly developed judging abilities of the evaluator--to determine rather accurately whether a certain kind of work, to which a "Requirement Profile" is available, is adequate for a certain disabled person--for whom an "Ability Profile" has also been developed. The question whether the chosen work is fully adequate can thereby be answered with maximum accuracy only at the corresponding workplace by an occupational physician and the other professionals responsible for the employment of the disabled. The ERTOMIS system thus facilitates the job placement of disabled people; it can also help decide on eventual complementary rehabilitation measures directed towards the better adjustment of the disabled to a certain work, or the improved adjustment of that work to the abilities of the disabled. Each disability is unique to each individual; by means of this system system--completed with the personal dossier from which data on the vocational training and experience of the disabled can be taken--it can also be assessed in a way that reflects this important individuality. The criteria describe only abilities and requirements relevant to work performance. If one so chooses, for data protection reasons the "Ability Profile" can be handed out to the disabled person only. No copies of documents may be kept except for the purpose of medical records.