探讨社区护士在社区护理中的作用

伴随着社会医疗体制的不断发展和深入化改革,我国已经在有能力地区全面开展了社区医疗卫生服务,社区护理工作发展趋势也在不断的完善,将有一批护士,从封闭的医院科室走向千家万户,展开社区医疗卫生服务,以病人为点,以社区为面,开展新型的社区医疗服务,针对不同地域和区域的慢性病和老年人群进行针对性的护理。     

离退休老年人群主要消费支出分布特征分析

目的:调查分析西安市离退休老年人群主要消费支出分布特征,为有效提高老年人生存质量,加强老年人社区护理提供科学依据.方法:采用整群抽样方法抽取西安市4个社区238名离退休老年人群作为研究对象,调查其主要消费支出.结果:本次调查的238名离退休老年人群中,消费支出依次为:伙食费(89.11％)、医疗费(27.82％)、健康护理费(21.98).结论:随着社会人口老龄化,社会经济的发展,老年人医疗和健康护理需求不断加大,我国政府应加大基本公共卫生服务投入,加强老年人养老设施建设,满足老年人群卫生服务和养老需求.     

政府协同与医保助推:“四医联动”保障下的家庭医生服务

政府协同式治理是当前我国医改推进的必要支撑和重要方向。上海市长宁区家庭医生制度模式发展过程中,通过卫生、医保、民政、财政等部门面向困难人群的"基本医疗保险+基本医疗服务+政府医疗救助+社会组织医疗帮扶"的"四医联动"基本医疗保障协同治理模式实现了激励相容的可持续发展。十年的改革探索和政策实践表明,卫计委、民政部门精准确定服务人群,医保、财政支付家庭医生签约服务费的政策协同,社区家庭医生工作室的医疗资源整合支撑,社区健康共建共享是我国家庭医生服务模式不断完善的发展方向。     

上海市社区老年护理师培训效果的分析与研究

目的 :对2014年复旦—上海市卫生计生委社区老年护理系列综合初级培训的效果进行分析,为完善我国社区老年护理师培训提供依据。方法 :采用自制问卷对培训班的273名学员进行调查。结果 :72.7%的学员对老年护理工作理念有所转变;65.3%的学员认为通过此次培训获得对今后的社区护理工作新的启示;70.8%的学员在培训结束后,将所学的内容运用到工作中(包括传递给病人、同事等);53.5%学员在培训结束后,所学到的知识和技能得到了领导的重视和支持;12.9%的学员在培训结束后,在岗位上的工作有所创新与改变。结论 :培训加深了社区护士对老年护理的认识,有助于培养社区护士的核心能力;此外,为更好地完善社区老年护理师的培训,在培训内容及培训方式上应进一步完善,同时建议政府健全相关法律法规、完善相关政策制度,社区管理者提升对社区老年护理工作的重视。     

澳大利亚的社区老年照护服务

溴大利亚建立了比较完善的社区老年照护服务体系，并将老年人的医疗护理、家庭护理和生活照料相对分离又有效衔接。政府是老年照护服务费用的主要支付方。澳大利亚政府强调，联邦和州政府有责任为老年人提供护理，但应尽可能居家或在社区解决，以降低护理成本，节约政府开支。     

上海某中心城区老年护理院“入院难”问题的对策研究

通过对本区域老年人健康状况护理需求,以及老年医疗生活护理机构服务量的调查,提出建立以社区卫生服务为平台的老年康复护理社区分层管理模式,针对老年人不同层次的健康护理需求,提供相应适宜的健康护理服务,提高现有老年护理资源的服务效率和服务供应量,为缓解老年护理院"入院难"的矛盾提供科学依据。     

老年晚期人口的养老预期与社会保障模式构建——以湖北省为例

目的:了解湖北省老年晚期人口的养老需求,在此基础上探讨适合失能老人的社区服务供给体系与社会保障安排.方法:自制调查问卷对湖北省内1200名老年居民进行了问卷调查,回收有效问卷1148份.调查数据结果采用SPSS16.0统计软件进行分析和讨论.结果:目标人群中31%的患有各种慢性非传染性疾病,70%以上为失能后的医疗护理与生活照料及其经济困难担忧,62.6%的期望政府建立符合老年晚期人口的社会保障制度.调查显示:家庭与社区照顾是其首选.结论:政府尽早进行老年晚期人口社会保障制度安排,完善社区服务供给体系及其专业化管理、政府适当经济投入与社区有偿服务结合等,是应对湖北人口老龄化快速发展形成的赡养压力,促进湖北经济社会和谐发展的基本策略.     

社会老龄化下日本对老年护理行业的布局及对我国的启示

据报告显示,2011年以后的30年里,中国人口老龄化将呈现加速发展态势,到2030年,中国65岁以上人口占比将超过日本,成为全球人口老龄化程度最高的国家.到2050年,社会进入深度老龄化阶段.到2030年,中国65岁以上人口占比将超过日本,成为全球人口老龄化程度最高的国家.可见,中国老龄化形势严峻,在国内呈现一种"未富先老"的态势,社会老龄化的加剧、护理需求的持续增加使得老人护理行业面临挑战与机会并存.本文通过研究日本的护理经验和护理现状,探讨对于国内应对逐渐深入的老龄化社会,从中能得到的启示.第一部分为背景,主要介绍了相关定义,对选题意义、国内外现状等进行了相关介绍;第二部分主要描述了日本老年护理服务业的产业布局,重点介绍了日本护理老年福利政策投入相关问题、老年护理服务的政府资金支持、专业人才的培养和筛选;第三部分主要是提出日本老年护理服务业发展对我国老年护理服务业发展的启示,重点归纳了日本老年护理服务政策引导、制度规定、财政支持、人才专业性、人性化创新等诸多启示.     

老年医疗保障体系研究与构建

借鉴国外在实施老年医疗保障方面的经验,剖析我国老年医疗保障存在的问题与面临的挑战：（1）老龄化带来的巨大医疗需求和医疗费用的上涨;（2）老年医疗保障制度不健全;（3）老年医疗服务机构数量少、服务质量差。分析从宏观、中观、微观三个层面提出老年医疗保障体系框架性设计,提出强调政府的责任与制度的完善,建立和完善以社区为中心的老年医疗卫生服务体系的,家庭护理体系的构建和完善等一系列措施。并展望老年医疗保障制度的未来。     

老年护理服务市场的需求及对策

文章针对老年护理服务市场的需求状况进行分析，提出了政府对老年护理服务市场的规范化、法制化；加强护理人员的培训和教育；建立符合不同人群需求的老年护理机构；建立老年护理保险制度等措施是满足老年护理服务需求的重要对策。老年护理服务市场有着较大的需求和广阔的前景，需要我们去开拓，为老年人提供多种形式的服务，不断提高老年人的生活质量。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.