西盟佤族蚊帐使用的现状、态度和推广障碍(in English)

目的　评价佤族蚊帐使用的现状、态度和推广障碍。　方法　采用问卷调查、专题性小组讨论和直接观察的方法进行调查。　结果　佤族社区中 ,蚊帐覆盖率极低 ,而且问卷调查所得使用率为 18 4% ,显著高于直接观察的11 8% ( χ2 =13 5 7,P <0 .0 1) ;所有流动人员在田棚、森林和缅甸过夜时均不使用蚊帐。 74 3 %的问卷调查对象愿意支付购买蚊帐的部分费用 ;愿意支付购买单人和双人蚊帐的费用额分别为 ( 2 2 5 7± 1 0 5 ) (范围 :5～ 70 )元和 ( 3 7 66±1 79) (范围 :10～ 15 0 )元。推广使用蚊帐的障碍为经济、社会和地理上的不可及性。　结论　蚊帐的推广使用 ,需要包括通过IEC提高意识和改变行为、补贴改善经济上的可及性和社会营销等综合性措施。     

Principles of effective communication with patients who have intellectual disability among primary care physicians

ObjectiveExamine physicians’ implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors.MethodsFocus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID.ResultsSubjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect.ConclusionGreater familiarity may enhance care for these patients.Practice implicationsIncrease exposure to patients with ID within training.     

A flow-based statistical model integrating spatial and nonspatial dimensions to measure healthcare access

Assessing access to healthcare for an entire healthcare system involves accounting for demand, supply, and geographic variation. In order to capture the interaction between healthcare services and populations, various measures of healthcare access have been utilized, including the popular two-step floating catchment area (2SFCA) method. However, despite the many advantages of 2SFCA, the problems, such as inappropriate assumption of healthcare demand and failure to capture cascading effects across the system have not been satisfactorily addressed. In this paper, a statistical model for evaluating flows of individuals was added to the 2SFCA method (hereafter we refer to it as F2SFCA) in order to overcome limitations associated with its current restriction. The proposed F2SFCA model can incorporate both spatial and nonspatial dimensions and thus synthesizes them into one framework. Moreover, the proposed F2SFCA model can be easily adapted to measure access for different types of individuals, over different service provider types, or with capacity constraints in a healthcare system. We implemented the proposed model in a case study assessing access to healthcare for the elderly in Taipei City, Taiwan, and compared the weaknesses and strengths to the 2SFCA method and its variations.     

Création d’une consultation psychiatrique ouverte aux préparationnaires du 5e et du 6e arrondissement de Paris : retour d’activité sur l’année 2017–2018

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.ObjectivesThis study aims to debrief the activity and the student profiles in the first year of this consultation.Patients and methodsThe patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.ResultsFifteen students consulted with a mean of 5.2 ± 2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.ConclusionThe consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.     

Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations

We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11–20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.     

基于位置分配模型的医疗机构空间布局优化研究

目的 分析广西北部湾沿海城市二级及以上等级的医疗机构空间布局和可达性,拟新增医疗机构提高居民点到达医院的可达性,为政府卫生规划的制定提供参考.方法 运用GIS软件对区域内33个二级及以上等级的综合医院,以及124个乡镇一级居民点,采用OD成本矩阵分析空间布局现状,基于不同阻抗中断值计算居民点与医疗机构间的可达性,并运用...     

初中生线索熟悉性与信息易接近性对知晓感判断的影响

目的 以初中生为被试,探讨线索熟悉性与信息易接近性对知晓感(FOK)判断的影响模式.方法 采用不相关联的中文词对为识记材料,同时操纵线索熟悉性与信息易接近性,来探讨二者对初中生FOK判断的影响.结果 线索熟悉性与信息易接近性对初中生的FOK判断等级都有影响,但二者之间不存在交互作用.结论 这一影响模式与在大学生被试中发现的模式相同,具有一定的普遍性.