农村公共卫生投融资机制研究样本抽取的区域分类方法

目的：构建农村公共卫生投融资机制抽样研究的区域分类指标体系,并计算分类标志值.方法：本文在广泛收集我省农村公共卫生投融资方面的资料数据的基础上,运用专家咨询法确立符合本研究领域特征的指标体系和指标权重,并运用极差法对实际数据进行无量纲化处理,采用加权平均法计算出我省14个地州市的区域分类标志值.结果：我省14个地（州、市）的分类标志值虽然极差较大（反映发展不平衡）,但主要分布于（40,70）这一区间内,其中,大于60的有5个地（州、市）,小于50的有5个,在50-60之间的有4个,我们依此将其分为三个类别的区域.结论：经过专家咨询所筛选的9个指标所计算的标志值能够较好地反映一个地区的农村公共卫生投融资的现状,可以作为本研究抽样的依据.     

2005年山东省开展农村改厕知识培训效果评价

[目的]为了解山东省各级农村改厕人员对《农村改厕基本知识》、《农村改厕技术知识》的知晓情况,评价培训效果。[方法]对2005年山东省举办的国家农村改厕知识培训班学员有关测试资料进行分析。[结果]227名培训学员对农村改厕各项知识平均得分,培训前为(89.07±37.68)分,培训后上升到(165.11±23.82)分,后者高于前者(P<0.01)。及格率培训前为49.78%,培训后上升到94.71%,后者高于前者(P<0.01)。知晓率培训前为53.57%,培训后提高到85.73%,后者高于前者(P<0.01)。[结论]培训后227名学员对农村改厕各项知识的平均得分、及格率和知晓率都有显著提高,效果良好。     

农村艾滋病预防与控制的思考

目的分析当前农村艾滋病的预防与控制情况。方法结合某区艾滋病控制过程中的具体措施,提出对应控制方法。结果通过强化农村艾滋病的预防控制,能够完善艾滋病防控体系,切实保障农村村民的身体健康利益。结论应对农村艾滋病传播需要有切实可行的控制预防措施,包括建立健全防控体系、强化宣传教育、完善管理、加大资金投入等。     

Effects of social activation and physical mobilization on sleep in nursing home residents

Age-related changes in sleep physiology, frequent occurrence of health impairments, and a sedentary lifestyle make nursing home residents particularly vulnerable to sleep disturbances. Despite the high prevalence of sleep disturbances in nursing homes, there is a lack of research concerning the use of non-pharmacological approaches for improving residents' sleep. This study aimed to promote residents' sleep by improving their social activation and physical mobilization. An experimental group of residents attending an activation program four times a week during an eight-week study course was compared to a non-treated control group in a cluster-randomized intervention trial among 85 residents of 20 nursing homes. Sleep was assessed by the Insomnia Severity Index (ISI), nurses' ratings of residents' sleep disturbances and actigraphy-based sleep parameters. Although no changes in actigraphy-based sleep parameters were observed, the subjective sleep quality ratings of the intervention participants significantly improved compared to the control group members (p = 0.004). This study suggests that physical mobilization and social activation may improve residents' subjective sleep quality. Further efforts to improve residents' sleep by increasing their physical and social activity should consider existing obstacles to encourage participation and adherence to the program.     

感染科住院医师规范化培训的实践与探索

住院医师规范化培训是医学生毕业后教育的重要组成部分,是培养合格的、具有综合素养的青年医师的重要手段。西安交通大学第二附属医院感染科在住院医师规范化培训的实践与探索中,逐步建立了符合专业特点的规培管理体系,包括规培管理梯队、规培实施细则、三阶段评价反馈体系、教学相长双向培训模式、三维评价体系等,旨在以岗位胜任力为导向,从理论知识、临床技能、医学人文素养、科研能力、人际沟通能力,多维度高质量的进行住院医师规范化培训工作。     

Prevalence and treatment gap of active convulsive epilepsy: A large community-based survey in rural West China

PurposeActive convulsive epilepsy (ACE) impacts patients greatly, especially in low-income countries where patients do not receive appropriate treatment. In the present study, we measured the prevalence and treatment gap (TG) of ACE in rural West China.MethodsSix rural areas in West China that have a total population of 3,541,319 were selected to conduct prevalence and TG estimates of ACE via a clue survey from 2007 to 2009. Clue survey here is a community-based screening strategy among defined population which requires employed well-trained local physicians//health workers to collect all clues available to discover/identify/recruit patients within a study period. Questionnaire-based interviews were used for the identification of ACE patients, and information was obtained during the survey. Prevalence and TG of ACE were calculated.ResultsA total of 6547 patients with ACE were identified. The estimated prevalence of ACE was 1.8 per 1000 in the general population, with the prevalences in males and females determined to be 2.0 and 1.7, respectively (p < 0.001). The TG in the general population was 66.3%, and it was 66.6% and 66.0% in males and females, respectively (p > 0.05). The TG figures dropped with advancing age and increased above 30 years of age. Patients aged 60 years or older had the largest TG (77.8%); those with disease course less than 10 years showed a larger TG and those who experienced two to five seizures annually had a significantly larger TG (70.6%). Additionally, only 63.9% of the ACE patients included in the study were aware of the disease and had consulted a doctor.ConclusionsThere exists a large TG of ACE in West China rural areas. Majority of those ever consulted a doctor but failed to receive or adhere to an appropriate treatment program. Management including public education as well as training of local physicians were necessary to fill that gap.     

Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study

BackgroundAn understanding of stakeholders’ views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals.MethodsThis is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system.ResultsWe conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care.ConclusionsThis study provides insight into rural professionals’ perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems.     

Behavioral Self-Management

While behavioral treatments have been increasingly utilized with older patients, they have almost entirely involved operant, rather than self-management, approaches. In the present paper, differences between operant and self-control behavioral approaches are discussed. A case example is presented of the successful use of a behavioral self-management treatment with an elderly patient with severe agitation. The potential utility of the self-management approach with older patients is discussed.     

Pro Re Nata Drug Use in Nursing Home Residents: A Systematic Review

Objectives

In addition to routinely administered long-term medication, complex drug regimens of nursing home residents often include as needed or pro re nata (PRN) medication. However, there has been no systematic evaluation of the frequency and concomitants of PRN medication in nursing homes. The main objective of this systematic review was to provide a current assessment of PRN drug use in nursing homes.

Effect of Life Review on Quality of Life For Older Adults Living in Nursing Homes

Aim: To examine the effects of life review on daily activities, social participation, outlook on life, and perceptions of living in a nursing home measured by life satisfaction and quality of life in older adults. Method: The study design was a two-phase quasi-experimental pre-post-tests including development and testing of a life review protocol. Nine residents, age ≥65, participated in a life review group once weekly for 6 weeks. Outcomes were analyzed using the Life Satisfaction Index-Z (LSI-Z) and pre-post surveys. Results: LSI-Z scores improved post-intervention and survey outcomes indicated participation in activities of daily living (ADLs), socialization, outlook on life, and living in a nursing home perceptions improved for all participants. Conclusion: The study demonstrates the effectiveness of a life review protocol to improve ADLs, social participation, and enhancing perceptions of outlook on life and living in a nursing home enhancing QOL and life satisfaction for older adult nursing home residents.