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61.
62.
背景 作为全球第二大常见致死病因,脑卒中给患者带来了极大的经济负担和家庭负担。患者的卫生服务利用状况会影响其医疗费用的支出,但目前关于我国城镇脑卒中患者住院卫生服务利用情况的研究较少。目的 了解我国城镇脑卒中患者的住院服务利用情况,并探讨住院费用的影响因素,为降低患者疾病经济负担、加强患者经济保护、控制医疗费用过快增长提供理论支持和现实依据。方法 数据来源于“全国基本医疗保险卫生服务利用调查数据库”(2010-2015年),于2018年10月采用机械抽样法在数据库中抽取城镇缺血性脑卒中患者56 485例,收集其基本情况和住院服务利用情况(住院次数、住院天数、住院费用)。采用单因素分析比较不同基本情况脑卒中患者的住院服务利用差异,采用多元线性回归分析脑卒中患者住院费用的影响因素。结果 我国城镇脑卒中患者的年均住院次数为1(0)次,次均住院天数为11.0(6.0)d,次均住院费用为6 070.06(8 289.87)元。不同性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别的患者,年均住院次数、次均住院天数、次均住院费用比较,差异有统计学意义(P<0.05)。多元线性回归分析结果显示:性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别、次均住院天数是患者住院费用的影响因素,其中男性患者住院费用较女性高1.8%,年龄每增长1岁患者住院费用上升0.07%,职工医疗保险患者住院费用较居民医疗保险患者高20.1%,卒中类型为入脑前动脉未特指的闭塞或狭窄引起的脑梗死(I63.2)、大脑动脉血栓形成引起的脑梗死(I63.3)患者住院费用分别较脑梗死(I63)患者高40.8%、38.8%,二级、三级医院就诊患者住院费用分别较基层医院就诊患者高72.1%、121.1%,东部地区患者住院费用分别较中部、西部地区高23.5%、34.0%(P<0.05);住院次数也是患者住院费用的影响因素,住院次数每增加1次患者住院费用上升57.7%(P<0.05)。结论 不同特征脑卒中患者的住院卫生服务利用状况存在差异,住院费用与多种因素有关;应通过提高医院诊疗技术、缩短住院天数、加强对患者的健康教育等方式来实现费用控制,降低患者负担。 相似文献
63.
64.
Kate Phillips 《International Journal of Art Therapy》2019,24(1):21-29
The recent report from the United Kingdom (UK) All-Party Parliamentary Group on Arts, Health and Wellbeing is receiving widespread publicity across the media. Newspaper articles and social media posts espouse the benefits and importance of employing creative arts within the health domain, citing the report as proof of this. The report is inclusive of the entire range of arts practices, while its recommendations relate in the most part to UK policy and systems. The focus of this article is specific to visual arts practices and art therapy (art-for-health), but may have relevance across arts modalities and approaches (arts and health). This article questions the approach to the evidence taken in the report, and highlights the need for rigour, balance and impartiality in conducting research and presenting evidence. A case is made for the use of formal systematic reviews as appropriate ways to develop the evidence base. Another suggestion is a request for more explicit consideration of the ideological commitments underpinning beliefs about purpose and value within art therapy and the wider arts and health arena. 相似文献
65.
Camilla Sandberg Albert G. Crenshaw Guilherme H. Elçadi Christina Christersson Joanna Hlebowicz Ulf Thilén Bengt Johansson 《The Canadian journal of cardiology》2019,35(12):1815-1823
BackgroundAdults with complex congenital heart disease (CHD) show reduced aerobic exercise capacity and impaired skeletal muscle function compared with healthy peers. Peripheral muscle factors are presumed to be important contributors to the aerobic capacity, but the mechanisms are poorly understood. The aim of the present study was to investigate differences between adults with CHD and controls in muscle oxygenation kinetics at rest, and during and after exercise.MethodsSeventy-four patients with complex CHD (mean age 35.6 ± 14.3 years, female n = 22) were recruited. Seventy-four age- and sex-matched subjects were recruited as controls. Muscle oxygenation was successfully determined on the anterior portion of the deltoid muscle using near-infrared spectroscopy in 65 patients and 71 controls. Measurements were made at rest, during isotonic shoulder flexions (0-90°) to exhaustion, and during recovery.ResultsThe patients with CHD performed fewer shoulder flexions (40 ± 17 vs 69 ± 40; P < 0.001), had lower muscle oxygen saturation (StO2) at rest (58 ± 18% vs 69 ± 18%; P < 0.001), slower desaturation rate at exercise onset (?9.7 ± 5.9 vs ?15.1 ± 6.5% StO2 × 3.5 s?1, P <0.001), and slower resaturation rate post exercise (4.0 ± 2.7 vs 5.4 ± 3.6% StO2 × 3.5 s?1; P = 0.009) compared with the controls.ConclusionsIn comparison with age- and sex-matched controls, adults with complex CHD had slower oxygenation kinetics. This altered skeletal muscle metabolism might contribute to the impaired skeletal muscle endurance capacity shown and thereby also to the reduced aerobic capacity in this population. 相似文献
66.
67.
Yassir Turki Suha Saleh Shatha Albaik Yasmeen Barham Dorien van de Vrie Yousef Shahin Majed Hababeh Akihiro Seita 《Lancet》2019
Background
Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.Methods
The UNRWA Health Programme conducted a cross-sectional study of a sample of 220 out of the 390 male and female doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan during November, 2017. Individuals on duty at the health centres on the day of the survey were included. The 16 health centres were selected based on their size and accessibility to surveyors (reflecting proximity to Amman, and the size of population served). Of the selected health centres, seven were large, seven were medium, and two were small according to the UNRWA classification of health centres (based on the number of medical doctors). A validated self-administered questionnaire was used. Ethics approval was granted by the UNRWA Health Programme ethics committee, and informed written consent was obtained from all participants. Data analysis was performed using SPSS (version 22).Findings
Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p=0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220).Interpretation
Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation need to be tackled with a structured plan of action.Funding
The UNRWA Health Programme, UNRWA Headquarters, Amman, Jordan. 相似文献68.
Souhail Chatti Imane Kacem Maher Maoua Houda Kalboussi Mohamed Ayem El Asmi Aicha Brahem Sana El Guedri Olfa El Maalel Faten Debbabi Nejib Mrizak 《Annales médico-psychologiques》2019,177(4):364-369
Purpose
To describe the relationship between psychosocial factors and mental health among housekeepers.Methods
A cross-sectional study was conducted nearby all the housekeepers of Farhat-Hached teaching hospital of Sousse (Tunisia). After their oral consent, employees completed a self-administrated questionnaire including socio-demographic and lifestyle data, the Job Content Questionnaire (JCQ) evaluating psychological stress at work and the Hopkins Symptoms Checklist (HSCL-25) studying mental health.Results
Overall, 136 cleaners were enrolled in the study, corresponding to a response rate of 89.5%. The mean age was 41.9 ± 7.7 years. According to the demand control model, 26.5% of the participants were in the situation of job-strain. The study of HSCL-25 scales revealed a positive mental health disorders in 50% of cases. The study of the psychosocial factors revealed a correlation between job-strain and urban origin (P = 0.007), high psychological demand and seniority in the cleaning sector (P = 0.030) and low decision latitude and the night work (P = 0.015). The mental health association were associated with unmarried status (P = 0.006), high psychological demand (P < 0.001), active employees (P = 0.037), and iso-strain (P = 0.013). Mental disorders were associated with a high psychological demand in the presence of a high decision latitude (OR = 9.2 [2.8–30.8]) and a job-strain in the presence of low social support (OR = 3.5 [1.2–10.4]).Conclusion
Psychosocial factors can deteriorate seriously the mental health of workers. Their identification is the most important step in any efficient preventive strategy. 相似文献69.
Nabile M. Safdar 《Journal of the American College of Radiology》2019,16(4):542-546
A substantial and growing body of literature explores health disparities in radiology and imaging. The term “health disparities” refers to health differences related to disadvantages experienced by vulnerable populations, often caused by underlying social determinants of health. As such, health disparities are often closely tied to issues of social justice. Radiologists can work to reduce health disparities in different ways, including through supporting education, diversity and inclusion efforts, disparities research, and advocacy. 相似文献
70.
Shih-Chuan Chou Justine M. Nagurney Scott G. Weiner Arthur S. Hong J. Frank Wharam 《The American journal of emergency medicine》2019,37(6):1037-1043
ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures. 相似文献