“心境促进协作医疗”模式对社区老年抑郁症生活质量影响及初步卫生经济学评价

目的探讨＂心境-促进协作医疗＂（IMPACT）管理模式对社区老年抑郁症患者生活质量影响及卫生经济学价值。方法对30名社区老年抑郁症患者实施为期2年的IMPACT管理治疗,按1：1配对另30例作为对照组,对其实施常规的社区精神病康复管理。在干预第一年末及第二年末使用汉密尔顿量表（HAMD）、家庭负担表（FIS）、生活满意度（LSR）进行评定并观察费用成本。结果在实施干预的第一年末和第二年末,干预组患者的HAMD和FIS得分较对照组显著降低、干预组患者LSR得分较对照组显著升高（列联表卡方检验结果中,χ^2均大于5.9,P值均〈0.05）。2年内干预组患者总费用低于对照组,表现在门诊费用、住院费用、社区防治费用和家属误工费用等方面干预者患者的支出要明显少于对照组患者（t检验结果中,P值均〈0.05）;同时,两者患者在药物费用支出方面无显著差异。结论 IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,并显著降低患者因疾病产生的各项费用成本。     

“心境-促进协作医疗”模式对精神分裂症患者抑郁和焦虑的影响

[目的]探讨\     

“心境-促进协作医疗”模式对精神分裂症患者生活质量和复发的影响

[目的]探讨\     

区域性协作医疗中社区糖尿病群组看病模式探讨

目的在区域性协作医疗中,糖尿病专科医师参加糖尿病社区管理,建立糖尿病群组的看病模式。方法分析上海市糖尿病社区管理现状,比较不同糖尿病社区管理模式,在区域性协作医疗下,建立糖尿病群组看病模式和病历管理体系。结果建立糖尿病群组看病模式,有助于糖尿病管理的全科—专科间双向转诊,实现糖尿病社区与医院的一体化管理。结论糖尿病群组看病改变了传统的"医生—病人"的单向看病方式,形成了以"病人群组"为中心的看病模式,合理配置了社区医师人力资源,同时可以发挥区域性协作医疗中糖尿病专科医师在社区医疗的实践价值。     

社区医疗服务对老年保健作用

为了解决老年人看病难、住院难的矛盾,探讨社区医疗服务在老年保健中的作用,我们自1992年在日照市区开展了家庭病床服务项目,其中收治了60岁以上老年     

安徽省农村社区老年抑郁症发病率调查

目的了解我国农村社区老年抑郁症的发病率及其危险因素，为进一步探讨积极有效的预防和控制老年抑郁症的干预措施提供依据。方法以2003年安徽省家村社区调查时的非抑郁老年人为对象，于2004年进行随访研究。采用老年精神状况量表和老年抑郁症危险因素量表作为调查工具，采用SPSS10．0软件进行分析。结果随访到的1236名老年人中共有89名病例，首次发病率为7．2％。X^2检验表明，不同性别发病率差异有统计学意义（P〈0．05），不同年龄、婚姻、职业和文化之间发病率差异无统计学意义（P〉0．05）。多元Logistic回归分析表明。性别是老年抑郁症发病率的危险因素（P〈0．05，RR为1．68，95％CI=1．07-2．64）。结论农村社区老年抑郁症发病率水平高于预期，老年女性是农村社区老年抑郁症的高危人群，应作为重点干预对象。     

老年抑郁症及其社区护理与防治

中国进入老龄化社会时间较晚，但发展迅速，随着社会发展，经济增长和科技的进步，人均寿命值在增高。由于老龄化的加速，也带来了相应的社会保健需求。     

社区医疗单位老年患者的护理

目的 探讨加强社区医疗单位老年住院患者的护理措施.方法 通过对老年患者住院期间的临床护理观察及体会.结果 通过加强基础护理,结合有效护理可以明显提高老年患者的治疗效果.结论 做好护理,降低危险因素的发生率,创造安全的就医环境,可提高老年患者生活质量.     

农村社区老年抑郁症患病率影响因素调查

目的调查农村社区老年抑郁症患病率，了解其危险因素，为制订防治措施提供科学依据。方法采用整群随机抽样方法以及描述性分析、Logistic回归分析方法。结果老年抑郁症患病率为5．9％。单因素分析表明，不同性别、婚姻状况和是否吸烟的老年人之问抑郁症患病率差异有统计学意义。多因素Logistic回归分析显示，女性、健康自评一般、经济自评差、独居、伤感情绪和恐怖经历则增加老年人抑郁症患病率，经常与他人交流可降低抑郁症患病率。结论性别、婚姻状况、健康自评和经济自评以及负性生活事件是农村社区老年抑郁症患病的危险因素。     

社区老年抑郁症的护理

老年抑郁症是较常见的老年期精神障碍。广义的老年抑郁症泛指发生于老年期（≥60岁）这一特定人群的抑郁症，包括原发性（含青年或成年期发病，老年期复发）和继发性（老年期出现的各种抑郁症），又称症状性抑郁。狭义的指≥60岁首次发病的原发性抑郁症。随着社会的老龄化，老年抑郁症患者日益增多，国外调查表明，社区老年抑郁症患病率约为5％～15％，我国的患病率大约为6％～29．4％。老年抑郁症对老年人身心健康危害严重，而老年人大多数时间生活在社区，社区护理对老年抑郁症患者的康复显得尤为重要。现将我院家庭老年抑郁症患者护理报道如下。     

Improving quality of care for depression: the German Action Programme for the implementation of evidence-based guidelines.

ISSUE: Depressive disorders are of great medical and political significance. The potential inherent in achieving better guideline orientation and a better collaboration between different types of care is clear. Throughout the 1990s, educational initiatives were started for implementing guidelines. Evidence-based guidelines on depression have been formulated in many countries. PURPOSE: This article presents an action programme for structural, educational, and research-related measures to implement evidence-based care of depressive disorders in the German health system. The starting points of the programme are the 'Guidelines Critical Appraisal Reports' of the 'Guideline Clearing House' and measures from the 'Competence Network on Depression and Suicidality' (CNDS) funded by the Federal Ministry of Education and Research. The article gives an overview of the steps achieved as recommended by the Guidelines Critical Appraisal Reports and the ongoing transfer process into the German health care system. RESULTS: The action programme shows that comprehensive interventions to develop and introduce evidence-based guidelines for depression can achieve benefits in the care of depression, e.g. in recognition, management, and clinical outcome. CONCLUSION: It was possible to implement the German Action Programme in selected care settings, and initial evaluation results suggest some improvements. The action programme provides preliminary work, materials, and results for developing a future 'Disease Management Programme' (DMP) for depression.     

Development and testing of a utility measure for major, unipolar depression (McSad)

Objective: To develop and test a direct utility measure (McSad) for major, unipolar depression. Methods: A depression specific, multi-attribute health state classification system was created; clinical validity was evaluated by experts using specially designed structured exercises; a cross-sectional survey was conducted to obtain directly measured utilities for depression health states. Setting: Tertiary care, university medical centre. Participants: Three psychiatrists, 3 psychiatric nurses and 3 social workers assessed depression health state clinical validity. Survey participants were referred by psychiatrists and consisted of 105 out-patients, currently in remission with at least one episode of major, unipolar depression in the past two years. Survey results: Respondent self-health state utility (mean and 95% confidence interval (CI)) was 0.79 (0.74–0.83). Utilities for hypothetical, untreated depression health states were: mild depression, 0.59 (0.55–0.62); moderate depression, 0.32 (0.29–0.34); severe depression, 0.04 (0.01–0.07). Fifty-six percent of respondents rated severe depression worse than being dead. Utilities for the hypothetical health states were not correlated with self-health utility. The intra-class correlation coefficient (ICC) was satisfactory for 13 of the 14 health states assessed. Conclusions: McSad was feasible and acceptable in patients with a history of major unipolar depression. The utilities for mild, moderate and severe untreated depression show the low health-related quality of life associated with depression. Initial assessments of test–retest reliability and validity yielded satisfactory results but further studies are needed to extend our knowledge of the measurement properties of McSad.     

社区居家养老服务高质量发展评价指标体系的构建研究

目的：社区居家养老服务对于缓解养老压力和提升老人生活质量具有重要作用,本文结合新时代养老服务高质量发展需求,基于SERVPERF模型,构建社区居家养老服务高质量发展评价指标体系,为社区居家养老服务高质量发展的评价和改进提供参考。方法：通过梳理社区居家养老服务相关政策及文献,结合专家访谈,确定初步指标池;开展两轮德尔菲专家咨询,确定评价指标体系。结果：两轮咨询专家积极系数均为100%,专家权威系数分别为0.79、0.82,专家协调程度逐轮提升;最终确定的评价指标体系包括6个一级指标和36个二级指标。结论：本研究构建的社区居家养老服务高质量发展评价指标体系具有一定科学性和可靠性,可为社区居家养老服务高质量发展的评价、建设和改进提供依据。     

社区管理与综合干预对糖尿病患者病情控制效果分析

目的分析评价昆明市糖尿病社区管理与综合干预措施对糖尿病患者病情控制的效果。方法 2008年5月在昆明市石林县选择两个社区的335例糖尿病患者进行问卷调查和体检,科兴社区为干预社区,对患者采取干预管理措施,鹿阜社区为对照,经过1.5年的干预后进行调查评估。结果社区干预管理可改善糖尿病患者病情控制效果,经过1.5年的干预管理后,干预组患者血糖控制理想率提高,达到50.24%,且高于对照组(19.56%),差异有统计学意义(χ2=60.287,P=0.000);干预组患者空腹血糖水平下降,干预前后的差异有统计学意义(t=5.061,P=0.000),对照组空腹血糖水平没有改善(t=1.316,P=0.189);干预组患者血压控制理想率提高,达到77.18%,且高于对照组(44.57%),差异有统计学意义(χ2=32.853,P=0.000);而干预组和对照组患者体重控制情况尚无变化。结论社区规范化管理与综合干预有助于糖尿病患者的病情控制,社区基层医生应结合规范化药物治疗和个体化行为干预对糖尿病患者进行综合干预与管理。     

Effectiveness of Written Dietary Advice for Improving Blood Lipids in Primary Care Adults—A Pragmatic Randomized Controlled Trial (MYDICLIN)

Lifestyle management is the first line of treatment for moderately elevated blood lipids in healthy individuals. We investigated the effectiveness of providing food-based written advice for lowering low-density lipoprotein (LDL) cholesterol (intervention) or triglycerides (control) in a pragmatic randomized controlled trial with two parallel arms from 2018–2019 at a rural primary health care center. We sent feedback letters after 3 weeks and 6 months. Out of the 113 adult primary care patients randomized, 112 completed the study. There were no differences between the intervention and control groups for changes in LDL cholesterol after 3 weeks (mean ± standard deviation −0.21 ± 0.38 vs. −0.11 ± 0.34 mmol/L, p = 0.45) or 6 months (−0.05 ± 0.47 vs. 0.02 ± 0.41 mmol/L, p = 0.70) (primary outcome). Following the advice to consume plant sterols and turmeric was associated with a reduction in LDL cholesterol after 3 weeks. Following the advice to consume less carbohydrates was associated with reduced triglycerides. In the intervention arm, 14 individuals (25%) reduced their LDL cholesterol by ≥10% after three weeks. Their reduction was attenuated but maintained after six months (−7.1 ± 9.2% or −0.31 ± 0.38 mmol/L, p = 0.01 compared with baseline). They differed only in higher adherence to the advice regarding turmeric. In conclusion, this undemanding intervention had little effect on blood lipids for most individuals.