脊髓损伤的程度评价及流行病学现状

近年脊髓损伤的程度评价及流行病学状况有了很多新的进展,特别是对脊髓损伤的流行病学深入研究,有效地指导了临床预防工作的开展,在预防脊髓损伤发生及降低伤后伤残程度方面,均显示出较好效果.作者复习了国内脊髓损伤资料并加以综合归纳,探讨了脊髓损伤的程度评价及流行病学现状,希望能有助于增加医生对患者损伤情况处理的预见性,并直接开展脊髓损伤的预防工作.     

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.     

An evaluation of a Lyme disease prevention program in a working population

PURPOSE: Lyme disease vaccine was offered to New York State Department of Health employees considered at risk for Lyme disease because of their job duties. This evaluation was conducted to assess (1) attitudes that affected employees' decisions to accept or decline the vaccine, (2) preventive behaviors among employees who received the vaccine, and (3) effectiveness of the educational modalities offered in improving knowledge of Lyme disease and Lyme disease vaccine. METHODS: A total of 190 eligible employees were identified and were offered two educational modalities before deciding whether to receive the vaccine. The subsequent evaluation involved three telephone interviews, one pre-education and two posteducation-vaccination, to assess factors affecting the decision about vaccination and attitudes, behaviors, and knowledge among vaccine recipients (N=30) and nonrecipients (N=160). RESULTS: This evaluation indicated that the majority of vaccine recipients decided to receive the vaccine because of an anticipated risk of tick exposure. For employees who declined vaccination, many were concerned about the safety (64%), novelty (56%), or efficacy (48%) of the vaccine. Posteducation knowledge of Lyme disease vaccine significantly improved among those who attended an education session compared with those who did not and was retained 1 year later. DISCUSSION: The results suggest that when a vaccine-related disease-prevention program is undertaken, (1) attitudes about disease risks and vaccine risks influence decisions to accept vaccination, and (2) in-person education should be a mandatory element of the program.     

骶3神经电针预防脊髓损伤后尿路感染的临床研究

目的 探究骶3神经电针预防脊髓损伤后尿路感染情况,并研究分析在不同的电针刺激强度对患者效果,为临床诊断治疗提供决策依据.方法 选取医院2010年1月-2012年1月收治的由于各种原因引起的脊髓损伤患者60例,随机分成两组,每组各30例,治疗组采取电针刺激骶3神经的方式预防脊髓损伤后产生的尿路感染,根据不同的患者调节适当电针刺激强度,对照组未使用电针刺激骶3神经,通过是否使用电针刺激骶3神经及电针刺激强度观察患者尿路感染,并在治疗后比较两组患者尿路感染情况.结果 两组患者结果显示尿路感染的例数均呈减少的趋势,治疗组患者在经电针刺激骶3神经后尿路感染的例数较对照组患者明显减少,特别是在1、2个疗程后较明显,差异有统计学意义(P＜0.05).结论 使用电针刺激骶3神经预防脊髓损伤的患者尿路感染有明显疗效,且无不良反应.     

An evaluation of a state hepatitis prevention and control program: focus group interviews with clients

This article presents the results of the qualitative component of a comprehensive evaluation of a state hepatitis prevention and control program. The qualitative component of the evaluation was designed to assess the motivational factors behind clients seeking hepatitis-related services and explore their experiences with the services provided by local health departments. The transtheoretical model was employed as a means of identifying the stage of change the client was in and what processes of change were useful in moving the client through the various stages of change. Focus groups were conducted with 44 participants in six different counties in Florida. Results of the focus group interviews support the use of the transtheoretical model in program evaluation using focus group methods. The findings of the focus groups suggest the need for education of the public and health care providers regarding hepatitis and the importance of supportive relationships to clients seeking and receiving hepatitis screening and vaccination.     

Back to the basics: identifying positive youth development as the theoretical framework for a youth drug prevention program in rural Saskatchewan,Canada amidst a program evaluation

Background

Despite endorsement by the Saskatchewan government to apply empirically-based approaches to youth drug prevention services in the province, programs are sometimes delivered prior to the establishment of evidence-informed goals and objectives. This paper shares the 'preptory’ outcomes of our team’s program evaluation of the Prince Albert Parkland Health Region Mental Health and Addiction Services’ Outreach Worker Service (OWS) in eight rural, community schools three years following its implementation. Before our independent evaluation team could assess whether expectations of the OWS were being met, we had to assist with establishing its overarching program goals and objectives and 'at-risk’ student population, alongside its alliance with an empirically-informed theoretical framework.

Methods

A mixed-methods approach was applied, beginning with in-depth focus groups with the OWS staff to identify the program’s goals and objectives and targeted student population. These were supplemented with OWS and school administrator interviews and focus groups with school staff. Alignment with a theoretical focus was determined though a review of the OWS’s work to date and explored in focus groups between our evaluation team and the OWS staff and validated with the school staff and OWS and school administration.

Results

With improved understanding of the OWS’s goals and objectives, our evaluation team and the OWS staff aligned the program with the Positive Youth Development theoretical evidence-base, emphasizing the program’s universality, systems focus, strength base, and promotion of assets. Together we also gained clarity about the OWS’s definition of and engagement with its 'at-risk’ student population.

Conclusions

It is important to draw on expert knowledge to develop youth drug prevention programming, but attention must also be paid to aligning professional health care services with a theoretically informed evidence-base for evaluation purposes. If time does not permit for the establishment of evidence-informed goals and objectives at the start-up of a program, obtaining insight and expertise from program personnel and school staff and administrators can bring the program to a point where this can still be achieved and theoretical linkages made after a program has been implemented. This is a necessary foundation for measuring an intervention’s success.

     

Sexual counseling and spinal cord injury

Spinal cord injury (SCI) may result in significant disruption of physical, social, vocational, psychological and sexual function. As an integral component of human behavior, it is a mistake to isolate and treat sexual activity as a separate entity, or to ignore it entirely in the rehabilitation setting. This article reviews the important variables that influence the ability of spinal cord injured individuals to perceive of self and act as a sexual being. Assessment issues are addressed, with a specific focus on those aspects of assessment that are unique to or need special consideration in treating spinal cord injured individuals. The PLISSIT mode of sex therapy is described to illustrate the interventions used with the spinal cord injured client. This model is utilized because it allows each staff member to participate according to their level of skill, knowledge, and comfort. This article demonstrates that through use of multiple therapeutic modalities it is possible for the spinal cord injured client to be rehabilitated to a satisfactory level of sexuality.     

Combatting sexual assault: an evaluation of a prevention program

Few guidelines exist for the planning or evaluation of community-based sexual assault prevention initiatives. Records from the Safety Van Program, as well as survey data from 60 users and 60 non-users characteristic of the target group, were used to explore the complex relationship between awareness, fear of assault and service use. Findings from the evaluation address issues such as basing program expansion on utilization rates, and using incidence rates to justify service need.     

An injury prevention program in an urban African-American community.

OBJECTIVES. Injury is a major US public health problem, particularly in urban minority communities. This paper evaluates the impact of the Safe Block Project, a comprehensive injury prevention trial, on home hazards and injury prevention knowledge in a poor urban African-American community. METHODS. Nine census tracts in the community were allocated to either the intervention area or the control area. The intervention, carried out by trained community outreach workers, consisted of (1) home modification for simple prevention measures, (2) home inspection accompanied by information about home hazards, and (3) education about selected injury prevention practices. Approximately 12 months after the intervention, random samples of control and intervention homes were assessed for home hazards and injury prevention knowledge. RESULTS. A significantly larger proportion of intervention homes than control homes had functioning smoke detectors, syrup of ipecac, safely stored medications, and reduced electrical and tripping hazards. No consistent differences were observed between control and intervention homes on home hazards requiring major effort to correct. CONCLUSIONS. There was a distinct difference between control and intervention homes with respect to safety knowledge and home hazards requiring minimal to moderate effort to correct. The Safe Block Project could serve as a model for future urban injury prevention efforts.     

Sexual questions and comments on a spinal cord injury service

Fifty-one staff members in a spinal cord injury (SCI) rehabilitation setting rated 47 sexual questions and comments with which they might be confronted by SCI patients on the basis of the amount of discomfort they would feel. The subjects indicated which of the situations had occurred to them. Finally, for 31 of the items, the staff rated on a 5-point scale how informed they were to deal with the situations. The most highly rated situations are presented, as well as interrelationships among the various ratings, demographic variables, and professional disciplines.     

Violence prevention in a small-scale psychiatric unit: program planning and evaluation

Aggression against nurses and ancillary personnel is a major--overall under-reported--occupational problem in sociomedical facilities for psychiatric and demented patients. The frequency of violent incidents against workers in a residential rehabilitation unit was assessed during medical examinations in the workplace between 1996 and 2009. The majority of the workers had been subjected to physical aggression over time. A violence prevention program that included educational, organizational, and medical measures was implemented in 2002. Interrupted time series analysis showed that the aggression trend prior to intervention was flat (beta3 = -0.004; SD = 0.003; P = 0.241), while there was a significant drop in aggressions after the intervention (beta3, = -0.149; SD = 0.018; P < 0.0001). No late increase in trend was observed in the post-intervention period (beta3, = -0.006; SD = 0.004; P = 0.175). The program contributed to reducing violence in the workplace.     

脊髓损伤的康复护理

目的提高脊髓损伤致截瘫患者的生存率、生活能力和生活质量,增强生活的自信心,减少和预防并发症的发生.方法做好患者心理康复指导,鼓励和协助患者进行系统性康复功能训练,积极做好并发症的预防和康复护理.结果通过一系列的康复功能训练,提高了患者生活自理能力(进食、洗漱、排泄等)和生活质量,减轻了家庭和社会的负担.结论脊髓损伤患者通过心理康复指导,肢体早期康复功能训练,最大限度使用尚有运动功能的肌肉,来代偿已丧失的功能,消除和减轻患者功能上的障碍,还能促进肢体关节残存功能的恢复和重建,预防和减少了并发症的发生,达到了最大限度的适应独立生活和参与社会的能力,有着较大的社会效益和经济效益.