社区开展艾滋病护理的难点与对策

艾滋病在我国的流行在历经传入期、播散期，目前已处于快速发展期，开展艾滋病社区护理已成为我国艾滋病防治工作不可或缺的重要组成部分。在社区开展艾滋病护理工作还存在着一系列的问题：居民对艾滋病知识的缺乏；流动人口增多；护理人员艾滋病知识呈现“三低一高”的态势；工作中缺乏与有关部门的配合；医疗经费难以保障等。为此建议有关部门可采取有针对性的健康教育；健全组织管理：强化对流动人员的管理；加强对护理人员的培训等对策予以应对。     

唐山市社区中老年人健康教育需求调查

目的：调查唐山市社区中老年居民的健康教育需求情况，以便开展有针对性的健康教育。方法：调查于2005-03／04在唐山市铁路楼居委会完成。选择该小区45岁以上、能正常回答提问的中老年居民321名，均自愿参加调查。由经过统一培训的人员通过入户问卷调查的方式了解居民对健康教育的需求，调查项目包括基本情况、体力活动、健康服务及卫生要求、社区卫生需求、饮食方式、慢性非传染性疾病健康知识及生活质量等。结果：调查321名中老年人，全部进入结果分析，无脱落。①社区中老年居民的文化程度及卫生需求：该社区中老年人具有一定的文化基础（初、高中以上学历比例为75．9％）；67．5％的居民希望获得保健知识；87．5％的居民赞成建立社区卫生服务机构。②社区中老年居民的生活习惯及饮食习惯：25．8％的居民不知道含胆固醇高的食品或回答错误；39．5％的居民不清楚胆固醇与心血管疾病的关系；41．4％的居民不清楚食盐的正确摄入量；29％的居民不认为食盐会对血压造成影响。（3）社区中老年居民对慢性病保健知识的知晓率：长期高血压会导致的疾病为20．7％；血脂高可能导致的疾病为23.3％；自己的血脂水平为46．7％；自己的血糖水半为53.3％。结论：该社区居民对饮食常识和慢性病保健知识了解不够，因此开展健康教育很有必要，主要内容应为培养健康的生活方式、防治慢性病。但针对该社区居民学历层次不高的特点，健康教育的方法要直观、通俗。     

社区卫生服务人员艾滋病知识、态度的调查分析

目的了解社区卫生服务人员对艾滋病知识、态度的现状及其影响因素,为进一步发挥社区卫生服务人员的积极作用及社区艾滋病防治工作的深入开展提供依据。方法采用定量研究方法调查社区卫生服务人员艾滋病知识、态度的现状,用定性和定量相结合的方法探讨影响社区卫生服务人员知识和态度的因素。结果调查对象对83．4％的艾滋病相关知识条目回答正确率在54．1％以上,16．6％专业性较强条目的回答正确率低于30％;单位的重视程度及工作性质是影响知识获取的主要因素。85．2％的人对艾滋病的态度不明确,心理矛盾冲突,14．8％的人持正性态度;角色、性别、文化程度、与单位关系、是否接受过艾滋病的专业培训等特征不同,对待艾滋病的态度也不同（P〈0．01）。结论需要进一步加强对社区卫生保健人员的培训和指导。     

社区开展艾滋病护理的难点与对策

艾滋病在我国的流行在历经传入期、播散期,目前已处于快速发展期,开展艾滋病社区护理已成为我国艾滋病防治工作不可或缺的重要组成部分.在社区开展艾滋病护理工作还存在着一系列的问题:居民对艾滋病知识的缺乏;流动人口增多;护理人员艾滋病知识呈现"三低一高"的态势;工作中缺乏与有关部门的配合;医疗经费难以保障等.为此建议有关部门可采取有针对性的健康教育;健全组织管理;强化对流动人员的管理;加强对护理人员的培训等对策予以应对.     

南海区精神病病人社区防治状况及社区护理干预模式研究

目的了解南海区精神病病人社区防治状况，为探讨更完善的社区护理干预模式提供依据。方法对佛山市南海区17个镇精神病病人分布情况、到精神病防治康复站定期取药情况和政府费用支付比例进行调查。结果南海区17个镇均建立了精神病防治康复站，共有精神病病人6165人，患病率6．05‰。定期到精神病防治康复站取药坚持治疗的病人仅1114人占18.07％，药费由政府资助比例30％-100％小等，其中支付90％以卜的镇有8个。结论政府对精神病社区防治资金投入大，精神病专科医院协作的精神病防治网分布较为全面，为全面建成社区病人、家属及普通人群的精神卫生服务体系提供有利条件。可建立全面的社区护理干预模式：利用各镇的精神病防治康复站和每月的精神病防治日开展对精神病病人、家属和社区人群的教育，纠正其偏见和错误认知，为病人康复创造良好社会环境；加强宣传提高病人服药依从性，对不依从病人进行人户随访和电话随访；由精神病专科陕院派专业人员到各镇指导、协助诊治和规范化管理精神病病人。     

社区艾滋病防治的重要作用与相关策略

充分发掘和利用社区资源优势及功能,利用社区文化和环境影响进行艾滋病健康教育、行为干预可增强干预的深度、广度及持续性和实效性。社区卫生服务急需将不同人群艾滋病教育和行为干预纳入日常工作计划。开展社区艾滋病防治的重要策略包括:发挥政府主导和协调作用,建立社区艾滋病防治网络;开展广泛社区动员,共同参与艾滋病防治活动;加强医护人员自身队伍建设,发挥社区卫生服务功能;从伦理角度探讨艾滋病防治,形成良好的社区人文环境。     

北京市西城区2型糖尿病社区管理效果评价

目的评价2型糖尿病病人社区管理的效果。方法2006年对在西城区某社区站就诊的190例2型糖尿病病人建立健康档案、问卷调查及体格检查后，对病人进行社区干预1年，再次进行问卷调查及体检。结果管理后糖尿病病人空腹血糖控制理想的比例从19．6％提高到22．8％（P〈0．05），糖化血红蛋白控制理想的比例从18．5％提高到27.2％（P〈0．05）；用胰岛素治疗的比例从21．7％提高到31．5％；定期监测糖化血红蛋白、血脂、尿常规和微量白蛋白的比例均明显提高（P〈0.05）；病人生活质量得以改善。结论社区管理可明显改善2型糖尿病病人的治疗和控制状况，但是与《中国糖尿病防治指南》的要求相比仍有较大差距，如何提高社区疾病管理的水平和效果是亟待解决的重要问题。     

安徽某地艾滋病病毒感染者配偶及子女HIV感染情况调查

目的为了解某地艾滋病病毒感染者配偶及子女HIV感染情况，探索降低性及母婴传播艾滋病的综合性防治策略。方法采艾滋病病毒感染者配偶及子女血液，分别用华美和万泰试剂厂生产的1 2酶联免疫吸附试剂盒做筛查。对HIV抗体初筛检测呈阳性反应的标本，送省疾病预防控制中心艾滋病确认实验室确认。结果共检测艾滋病病毒感染者配偶206人。其中HIV抗体检测阳性34人(WB)，阳性率16．5％；艾滋病病毒感染者子女314人，其中HIV抗体检测阳性5人（WB)，阳性率1．6％，年龄中住数8岁。配偶及子女共调查520人，阳性39人，阳性率7．5％。34例艾滋病病毒感染者中，有7例明确表示无卖血和受血史，占20．6％(7／34)，占调查配偶人数的3．4％(7/206)以上。正直性活跃期的30岁、40岁组配偶感染率18％(27／150)。结论某地艾滋病病毒感染者配偶及子女HIV感染情况应引起高度重视，必须采取切实可行的综合性防治措施控制艾滋病在该地的流行。阻断HIV母婴传播是低投入高效益的举措。     

妇产科门诊开展艾滋病自愿咨询检测及护理干预探讨

[目的]了解孕妇接受艾滋病（AIDS）自愿咨询检测（VCT）情况及对AIDS防治知晓率，开展有效健康教育服务。[方法]对我院产科门诊行首次产科检查建卡的2000位孕妇，由孕妇决定是否接受HIV检测，并有针对性开展健康教育、行为干预及关怀干预服务，对干预前后AIDS防治知识及恐惧、焦虑心理进行调查。[结果]2000位产检孕妇中有1568人自愿接受HIV检测，达78．4％，从中检出HIV阳性10人，占0．64％，开展VCT前孕妇对AIDS防治知晓率较低，且恐惧发生率68.9％，焦虑57．5%，干预后孕妇对AIDS防治知识知晓率显著提高，恐惧、焦虑分别下降到34．3％、29．5％．[结论]在产科门诊开展艾滋病VCT及护理干预是防止AIDS母婴传播的一项有效措施。     

贵阳城区社区卫生服务现状的调查研究

目的了解贵阳市城区社区卫生服务的现状及存在的问题。方法采用统一的调查表对贵阳市城区63个社区卫生服务中心(站)的工作进行调查。结果我市63个社区，其中属省级医院13所，拥有床位数8464张，医生308人，护士268人。医护比例为1：0．89，初、中、高级职称比例为6．5：3．7：1。投入与支出差额为-1，285．5万元。讨论我市社区卫生服务资源较为丰富，但卫生人力资源结构不甚合理，必须加强社区卫生服务人员队伍的建设。卫生经费的投入小于支出。预防保健等服务项目开展不足。     

基于社区的HIV/AIDS患者心理支持模式的研究

目的探讨基于社区HIV/AIDS患者心理支持模式。方法建立以社区为基础,由心理学专家、社区志愿者、社区医生、社区护士、患者家属等组成的心理支持团队,通过心理咨询、健康教育、反歧视宣传、同伴交流等活动,为HIV/AIDS患者提供心理关爱和情感支持。结果基于社区的心理支持模式,能有效地帮助HIV/AIDS患者走出心理困境、降低焦虑抑郁程度、提高生活满意度。采用患者单一条目自我评分法,心理支持前后焦虑抑郁和生活满意度的差异有统计学意义(P0.01)。结论建立以社区为基础的心理支持模式有着传统心理支持不可比拟的优势,对充分发挥社区在艾滋病防治方面的功能及动员社会力量控制艾滋病的传播有重要的现实意义。     

Specialist or generic community nursing care for HIV/AIDS patients?

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings Most community-based health care in the United Kingdom is provided by primary health care teams general practitioners and community nurses, with support from social workers However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA) Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms Three models of care have developed in NETRHA specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity     

Taking action in communities: women living with HIV/AIDS lead the way

For the past 5 years, a successful collaboration of a medical center, a community-based HIV/AIDS service organization, a university school of nursing, and women living with HIV/AIDS in an inner city community resulted in a series of educational programs1 for women living with HIV/AIDS, their family, friends and caregivers. These programs were intended to provide inner-city women who were living with HIV/AIDS with knowledge and new insights from the voices of their peers. Topics focused on their self-care and empowerment so that they could take control of their wellness and their health care while remaining in their community. The efforts made in launching the collaborative educational series created trusting relationships between academic, clinical, and community service agencies, professional caregivers, and the recipients of their care. The most significant contribution belonged to the women living with HIV/AIDS themselves: After the programming they turned their health and life experiences into "action" by planning a research project that will test the efficacy of an intergenerational HIV prevention program for adolescent women of color in their community in the future.     

AIDS prevention for women: a community-based approach.

There were approximately 3 million HIV-positive women in the world, most of them in reproductive age according to the WHO's 1991 estimates. One third of the world's HIV-positive individuals are women; by the year 2000, women will account for half of the HIV-positive population. There are at least 200,000 HIV-positive women in Asia, mainly in Thailand, India, and China. The community-based Botswana project approach to AIDS prevention for women was based on a community-based model project at the University of Illinois to promote health in 2 low-income communities in Chicago by teams of trained residents and a nurse. Program elements included: women as health promoters; acceptance of primary health care; and emphasis on self-care in basic health. In Botswana the fertility rate is 5%, and approximately 40% of the women use contraceptives. The overall mortality rate is 37 per 1000. The 1st case of AIDS in Botswana was identified in 1985. As of January 1991, there were 180 cases and 59 AIDS-related deaths. There are 20,000 to 47,000 HIV-positive individuals in Botswana. There have been more women than men among reported AIDS cases in Botswana. Most women in their childbearing years are at moderate risk of HIV infection because of weak partner ties and occasional multiple partners. A 2-stage study of the effectiveness of nurse-managed peer education and support groups for AIDS prevention for women has been in operation for the 2nd year. In the 1st phase, interviews with more than 50 urban women explored their current risk of HIV infection and the risk-reduction strategies. The strategy for change used peer education and support groups led by trained community women to achieve lasting behavioral changes that promote health. The target group approach will include all women in the community. Heterosexual transmission of HIV is the predominant route of infection for women, hence promotion of safer sex is central in the Botswana intervention. The same AIDS preventive practices also protect against other sexually transmitted diseases including gonorrhea, syphilis, and chlamydiosis, which have high prevalence rates in Botswana.     

社区组织对艾滋病病毒感染者与病人的服务效果分析

目的：分析社区组织为艾滋病病毒感染者和病人（ people Living with HIV/AIDS,PLHA）提供服务的效果,为政府购买其服务提供依据。方法选取一基层社区组织,通过现有资料收集、关键人物访谈、专项调查等对社区组织为PLHA提供服务的过程、效果和经济指标进行比较分析。结果该社区组织2012年和2013年服务的PLHA人数、检测治疗指标均达到国家要求,超过全国和四川省的平均水平;病毒抑制达到较高水平;机会性感染发生、病死率均维持较低水平,且低于我国其他地区;服务的人均成本下降超过30％。结论该社区组织为PLHA提供服务的成效明显;社区组织为PLHA提供服务具有较多优势;社区组织应加强自身建设以更好为PLHA提供服务;各地政府和相关部门要加强对社区组织参与艾滋病防治工作的支持。     

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in today's urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.     

Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS

There is a growing need for advanced practice mental health and drug and alcohol nursing roles in the care of people living with HIV/AIDS; however, limited publications address these domains. This study evaluated a community-based mental health drug and alcohol nurse role caring for people living with HIV/AIDS (Mental Health D&A Nurse) in a large not-for-profit district nursing organization providing care to people living with HIV/AIDS in an Australian city. Outcomes from a client assessment and 6–8-week follow-up by the Mental Health D&A Nurse are presented as captured by the Depression Anxiety Stress Scales (DASS 21), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Health of the Nation Outcome Scales (HONOS) and WHOQoL BREF. Mean scores and caseness were analysed, and significant differences were found on the 'impairment' and 'social problems' subscales of the HONOS. Results of semi-structured interviews with clients describe effective and supportive mental health care and health-promoting education following visits by the Mental Health D&A Nurse. These positive findings support continuing implementation of the role within this community setting and indicate that even greater benefits will ensue as the role develops further. Findings are of interest to clinicians and policy makers seeking to implement similar roles in community-based HIV/AIDS care.     

Black populations, human immunodeficiency virus/acquired immune deficiency syndrome, and research: implications for nurses.

Knowledge that is generated from research is critical toward understanding the prevention, impact, and treatment of human immunodeficiency virus (HIV) disease and acquired immune deficiency syndrome (AIDS). During the past several decades, the Black community has been disproportionately affected by the HIV/AIDS epidemic. Therefore, engaging their participation in HIV/AIDS research is necessary to understand the disease further and to develop strategies for nursing interventions. Many factors hinder Blacks from participating in HIV/AIDS research. This review provides information for nurses about problems related to recruitment and recommendations for recruiting Black participants for HIV/AIDS research.     

Community-based participatory research to prevent substance abuse and HIV/AIDS in African-American adolescents

Adolescence is a time for exploration and risk-taking; in today's urban environment, with the twin threats of substance abuse and HIV/AIDS, the stakes are particularly high. This paper describes a community-based participatory research project to design, implement, and evaluate a faith-based substance abuse and HIV/AIDS prevention program for African-American adolescents. A coalition of university-based investigators and African-American church member stakeholders collaborated on all aspects of Project BRIDGE, the 3-year intervention to reduce substance abuse and HIV/AIDS in African-American adolescents. Our results support the use of community-based participatory research to create desirable change in this setting. Adolescents who participated in Project BRIDGE reported significantly less marijuana and other drug use and more fear of AIDS than a comparison group. Project BRIDGE has been designated an official ministry of the church and the program has been extended to others in the larger metropolitan community. The church now has a well-trained volunteer staff. University faculty developed skills in negotiating with community-based settings. The coalition remains strong with plans for continued collaborative activities.     

Community health, media, and policy in sub-Saharan Africa: a primary prevention approach to the AIDS crisis.

Availability, access and utilization of essential health services present challenges to community health services in Sub-Saharan Africa. HIV/AIDS infection has added yet another dimension to a continent already experiencing economic crises. A primary prevention approach is emphasized as a means of addressing sexual behaviors that decrease risk of transmission. Educating the sexually active to use condom and also HIV/AIDS testing and counseling can be effective in curbing transmission of the virus. Community forums such as the local schools and churches, together with the political leadership need to coordinate primary prevention efforts against HIV/AIDS transmission. The media can be powerful in raising awareness, community activism, and mobilization of the masses at grass-roots level by advocating behaviors that promote health. African leaders must indicate a strong political will by shaping policies that address HIV/AIDS. These leaders need resources (both internally and externally) to fund primary prevention programs that are community-based and outcome-oriented.