A follow-up study on effects of ADL deterioration on QOL in patients with neurological intractable diseases]

OBJECTIVE: This follow-up study examined correlating factors, including change of activity of daily living (ADL), which are associated with subjective quality of life (QOL) in patients with neurological intractable diseases such as amyotrophic lateral sclerosis, spinocerebellar degeneration and Parkinson disease. METHODS: Baseline information of 159 patients with above mentioned three intractable diseases registered by two public health centers in Niigata and Fukuoka Prefectures was obtained in 1993-1994, and they were followed to 1995. At the end of follow-up, 124 subjects were interviewed by public health nurses using the 27 item-subjective QOL scale for patients with neurological intractable diseases, previously confirmed for reliability and validity. RESULTS: Low level of ADL at the time of registry and deterioration of ADL after the registry were independently related to low level of subjective QOL. CONCLUSIONS: It may be necessary to minimize the ADL deterioration, in order to maintain a high subjective QOL of patients with neurological intractable diseases.     

2008年北川县小坝乡地震灾后疾病预防控制工作对口支援效果评价

[目的]了解枣庄市对口支援地震灾后疾病预防控制工作的效果,为下一步援助工作提供决策依据。[方法]2008年12月（地震后7个月）。对北川县小坝乡26个村和1个社区进行调查。[结果]2008年小坝乡传染病发病率为228．07／10万,低于2007年的342．11／10万;苍蝇密度,在震后1个月（6月）为9．47（32／338）,10月为3．82％（P〈0．05）;未出现地震相关疾病的暴发、流行和突发公共卫生事件;对受灾群众开展震后饮食饮水卫生健康教育,教育前后健康知识回答正确率分别为26．78％、86．25％（P〈0．01）。[结论]对口支援疾病预防控制工作成效显著。     

Relationship between health services for maternal and child health and working hours of public health nurses]

Based on the "Maternal and Child Health Service Act", public health centers and municipalities offer health education, health counseling, health examination, and home visits for district children and for their mothers. The relationship between the number of the MCH services offered and the working hours of public health nurses at the public health centers and the municipalities was analyzed. Data were taken by a survey in 1989, which was used for evaluating services provided to the children and their mothers in 1988. Questionnaires were sent to 23 health centers and their districts and 100 responses from 8 wards, 20 cities, 47 towns, and 25 villages were analyzed. When total working hours of the public health nurse for MCH are allocated to the four parts-planning, implementation, evaluation and training-86.7% of working hours are for implementation itself. The correlation coefficient between the total working hours of the public health nurse for MCH and the population, and the number of births per year, were significantly positive. A total of 107 hours were supplied for the infant child health examination per 100 births per year, for which 64% was for implementation itself. In the case of the health examination for three-year-old children, total working hours were 143 hours, for with 79% was for implementation itself. The number of mother-child handbooks issued, the number of health education classes and health counselings conducted, various health examinations performed, and home visits made were correlated significantly with the working hours of the public health nurse.     

洪涝灾害现场医疗救援的研究进展

2021年7月,河南省遭遇特大洪涝灾害。洪涝灾害的发生具有突发性、复杂性等特点,是全球最具破坏性的自然灾害类型,对公众生命健康、社会经济文化造成巨大的影响。本文对洪涝灾害致病特点、洪涝灾害现场医疗救援人员国内外配备现状及医疗救援物资国内外配置等进行阐述,旨在为灾后现场医疗救援提供指导,为政府援助及公共卫生管理提供参考。     

Special categories of elderly patients with intractable neurological diseases (NANBYO) in Toyama, Japan

The purpose of this study was to elucidate special categories of elderly patients with intractable neurological diseases (NANBYO) in Toyama, Japan. This goal was accomplished through comparisons of data gathered in 1991 and 1997. Forty-eight (20 males, 28 females) with such diseases were recruited for the study and agreed to be interviewed. The surveys were performed by three public health center nurses. The same questionnaire was used in both years. The surveys show that the number of jobless patients and those who needed total support increased by approximately 20% from 1991 to 1997. In addition, it appears that the ratio of hospitalized patients and those who needed medical equipment installed at home increased considerably. The number of patients with caregivers increased by approximately 30%. As the caregivers got older, it was observed that the patients became more anxious about their health condition. Also, in both years, both patients and caregivers showed the highest concern about a sudden change in the patients' conditions. In conclusion, an assessment of patient and family needs is important for the development of a community health care system. It is also essential for all the parties in the field of health, medicine, and welfare, as well as volunteer groups, to have a good understanding of each other's services and to have a cooperative relationship coordinated by health centers through discussion of each individual case.     

汶川特大地震后双流县临时安置点灾区受灾群众心理卫生状况调查

[目的]了解地震后灾区群众的心理卫生状况,为开展其他危机事件及突发公共事件心理援助工作提供依据。[方法]2008年5月16~30日,对双流县黄龙溪临时安置点内128名来自地震灾区的群众开展心理卫生状况调查。[结果]调查128人,心理卫生状况良好的占36.72%,有轻度心理问题的占33.69%,有中度心理问题的占24.22%,有严重心理问题的占5.47%。存在心理问题者所占比例,男性为55.74%,女性为70.15%(P0.05);4~18岁、19~30岁、31~60岁、61~84岁的分别为53.33%、45.45%、73.85%、54.55%(P0.05),其中31~60岁高于其他年龄人群(52.38%)(P0.05);有亲属丧失者为90.53%,无亲属丧失者为54.17%(P0.01)。[结论]地震后灾区群众多数存在心理问题,青壮年和有亲属丧失者尤为严重。     

Cuba's international cooperation in health: an overview.

In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the "Integrated Health Program" was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.     

陕西省宁强县地震灾后医疗救助及其政策建议

“5·12”汶川大地震影响范围广,造成的人民生命财产损失特别严重。地震发生后,全国上下同心协力,抗震救灾。在国家民政部的组织下,“汶川地震灾后紧急医疗救助评估基线调查”调查组迅速成立,深入灾区,对灾区居民的受灾情况、医疗卫生需求,以及政府相关的医疗救助工作进行了详细了解。旨在探索更有效的医疗救助机制,并提出科学有效的政策建议。本文首先对宁强基本概况和受灾情况作了全面的介绍,而后对政府的救援工作进行概述,最后对宁强的灾后医疗救助情况进行重点分析,探讨存在的问题并提出政策建议。     

兰州市三甲医院临床护士灾害认知及灾害护理能力调查

目的 了解临床护士灾害认知及灾害护理能力现状,为临床护士灾害护理继续教育提供参考依据.方法 用便利抽样法,以网络问卷的形式对兰州市4所三甲医院临床护士的灾害认知及灾害护理能力现状进行调查,并对灾害护理能力的影响因素进行分析.结果 共收到合格问卷285份.临床护士对灾害认知量表6个条目的认知水平差异有统计学意义(P＜ 0...     

Factors in continuation of home health care for patients with intractable neurological diseases

OBJECTIVE: This study was carried out to elucidate factors related to difficulty in continuing home health care and to investigate problems of the corresponding support system for patients with intractable neurological diseases. SUBJECTS AND METHODS: Subjects were 139 cases of amyotrophic lateral sclerosis (ALS), 376 cases of spino-cerebellar degeneration (SCD) and 1,048 cases of Parkinson's disease (PD) who were collected from the nationwide survey of health and social service needs of the patients with intractable diseases in 1995. Factors and problems related to limited activity due to diseases and necessity for medical care were analysed. The need for facilities of long-term care was also studied. RESULTS: The characteristic conditions of patients with ALS were shorter duration of the illness, higher percentage of conditions requiring medical care and disorders of swallowing or respiration and full nursing care in daily life compared with the other two diseases. The characteristics of PD were higher percentage of female and older age in both patients and their family caregivers. The proportion of cases for whom health care was judged to be prone to difficulty was 23.0% in ALS, 10.9% in PD and 7.2% in SCD, respectively. Regarding the factors related to difficulty in continuing home health care, conditions requiring medical care, the need for full nursing care in daily life, and the duration of the illness were recognized in ALS. In SCD, 5 factors, including conditions requiring medical care, the need for full nursing care in daily life, patients age greater than 65 years, the duration of the illness, and patients being nursed by their sons or daughters were detected. In PD, 4 factors, such as conditions requiring medical care, the need for full nursing care in daily life, the patients being nursed by persons other than the spouse, and the need of nursing care were found. CONCLUSION: These results suggest the necessity of social functions of medical care, nursing and family support that can be supplied at home effectively according to symptoms in progress, and the need for facilities of long-term care of patients for whom continuation of home health care may become difficult, which will work as a support system for long-term care of patients with intractable neurological diseases.     

Essential but Excluded: Building Disaster Preparedness Capacity for Home Health Care Workers and Home Care Agencies

COVID-19 has demonstrated the essential role of home care services in supporting community-dwelling older and disabled individuals through a public health emergency. As the pandemic overwhelmed hospitals and nursing homes, home care helped individuals remain in the community and recover from COVID-19 at home. Yet unlike many institutional providers, home care agencies were often disconnected from broader public health disaster planning efforts and struggled to access basic resources, jeopardizing the workers who provide this care and the medically complex and often marginalized patients they support. The exclusion of home care from the broader COVID-19 emergency response underscores how the home care industry operates apart from the traditional health care infrastructure, even as its workers provide essential long-term care services. This special article (1) describes the experiences of home health care workers and their agencies during COVID-19 by summarizing existing empiric research; (2) reflects on how these experiences were shaped and exacerbated by longstanding challenges in the home care industry; and (3) identifies implications for future disaster preparedness policies and practice to better serve this workforce, the home care industry, and those for whom they care.     

Evaluation of intractable diseases

OBJECTIVE: The aim of this study was to determine priorities for specific intractable disease from the viewpoint of countermeasures. METHODS: A significance evaluation to provide a priority framework for intractable disease was performed with a questionnaire distributed to the staff of preventive medicine and public health departments of medical schools in Japan. To determine the actual conditions of these intractable diseases question were directed at the chairmen of individual clinical study groups. The priority to be assigned countermeasures for such diseases was obtained from the two questionnaires. RESULTS: When the 4 factors "rare nature of diseases," "level of clarity of causes and pathology," "unestablished curative treatment", and "influence on daily life" were evaluated using 100 point as a full score, the mean scores were 14.5, 27.1, 28.5 and 29.9 points, respectively. In attaching importance to the various items, regarding the "rare nature of disease" the elements of "few patients nationwide" and "few specialist doctors nationwide" proved important; for the "level of clarity of causes and pathology," this was the case for the elements of "unclear triggering mechanism" and "diagnostic criteria not established." With the "unestablished curative treatment," the "no efficacious treatment available" and "low 5-year survival rate elements were important; and with the factor of "influence on daily life," the two most significant were "high proportion of patients needing assistance in daily life" and "high percentage of patients impeded from attending school or obtaining a job (playing a role in society)". CONCLUSION: When the priority among the 118 intractable diseases was evaluated by combining the overall results of the questionnaire survey with preventive medicine and public health staffs, and actual condition data from survey investigation of the intractable diseases among chairmen of clinical study groups, it was suggested that some intractable diseases whose medical expenses are covered by the medical aid program have a low ranking.     

重灾区护士灾害救援经历及10年重建心理体验的质性研究

目的 探索重灾区护士参与汶川地震救援的心理体验及灾后10年重建的感悟。方法 采用质性研究的方法,对参与汶川地震救援的24名护士进行半结构式访谈,用录音笔和笔记录访谈内容,并将访谈内容转录成文字,通过提取有意义单元,浓缩意义单元,编码、分类,提取主题对访谈内容进行分析。结果 通过访谈得出了3个主题：（1）目睹突发性灾害时的“惊慌失措、恐惧不安”;（2）亲历救援现场的“黑暗无助、不断抗争”;（3）回首10年重建后的“自强乐观、活在当下”。结论 重灾区护士的救援经历是宝贵的,从目睹灾害发生到参与救援,再到10年重建,他们经历了较为复杂的心理体验过程。应加强对重灾区救援护士的心理的关注,同时也要关注他们所面临的伦理问题。应积极为重灾区救援护士构建良好的社会支持系统,使其保持良好的心理韧性水平和心理健康。     

Cancer treatment at home or in the hospital: what are the costs for French public health insurance? Findings of a comprehensive-cancer centre

OBJECTIVE: The objective of this study was to evaluate the cost of home-cancer-healthcare programs and their potential interest for public health insurance as compared to inpatient cancer care. PATIENTS AND METHODS: The study was conducted at the Centre Leon Berard (CLB), a comprehensive cancer centre in Lyon, France. Hospitals at home patients were monitored by nurses and oncologists from the CLB. All patients, who received home treatment over a 15-day period in 2001, were included in the study. Patients were broken down into groups according to the type of healthcare required and the corresponding impact on health insurance expenditure. For each of these patients, a fictive-hospital stay was then reconstructed, which corresponded to the inpatient hospital care that would have been required during the observation period, had hospital at home not been available. RESULTS: The average cost of hospital at home was significantly lower than the corresponding estimated cost for treatment at the hospital (776.6 versus 2012.5, P < 0.001). This difference was particularly high for patients in the "palliative care" group (N = 33) (1201.7 versus 3489.7, P < 0.001), whereas in the "chemotherapy" group, results were not significantly different (N = 34) (225.5 versus 318). CONCLUSION: Our study suggests that hospitalisation alternatives can generate substantial savings for public health insurance in France.     

2016中美医学救援对军队护理的启示

对护理人员参加中美联合灾害医学救援演练进行总结和探讨.此次演练,双方参演护理人员混合编组参与水上救援、废墟搜索等各方面救治演练.通过演练提升两军护理人员共同参与国际人道主义救援减灾领域合作的能力,学习美军先进的卫勤护理保障模式和军事护理人才培养机制.在两军混合演练中,中美护理人员参与卫勤保障的模式存在差异,护理人员参与此次国际救援演练完成非常出色,但仍然存在不足,需继续改进和提高综合素质.     

Evaluating mental health after the 2010 Haitian earthquake

Mental health is an important aspect of public health after a disaster. This article describes what is known and what remains to be learned regarding the mental health impact of the January 12, 2010, earthquake in Haiti. Public health surveillance efforts in Haiti and the United States in the first 2 months after the earthquake are described. Challenges in clinical assessment and public health surveillance are explored. Potential implications for survivors and public health officials are considered.     

Critical thinking on "home visits" through the case method using the teaching material, "the twelfth child birth"

OBJECTIVE: To use case method seminars in order to critically assess "home visits" for public health nursing practice. METHOD: "The twelfth childbirth" was developed for use as material for the case method in 2002. This case story involves the dilemma of a public health nurse as to whether or not she should intervene in the "private affairs" of a married couple. Case teaching was performed in two seminars during the period from July 2002 to February 2003. Participants in the first seminar were 18 health professionals (13 public health nurses and five supervisors) in Japan, and nine health professionals (8 midwives and one physician) from Cambodia took part in the second. RESULTS: For the problems from the case, the participants in the two seminars made their decisions analytically. Decision making was informative and took different directions. The public health nurses in Japan advocated a collaborative intervention with other health professionals. On the other hand, the midwives from Cambodia selected an approach involving heavy commitments to family planning undertaken by individual midwives. From the discussion in the seminars, this case story was satisfied through the following: (1) the participants used the information in the case to address the problem; (2) the participants thought analytically in order to evaluate potential solutions; and (3) the participants had sufficient information for analysis in the case. CONCLUSION: Both seminars provided good opportunities to enhance critical thinking on "home visits" as a tool for intervention and to develop thinking skills needed for public health nursing practice.     

北川县小坝乡汶川大地震灾后卫生防病状况调查

[目的]了解地震灾区灾后卫生防病工作状况,为开展灾后卫生援助,为灾后重建提供可靠依据。[方法]2008年7月,在北川县小坝乡的乡中心卫生院、乡驻地及各村进行调查。[结果]小坝乡震后公共卫生资源受到严重破坏,环境卫生、饮水卫生、饮食卫生均存在一定隐患,目前尚未出现相关疾病的暴发疫情。[结论]灾后小坝乡的公共卫生状况急需改善。     

东日本大地震： 相马市五年记录

日本“3·11”大地震并发大规模海啸,导致福岛第一核电站发生泄漏事故造成大规模人员伤亡和财产损失。日本福岛县相马市在地震后9 min即成立灾害应对总部并召开第1次会议。此次灾害应对分为3个阶段,第1阶段以生命卫护为首要任务,第2阶段以健康卫护和基本生活保障为首要任务,第3阶段则以生命质量卫护为首要任务。本文梳理了日本地方政府在灾害后的公共卫生应急处置过程,以期从中受到启发,促进我国突发公共卫生事件应急处置的进一步完善。