Comprehensive mental health care in a pediatric dialysis-transplantation program.

The dialysis-transplantation (D-T) program at The Hospital for Sick Children, Toronto has a mental health component directed by a psychiatrist and a social worker. As of Jan. 1, 1975, 53 kidney transplants had been carried out on 44 children. Patients and their families are counselled continuously by the psychiatrist and the social worker before, during and after transplantation. Members of the multidisciplinary team meet regularly to plan treatment for the children. Mental health issues are an integral part of team discussions and help determine D-T program policy. Psychological preparation, mental health consultation, therapeutic intervention and continuous counselling prevent many of the mental health problems that plague a D-T program.     

Oral Surgery: Present and Future

The history of the specialty of oral surgery is reviewed from the days of its origin, when it was essentially confined to exodontia, to its present status, in which it includes many and varied surgical operations relative to the human jaws and their associated structures. The scope and training pertinent to modern oral surgery are discussed. A three-year program on a graduate basis, required as partial fulfilment of the qualifications for accreditation and certification by the American Board of Oral Surgery, is described in detail. The need for mutual understanding by the medical and dental professions, as to what this specialty has to offer in terms of a total community health program, is emphasized.     

An ambulatory program for surgical residents and medical students

Teaching in the ambulatory setting is important for medical educators because of the economic, social, and medical trends that are pushing patients into this health care setting. While medical education in the hospital setting maintains its important role, education in ambulatory care demands innovations and new strategies. A pilot program based in a freestanding ambulatory surgery center has been developed as part of a surgical residency training program. In the present article, the author describes the program, outlines its curriculum, and details the daily activities of the residents and medical students. A brief history of ambulatory surgery is given.     

八年制医学生基层社会实践的探索

北京协和医学院的基层社会实践具有悠久的历史传统,并始终坚持医学生应当深入基层,“精英教育”应当脚踏实地的思路.为了使学生进一步了解基层卫生情况,体悟医师社会责任,北京协和医学院组织2008级八年制临床医学专业38名学生进行了为期半个月的基层社会实践.本文通过问卷调查的形式,总结分析了学生对本次基层社会实践的目的、收获,以及对本次实践的总体认可度与建议,旨在为日后的基层社会实践积累经验、探索方向.     

Health Education and Cigarette Smoking: A Report on a Three-Year Program in the Winnipeg School Division, 1960-1963

The smoking habits of Winnipeg school students were surveyed before and after a three-year program of health education on the hazards of smoking, directed to 8300 out of 48,000 students. The program consisted of informal approaches to students in elementary schools and a formal program of talks, lectures, films, and student participation for older students.

There were fewer students at all ages who had never smoked a cigarette at the time of the second survey. There was a slight decrease in the number of regular smokers in high school, most marked in the school where the program was enthusiastically received and student participation was most active. A direct relationship between parental smoking and that of the student, and an inverse relationship between academic achievement and student smoking, were shown on both surveys. The majority of students believed that smoking caused lung cancer and other hazards to health, although this was less marked among smokers.

The results indicated that an intensive program of health education directed to the teenagers in school was a potentially useful approach to the problem of cigarette smoking.

     

Health USA. A national health program for the United States.

The Health USA Act of 1991 addresses two fundamental health services financing problems: the more than 30 million uninsured persons and the rising costs for health care and for health insurance. Health USA would provide coverage of the entire resident population for comprehensive medical and preventive health and long-term care services through a universal tax-funded financing system. The federal government would contribute an average of 87% of program costs to each state, which would establish, under federal guidelines, a state health program. Each individual or family may enroll in any health plan approved by the state program, including many private plans, or a plan run by the state program. Through the approved plan of their choice, enrollees would receive covered services and obtain their care from participating physicians and other professional practitioners, hospitals, and other facilities. The state program would pay approved plans a capitation payment for every person enrolled. The plans would pay professional providers fees, as part of an all-payer system of fee schedules and expenditure targets, or capitation payments or salary. Hospitals would be financed through global budgets negotiated by the state program with each hospital. The plan run by the state program would pay the health care costs of any person who does not enroll in an approved plan, making the state plan the payer of last resort and eliminating uncompensated care and cost shifting by providers. Health USA would separate health care coverage from employment, ensuring uninterrupted coverage and eliminating employers' administrative role in providing coverage. Federal and state taxes would replace present methods of financing by private insurance premiums and large out-of-pocket expenditures. Building on the present system of health plans, Health USA would offer all persons a wide choice of competing plans in which to enroll and offer professional providers a wide choice of plans in which to practice. It would control costs by increasing financial accountability of providers and health plans, reducing present reliance on intrusive utilization review and on patient cost sharing. By controlling health care and administrative costs, Health USA would cover the entire population and, according to independent cost estimates, reduce national health expenditures by $11.5 billion in 1991.     

大连市社区卫生服务现状研究

社区卫生服务是城市卫生工作改革的一项重大举措。大连市社区卫生服务试点工作于１９９７年９月正式启动,５个试点区共覆盖１１个街道,２４５２１３个居民。其基本模式是采用一体式和分体式两种组织形式,主要开展老年人“四病”及常见病、多发病的诊治等工作,取得了良好的社会效益。同时仍存在一些问题制约着社区卫生服务的发展。作者认为关键是要强化政府职能,动员全民参与,才能保证社区卫生工作持续、稳定、健康地发展。     

The health and cost effects of substituting home care for inpatient acute care: a review of the evidence

BACKGROUND: There is much interest in reducing hospital stays by providing some health care services in patients' homes. The authors review the evidence regarding the effects of this acute care at home (acute home care) on the health of patients and caregivers and on the social costs (public and private costs) of managing the patients' health conditions. METHODS: MEDLINE and HEALTHSTAR databases were searched for articles using the key term "home care." Bibliographies of articles read were checked for additional references. Fourteen studies met the selection criteria (publication between 1975 and early 1998, evaluation of an acute home care program for adults, and use of a control group to evaluate the program). Of the 14, only 4 also satisfied 6 internal validity criteria (patients were eligible for home care, comparable patients in home care group and hospital care group, adequate patient sample size, appropriate analytical techniques, appropriate health measures and appropriate costing methods). RESULTS: The 4 studies with internal validity evaluated home care for 5 specific health conditions (hip fracture, hip replacement, chronic obstructive pulmonary disease [COPD], hysterectomy and knee replacement); 2 of the studies also evaluated home care for various medical and surgical conditions combined. Compared with hospital care, home care had no notable effects on patients' or caregivers' health. Social costs were not reported for hip fracture. They were unaffected for hip and knee replacement, and higher for COPD and hysterectomy; in the 2 studies of various conditions combined, social costs were higher in one and lower in the other. Effects on health system costs were mixed, with overall cost savings for hip fracture and higher costs for hip and knee replacement. INTERPRETATION: The limited existing evidence indicates that, compared with hospital care, acute home care produces no notable difference in health outcomes. The effects on social and health system costs appear to vary with condition. More well-designed evaluations are needed to determine the appropriate use of acute home care.     

Emergency Health Planning

This paper outlines the development of emergency health planning as a function of government. Ten provinces have the basic responsibility for the organization, preparation and operation of medical, nursing, hospital and public health services in an emergency. The Department of National Health and Welfare is responsible for the provision of advice and assistance to the provincial and municipal governments in such matters. Eight provinces have now hired full-time planning staffs to co-ordinate the health planning of the Provincial Departments of Health and Provincial Emergency Measures Organization.

Four major programs have been established. The first program provides for the continuity of leadership and guidance by health authorities at the federal, provincial and municipal level. Essential records have been developed and emergency legislation prepared. This program, however, will be of little use unless health services are organized at the municipal level. In this organizational program, advice and assistance have been provided to existing hospitals and departments of health in the conduct of disaster planning. The efforts of these agencies are co-ordinated by municipal health authorities into a community disaster plan. The third program deals with information and education of the general public and the health workers. This program is designed to make the family unit self-sufficient for up to seven days and the health worker prepared to undertake his emergency role. The first three programs are directed to the organization and training of manpower; the fourth program provides the necessary supplies. From the national medical stockpile of $18,000,000, some $12,000,000 has been received, packaged for long-term storage and distributed to regional depots across the country. To ensure their ready availability in time of emergency an agreement has been reached with seven provinces for the release of hospital disaster kits.

     

我国研究生心理健康研究述评

研究生心理健康研究目前已经成为我国医学界、教育界及心理学界研究的一个重要课题.笔者以近几年来我国关于研究生心理健康的研究为依据,综述了我国研究生心理健康的标准、研究内容、测量工具的开发与应用及其研究生心理问题的干预性研究等,以期提高我国教研究生心理健康研究水平.     

Innovative HIV/AIDS program launched in Ottawa.

Collaboration among 31 social and health care agencies and the provincial government has resulted in an innovative program for Ottawa-area patients with HIV infection or AIDS. The target group is the homeless and people with "unstable" housing who live in the city's downtown core, a group at high risk of contracting HIV. The education of family practitioners will be an important part of the program.     

以人为本的健康教育程序应用于卒中单元的效果

目的:观察以人为本的健康教育程序在卒中单元患者中应用的效果。方法:对120脑卒中患者进行随机分组,观察组60例,采用以人为本的健康教育程序,对照组60例进行传统健康宣教。结果:观察组在健康教育内容的掌握率、主动参与性、对健康教育的满意度、生活方式改变均明显高于对照组;再发病率低于对照组。结论:以人为本的健康教育程序注重人性化、个性化,实效化,体现"以患者为中心"的工作原则,对脑卒中患者教育成效的提高有显著作用。     

Urgent medical decision making regarding a Jehovah's Witness minor: a case report and discussion

BACKGROUND: Physicians strive to respect the autonomy of patients. The emergent care of Jehovah's Witnesses, however, leaves health care providers struggling with ethical and legal questions. These are further compounded when the patient in question is a minor. CASE: A girl aged 15 years presented with anemia, a large ovarian mass, massive hemoperitoneum, and parents who were devout Jehovah's Witnesses who refused administration of blood products. Following discussion of the patient's condition and treatment options with the patient, her family, members of the treatment team, and consultants, the patient was transferred to a hospital that offered a blood conservation program for surgical patients. The patient received surgical management without the need for blood transfusion. Her surgeons, however, reserved the legal right to give blood if an emergent need arose despite the lack of parental consent. CONCLUSION: Society grants considerable legal latitude in dealing with Jehovah's Witness minors, and physicians must be aware of the legal and ethical parameters surrounding the care of such patients.     

Operating Room Efficiency before and after Entrance in a Benchmarking Program for Surgical Process Data

Operating room (OR) efficiency continues to be a high priority for hospitals. In this context the concept of benchmarking has gained increasing importance as a means to improve OR performance. The aim of this study was to investigate whether and how participation in a benchmarking and reporting program for surgical process data was associated with a change in OR efficiency, measured through raw utilization, turnover times, and first-case tardiness. The main analysis is based on panel data from 202 surgical departments in German hospitals, which were derived from the largest database for surgical process data in Germany. Panel regression modelling was applied. Results revealed no clear and univocal trend of participation in a benchmarking and reporting program for surgical process data. The largest trend was observed for first-case tardiness. In contrast to expectations, turnover times showed a generally increasing trend during participation. For raw utilization no clear and statistically significant trend could be evidenced. Subgroup analyses revealed differences in effects across different hospital types and department specialties. Participation in a benchmarking and reporting program and thus the availability of reliable, timely and detailed analysis tools to support the OR management seemed to be correlated especially with an increase in the timeliness of staff members regarding first-case starts. The increasing trend in turnover time revealed the absence of effective strategies to improve this aspect of OR efficiency in German hospitals and could have meaningful consequences for the medium- and long-run capacity planning in the OR.     

Occupational-health training at the University of Hawaii

Occupational-health training at the University of Hawaii School of Public Health (UH-SPH) is a graduate-level program focusing on industrial hygiene; it also offers courses of interest to other health professionals, particularly physicians and nurses. The current training at the UH-SPH is designed primarily to prepare occupational-health practitioners at the master's degree level. The occupational-health program elective is considered to be an area of emphasis within a broader program of study in public health. The program offers special opportunities for occupational-health training and research in cross-cultural and international settings. Post-graduate and continuing-education occupational-health training in the community is also discussed.     

Surveillance de la santé à l''école maternelle.

In contrast to the traditional program of health assessment of schoolchildren based on periodic physical examination, the program described in this paper is based on the integration of information and data obtained by observation through the school year from parents, teachers and the school nurse, who coordinates the program. The numbers and the types of problems and the date on which they were identified are compared in an experimental group of 557 kindergarten children and a matched control group of 498 children in whom the traditional program was maintained. For problems of hearing, enuresis, learning and behaviour the number of cases detected was significantly greater in the experimental group than in the control group. Each element of the proposed program is analysed and the advantages of an integrated approach to health assessment of schoolchildren are underlined.     

A follow-up evaluation of a summer health career program for minority students.

In an effort to attract minority students to health careers, a special summer education health career experience was developed. A matched comparison group design was utilized to determine the value of this program. Data were collected on both the participants and a matched comparison group three months before and six months after the program. Differences on most of the measures were not significant; however, there was a significant difference on stability of first career choice, indicating that a special summer program can and does have an effect on the participants. The study makes it clear that program effects cannot be assumed unless a follow-up evaluation is undertaken.     

Severe obesity in children and adolescents: implications for treatment

The prevalence of clinically severe obesity in adults has been rising rapidly. We completed a needs assessment that examined the prevalence of severe obesity in a tertiary pediatric weight management clinic. The Arkansas Children's Hospital (ACH) Fitness Clinic, a specialty clinic treating overweight children and adolescents, is offered in partnership with the University of Arkansas for Medical Sciences Child and Adolescent Bariatrics Center. Our hypothesis is that the ACH Fitness Clinic has a large proportion of severely overweight children and that these patients are in need of more aggressive adjuvant therapies to improve their health status. The study reported here is part of an ongoing feasibility study regarding the need for pharmacologic and surgical options for Fitness patients who are morbidly overweight and are not responding well to a behavior treatment program alone. Of the 701 overweight (BMI >95th percentile for age and gender) children and adolescents seen in Fitness Clinic over a 29-month period, 72% had a Body Mass Index (BMI) >35, which is considered severe obesity in adults.     

综合外科病房护士心理健康状况调查与分析

目的了解基层综合医院综合外科病房护士的心理健康状况并进行原因分析。方法采用SCL-90症状自评量表对都江堰三所二级（含二乙）综合性医院的综合外科病房护士进行问卷调查。结果综合外科病房护士的SCL-90总均分和9个因子分与国内常模评分比较,前者均高于后者。结论综合外科病房护士心理健康水平较常人低下;常见的心理障碍为焦虑、抑郁、强迫及躯体化。应采取切实可行的措施,提供足够的支持,维护基层医院综合外科病房护士的心理健康。     

Liberal benefits, conservative spending. The Physicians for a National Health Program proposal

The Physicians for a National Health Program proposes to cover all Americans under a single, comprehensive public insurance program without copayments or deductibles and with free choice of provider. Such a national health program could reap tens of billions dollars in administrative savings in the initial years, enough to fund generous increases in health care services not only for the uninsured, but for the underinsured as well. We delineate a transitional national health program budget that would hold overall health spending at current levels while accommodating increases in hospital and physician utilization. Future national health program spending would be indexed to the growth in gross national product adjusted for demographic, epidemiologic, and technologic shifts. Financing for the national health program would transfer funds into the public program without disrupting the general pattern of current revenue sources. We suggest a funding package that would augment existing government health spending with earmarked health care taxes. Because these new taxes would replace employer-employee insurance premiums and substantial portions of current out-of-pocket expenditures, they would not increase health costs for the average American.