Online Health Communities and Chronic Disease Self-Management

This research uses content analysis (N = 1,960) to examine the computer-mediated communication within online health communities for evidence of chronic disease self-management behaviors, including the perceived benefits and perceived barriers to participating in such behaviors. Online health communities act as informal self-management programs led by peers with the same chronic disease through the exchange of health information. Online health communities provide opportunities for health behavior change messages to educate and persuade regarding chronic disease self-management behaviors.     

慢性病自我管理计划用于慢性肾脏病患者护理中的效果

目的 探讨慢性病自我管理计划应用于慢性肾脏病患者护理中的效果.方法 68例慢性肾脏病患者随机分为两组各34例,对照组采用常规护理,观察组在常规护理基础上采用慢性病自我管理计划,比较两组护理前后的自我管理能力评分及肾功能.结果 护理后6个月,观察组的自我管理能力评分显著高于对照组,Scr、BUN、PRO水平均显著低于对照...     

Disease-Specific Self-Management Programs in Patients with Advanced Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a long-term illness. As the disease progresses, it become more complex and spirals into an abstract complex of interrelated physical, emotional and psychosocial problems. Patients are in a constant process of learning as they endure, manage and adapt to the changing nature of the disease. It has recently been proposed that self management should be a part of the standard care for patients with COPD.This review presents a comprehensive and critical evaluation of the international literature with respect to the benefits of disease-specific self-management programs on health status and the use of health resources in patients with advanced COPD.This review screened all English-language studies indexed in Medline that investigated patient education and self management in patients with COPD, and were published in peer-reviewed journals between 1966 and 2003. Randomized controlled trials of self management in COPD were included in this review if health status or the use of health resources were measured.A best-evidence synthesis was conducted and ten studies were selected for this review. It was found that there was extreme variation between the studies in terms of the content and intensity of self-management programs, continuum of the patient program, follow-up visits, and support provided to patients. Of the ten studies, four reported a significant improvement in health status for patients in the self-management groups compared with usual-care groups. Physician visits (acute) were significantly reduced in the self-management group compared with the usual-care group in two out of four studies in which it was assessed. Self management was also associated with a reduction in emergency room visits in one out of two studies and a reduction in hospital admissions or duration of hospitalization in one out of five studies.The findings of this review reveal new evidence that disease-specific self management can improve patients’ health status and reduce physician visits and hospital use. Self-management programs that are coupled with a supervised exercise-training program would probably be more effective in improving dimensions of health status. Programs combined with communication from a trained health professional could be integrated into standard medical practice and support full population access. However, there are still many unanswered questions that need to be addressed with respect to the specific components of effective education for patients with COPD, methods to adjust self-management programs to suit the needs of individual patients, and long-term maintenance strategies.     

上海慢性病自我管理项目对自我效能的影响评价

目的　评价上海慢性病自我管理健康教育项目实施 6个月之后在改变患者自我效能方面的效果。方法　按照社区随机对照试验研究设计 ,将 954名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD)等疾病自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩检验 ,比较了有基线和 6个月之后两次问卷调查数据的 4 30名干预组患者和 34 9名对照组患者在项目实施 6个月之后在自我效能评分方面的变化。结果　干预组患者的症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 0 6 9分和 0 6 3分 (P值均 <0 0 1)。结论　上海慢性病自我管理项目可提高参加者对疾病管理的自我效能     

上海浦东慢性病自我管理项目实施效果评价研究

目的：评上海浦东区慢性病自我管理项目实施6个月之后的效果。方法：按照以社区为基础的随机的机对照试验研究设计，将297名 高血压病，心脏病，关节炎，中风， 哮喘，糖尿病，COPD等疾病自愿参加该项目的慢性病人，随机分为干预组和对照组。采用协方差的秩检验，比较了在基线及项目实施6个月之后两次问卷调查的140名干预组病人和129名对照组病人在自我管理行为，自我效有，健康状况和卫生服务利用等方面的变化。结果：与对照组合组比较，干预组在一种自我管理和为方面明显提高，6个月内认知性症状管理方法实践评分，干预组平均多增加了0．11分，症状管理自我效能和疾病共性管理自我效能评分6个月的增加值，分别经对照组高出1．08分和1．07分，干预组在健康状况的8个方面（整合健康自评，健康担忧，疲劳、气短、疼痛，疾病对病人生活影响，情绪低落及社会活动／角色受限），明显好于对照组（P值均＜0．05），干预组6个月内住院次数平均比对照组减少了0．14次（P＝0．01）；住院天数比对照组平均下降了0．87天（P＜0．01）。结论：上海浦东新区慢性病自我管理项目实施6个月之后改善参加者的自我管理行为，自我效能，部分健康状况，减少住院次数和住院天数。     

Disease State Management Programmes

Disease state management (DSM) is a new concept in healthcare which is rapidly growing in terms of interest and potential as an effective approach to improving patient outcomes. The term DSM refers to a ‘systematic population-based approach to identify persons at risk, intervene with specific programmes of care, and measure clinical and other outcomes.’ This alternative method for ‘managing care’ is being driven by an increased understanding of best practices coupled with new technologies for changing behaviour and measuring outcomes. The concept of health promotion coupled with a systems approach to healthcare could significantly improve clinical outcomes while reducing costs for many people with chronic diseases. This article describes the experience of one health plan with DSM. In addition, guidelines are presented to assist the reader in evaluating their own organisations’s ability and needs regarding disease management.     

我国慢性病防治管理的PEST分析

慢性病已经成为威胁人群健康的重大问题.PEST分析法是现代管理学分析战略或组织外部环境的一种方法.本研究应用PEST分析法,从政治、经济、社会、技术4个方面,对我国慢性病防治管理的外部环境进行深入分析,并提出了完善慢性病防治管理的策略.     

老年人群合理膳食与慢性病预防

中国已趋于老龄社会,老年人最关注的问题就是健康问题。合理的膳食营养是保证老年人群远离慢性疾病、提高生活质量的基础。     

Peer Reviewed: A Methodology for Evaluating Organizational Change in Community-Based Chronic Disease Interventions

Background

In 2003, the Monterey County Health Department, serving Salinas, California, was awarded one of 12 grants from the Steps to a HealthierUS Program to implement a 5-year, multiple-intervention community approach to reduce diabetes, asthma, and obesity. National adult and youth surveys to assess long-term outcomes are required by all Steps sites; however, site-specific surveys to assess intermediate outcomes are not required.

Context

Salinas is a medically underserved community of primarily Mexican American residents with high obesity rates and other poor health outcomes. The health department''s Steps program has partnered with traditional organizations such as schools, senior centers, clinics, and faith-based organizations as well as novel organizations such as employers of agricultural workers and owners of taquerias.

Methods

The health department and the Stanford Prevention Research Center developed new site-specific, community-focused partner surveys to assess intermediate outcomes to augment the nationally mandated surveys. These site-specific surveys will evaluate changes in organizational practices, policies, or both following the socioecological model, specifically the Spectrum of Prevention.

Consequences

Our site-specific partner surveys helped to 1) identify promising new partners, select initial partners from neighborhoods with the greatest financial need, and identify potentially successful community approaches; and 2) provide data for evaluating intermediate outcomes matched to national long-term outcomes so that policy and organizational level changes could be assessed. These quantitative surveys also provide important context-specific qualitative data, identifying opportunities for strengthening community partnerships.

Interpretation

Developing site-specific partner surveys in multisite intervention studies can provide important data to guide local program efforts and assess progress toward intermediate outcomes matched to long-term outcomes from nationally mandated surveys.     

Volunteer, lay tutors' experiences of the Chronic Disease Self-Management Course: being valued and adding value

Chronic disease is a public health issue that could be addressed, in part, by increasing the ability of individuals to better manage their condition and its consequences on a day-to-day basis. One intervention designed to facilitate this is the Chronic Disease Self Management Course (CDSMC) that is delivered by volunteer, lay tutors who themselves have a chronic disease. Although there is growing evidence of course effectiveness for participants, the experiences of tutors have been neglected. This study aims to address this omission. Telephone interviews were conducted with 11 (six male) tutors: all interviews were transcribed and thematically analysed. Being a volunteer lay-tutor was perceived to be an enjoyable and valuable experience despite the challenges associated with course delivery, such as organizational demands and managing the diverse needs of mixed groups of chronic disease participants that led to a tension between disease-specific needs and the generic approach of the course. Being valued and adding value to the lives of others were key benefits of being a volunteer tutor, along with increased confidence that they were doing something positive for others. Course delivery prompted the initiation and maintenance of tutors' own self-management behaviours.     

Behavioral Aspects of Arthritis and Rheumatic Disease Self-Management

Chronic diseases such as arthritis and related conditions have no ‘cure’, and thus require ongoing management. The long term nature of chronic disease gives the individual a crucial role, if not the most crucial role, in managing their condition. Day-to-day self-management is extremely important in achieving optimal health outcomes, and indeed, people with arthritis use a variety of strategies to relieve symptoms or manage disease consequences.This review identifies and discusses 6 different domains of arthritis self-management behaviors: (i) medical management; (ii) joint protection strategies; (iii) physical activity and exercise; (iv) topical applications; (v) complementary and alternative strategies; and (vi) stress and mind/body practices. Conceptualizing arthritis self-management in this manner enables a discussion of a range of practices that may be used to manage arthritis conditions.The literature on several established arthritis self-management programs that are designed to improve either self-care and/or exercise behaviors is also reviewed. Despite evidence of cost containment and improved health outcomes, these programs reach only a small percentage of people with arthritis who may benefit from them.Clinical intervention for people with arthritis may be enhanced if self-management is approached from a broad perspective and, if established, self-management programs are integrated into clinical interventions.     

瑜伽防治慢性病的原理和研究进展

本文重点阐述了瑜伽对人体各系统和器官整合优化的功能,瑜伽体位法对防治疾病、消除紧张和疲劳的作用,瑜伽呼吸法对洁净呼吸系统、排除身体毒素、达到思想纯净的作用,瑜伽冥想镇静神经、减轻消极情绪作用。介绍了瑜伽防治痛经、心理疾病、心肺疾患、颈椎病、腰肌劳损、代谢综合症的研究成果。通过对瑜伽健身和防病的功能原理、防治慢性病的研究概况进行综述,以期寻找规律,为瑜伽应用于临床提供更多的依据。     

瑜伽防治慢性病的原理和研究进展

本文重点阐述了瑜伽对人体各系统和器官整合优化的功能,瑜伽体位法对防治疾病、消除紧张和疲劳的作用,瑜伽呼吸法对洁净呼吸系统、排除身体毒素、达到思想纯净的作用,瑜伽冥想镇静神经、减轻消极情绪作用。介绍了瑜伽防治痛经、心理疾病、心肺疾患、颈椎病、腰肌劳损、代谢综合症的研究成果。通过对瑜伽健身和防病的功能原理、防治慢性病的研究概况进行综述,以期寻找规律,为瑜伽应用于临床提供更多的依据。     

Salud Para Su Corazón: A Community-Based Latino Cardiovascular Disease Prevention and Outreach Model

Cardiovascular disease (CVD) is the leading cause of death for Latinos living in the United States. This population is generally unaware of important lifestyle or behavioral changes that can prevent CVD. The National Heart, Lung, and Blood Institute (NHLBI) designed and implemented Salud para su Corazón (Health for Your Heart), a culturally appropriate, community-based, theory-driven intervention model. NHLBI's goals were: (1) to design an intervention model appropriate to Latino populations; (2) to pilot test the model in a specific community with the objectives of increasing awareness about heart disease, raising knowledge about CVD prevention, and promoting heart-healthy lifestyles; and (3) to disseminate the model and the materials developed to other communities with similar needs. An agency-community partnership, under the leadership of the Community Alliance for Heart Health, guided all stages of the community intervention project. The multimedia bilingual community intervention included television telenovela format public service announcements (PSAs), radio programs, brochures, recipe booklets, charlas, a promotores training manual, and motivational videos. An evaluation survey assessed the impact of the intervention. A pre-post intervention survey was conducted with more than 300 participants, and results showed that the respondents were substantially more aware of risk factors for CVD, and had greatly increased their knowledge of ways to prevent heart disease. Dissemination efforts have resulted in numerous requests by health organizations, universities, and health maintenance organizations (HMOs) for educational materials and communication strategies produced by Salud para su Corazón. In addition, Univision, the largest Spanish-language broadcast television network, is airing the initiative's PSAs. Also, training seminars for promotores are being conducted in differ ent regions of the United States, and several locations are planning to replicate this study.