中国农村医学发展道路的回顾与展望

在对我国农村医学发展历程进行回顾的基础上,对面向21世纪的农村医学发展道路进行了论述,即在“一个中心,三个适应”方针指导下,以实现PHC规划目标为龙头,把健全三级医疗网,巩固乡村医生队伍和健全农村医疗保健制度结合起来,配套进行改革和建设。     

The Australian experiment: how primary health care organizations supported the evolution of a primary health care system

Primary health care in Australia has undergone 2 decades of change. Starting with a vision for a national health strategy with general practice at its core, Australia established local meso-level primary health care organizations--Divisions of General Practice--moving from focus on individual practitioners to a professional collective local voice. The article identifies how these meso-level organizations have helped the Australian primary health care system evolve by supporting the roll-out of initiatives including national practice accreditation, a focus on quality improvement, expansion of multidisciplinary teams into general practice, regional integration, information technology adoption, and improved access to care. Nevertheless, there are still challenges to ensuring equitable access and the supply and distribution of a primary care workforce, addressing the increasing rates of chronic disease and obesity, and overcoming the fragmentation of funding and accountability in the Australian system.     

Apartheid and health in the 1980s

The last 5 years have seen dramatic developments in South Africa, with wide-based internal political struggles and international pressure forcing the government into a well publicized if temporary series of reforms. Yet this has not been paralleled by any substantial improvement in the health conditions of the majority of the population. Apart from improvements in black infant mortality in some urban areas, the health gap remains, a material expression of the social inequality that is part of the definition of apartheid. Black children continue to die from preventible afflictions at about 10 times the rate of their white counterparts. Maternal deaths among women classified as black, coloured or Asian continue to occur, mostly due to septic abortions. At national level, blacks are nearly 30 times more at risk of being diagnosed to have tuberculosis than whites, with some age groups being at still worse risk. Black children under the age of 4 years in Cape Town in 1984 were 205 times more likely to have tuberculosis than their white counterparts. The last 5 years has also seen a revival of rhetoric echoing the international support for primary health care in the 1970s, but health care processes have not been modified to cope with the continuing racial stratification of disease and access to health care. A move towards privatization of the health services has only benefited a few.     

Dutch health reforms in the 1980s

In the eighties most countries found it necessary to restrain or reduce health care expenditure, and it nowhere proved easy. Ute Ballay describes the consequences of efforts in the Netherlands to rationalise and control hospital budgets.     

Home health agencies in the 1980s

This article presents a review of issues in home health, including a discussion of current political philosophy and its impact on home care, an identification of problems and barriers in the home health field, and some approaches to resolve these difficulties. Among the issues explored are the administrative structure and financing of home health agencies; manpower considerations, with particular attention to the role of nursing; business practices, productivity and the industry's image, and finally, the relationship between long-term services and acute care.     

HRSA's role in primary care and public health in the 1990s

The principal responsibility of the Health Resources and Services Administration (HRSA) is to see to it that primary health care services and qualified health personnel and facilities are available to all Americans, particularly the disadvantaged and the underserved. HRSA's resources are directed toward not only the most financially, functionally, and culturally vulnerable segments of the population but also to those who have significant clinical needs such as pregnant women, children, those infected with HIV. The Agency seeks to carry out its mission in many ways. The central approach, however, is to assure the availability of services to its constituencies directly or indirectly through the more than 50 programs it administers. This article explains HRSA's role in detail and cites its many ramifications for the nation's health in the 1990s.     

Mental health in the early 1980s: some perspectives

The field of mental health, at the present time, has an important potential for rapid development. The reasons for this include important new knowledge that has become available, increased awareness of governments about the size of mental health problems and about the importance of psychosocial factors, and the development of an appropriate technology and a new doctrine of mental health care which allow useful interventions to be made, even when financial resources are extremely scarce.     

Current features of mental health care of children and adolescents in the primary health care system

The paper considers the state-of-the-art in mental health care in children and adolescents. It reflects the current features of this medical field. Some official statistical data of the Ministry of Health of the Russian Federation on morbidity and incidence of major mental diseases in this contingent of patients are analyzed. The most evident recent dynamic trends and the specific features of organization of specialized mental care at the present stage are examined.