农村社区老年人精神卫生服务需求与利用情况调查分析

目的:了解农村社区老年人的精神障碍患病率,掌握农村社区老年人精神卫生服务利用和需求情况.方法:在既往队列研究基础上,使用老年精神状况量表GMS(Geriatric Mental Scales)确定该队列人群精神障碍水平,使用自拟问卷测量精神卫生服务需求与利用情况.使用x2检验或Fisher确切概率法进行单因素分析.结果:①该研究实际随访到914名老年人,诊断有精神障碍的146(15.97％)人.②914人中仅有6人使用过精神卫生服务,146人中仅有2人使用过精神卫生服务.③191人(20.9％)表示需要进一步了解精神卫生服务知识.影响知识需求的因素有文化程度、自评经济、躯体疾病和心理障碍.④56人(6.1％)表示需要精神卫生服务.影响精神卫生服务的因素有性别、文化程度和心理健康水平.结论:农村社区老年人精神卫生服务使用率较低,自我心理保健意识较差.政府应加大精神卫生宣教的投入,提高社区老人对心理健康重要性的认识.     

突发性公共卫生事件应急管理及政策分析

本文采取实证研究的思路，通过规范分析和经验考察，讨论了我国现行突发性公共卫生事件应急管理公共政策在3个层面上的不足之处，并初步解释了潜在的原因，进而就应急管理及其相关公共卫生政策提出建议。     

Mental health needs and service use in Ontario

This study uses data from the Resident Assessment Instrument Mental Health (RAI-MH) on everyone admitted to an Ontario inpatient psychiatric facility between October 2005 and June 2007 to describe patients characteristics and service utilization, and to determine whether these differ based on prioritization of mental health issues in the Integrated Health Service Plan (IHSP) put forth by the Local Health Integration Network (LHIN) providing service.     

农村在校留守与非留守儿童心理健康服务获取现状及需求比较

目的了解农村留守与非留守儿童心理健康服务获取现状、需求以及2者的差异,为留守儿童心理服务体系的建立提供参考。方法于2018年4—7月,采用分层整群抽样法抽取四川、安徽、河南省共14所农村中小学四到九年级学生3 456人,通过自编农村留守儿童心理健康服务现状及需求问卷进行调查。结果农村留守与非留守儿童接受心理健康服务比率分别为27.9%和27.0%,2者无统计学差异;农村留守与非留守儿童获取心理健康服务途径及引带者、心理健康服务的效果评价、希望接受心理健康服务途径与方式等也均无统计学差异(P> 0.05);留守与非留守儿童希望获取心理健康服务的比率分别为63.0%和57.2%,2者差异有统计学意义(P=0.001);留守与非留守儿童在改善抑郁、焦虑等不舒服的感觉,克服回答问题或与陌生人交谈时紧张、面红心跳、流汗、口吃等现象,能够改变自己对事物的消极看法,肯定自己的价值,让自己内心强大,免于被欺凌,应对压力或其他不好事情的方式6个心理健康服务内容的需求条目上差异均有统计学意义(均P <0.05)。结论留守儿童已获取的心理健康服务比率、途径与其希望得到的服务情况有较大差距;与非留守儿童相比,留守儿童更需要心理健康服务,并且矫正性目标相关的需求更明显。     

Mental health. Commissioned for service

GPs often lack the data to make well-informed judgements about commissioning mental health services. A multi-agency group, including a multifund, health authority and social services, has developed service agreements which are proving useful to practices. The system provides primary care commissioners with clinical information linked to expenditure for all patients with a mental illness.     

Mental health service for medical students

Summary. The authors describe the problem of impairment of medical students from the point of view of mental health professionals who have directed a large and successful evaluation and referral service for students suffering from a wide array of stress-related and mental disorders. They outline the nature of the impairment problems, the history of the efforts at their medical school to address these problems, and their recent experience in providing mental health services to students who are referred for evaluation and treatment. Diagnostic data, referral and the implications of mental disorders for medical students are discussed. The authors offer some suggestions for the formation of student well-being committees prior to the implementation of student assistance programmes to address the problems of substance abuse.     

Changing health needs of the elderly demand new policies

As the U.S. population ages, the use of costly medical technology, especially in the last days of life, has been cited as a major factor contributing to our spiraling health care costs. Yet a growing body of evidence indicates that fewer elderly are disabled and that many survive--even thrive--after treatment of a serious illness or condition. The current debate over Medicare funding cutbacks needs to reflect the reality that high-technology care for the elderly is not inappropriate or wasteful in and of itself. In addition, policymakers should take into account the decreasing numbers of elderly people with disabilities by redirecting long term care resources toward quality community-based care, which can contribute to more timely, effective, and affordable treatment of major diseases.     

精神疾病的社区优先干预类型

随着经济和社会的不断发展,生活节奏加快,竞争压力的日趋增加,我国居民精神疾病的发病率呈上升趋势。2004年9月,国务院办公厅发布了《关于进一步加强精神卫生工作的指导意见》（以下简称《意见》）,强调了社区精神卫生服务在精神疾病防治中的重要作用,     

Shifting the demand for emergency care in Cuba's health system

Cuba has developed a programme of quality improvement of its health services, which includes an extramural emergency care system in which polyclinics and general practitioner networks play an important role. Using routine health information from the decentralised first line emergency units (FLES) and from the hospital emergency service (HES) for the period 1995-2000, we evaluated the effects of the emergency care subsystem reform on the utilisation rates of first line and hospital services in Baracoa and Cerro, a rural and a metropolitan municipality, respectively. In the self-contained health system of Baracoa, the reform of the emergency subsystem resulted in a first phase of increased utilisation of the FLES, followed by a second phase of gradual decrease, during which there was an increased utilisation of general practitioners. In contrast, the overall results of the reform in Cerro were unclear. The proximity to a hospital seems to be the most important element in the patient's decision on which entry point to the Cerro health system to use. A potential adverse effect of the reform is an increased emergency services utilisation in situations where GP care remains below patients' expectations. Given the current world-wide trends in health-care reform, the organisational alternatives developed in the Cuban health system might remain specific to the local contextual setting.     

广州市医务人员对公共卫生应急体系建设需求定性调查分析

目的 了解广州市医务人员对公共卫生应急体系的建设需求,旨为政府相关部门的决策提供科学依据。方法 采用小组专题访谈方法,对24家不同级别、类别和性质医疗机构的领导层和主要业务科室工作人员共220名医务人员召开24次专题组讨论;对记录的文字资料进行逻辑分类和分析。结果 83．7％医务人员因对SARS有所了解、个人防护措施得到了加强,不害怕SARS重来,11．2％医务人员主要担心SARS防控设施不符合规范或SARS影响经济收入;绝大部分医疗机构及医务人员（72．5％）对政府应对突发公共卫生事件有信心;公共卫生应急体系尚存在资金不足,信息流不畅通等方面不足,并提出加大防病经费投入、加强信息沟通及人才培养等需求。结论 应用专题访谈定性方法具有深入收集资料、观点及意见的优势。公共卫生应急体系建设应着重在专项经费投入、防疫网底巩固、信息整合及多方联合演练等方面加强整体配置和高效管理。     

社区卫生服务可持续发展相关政策探讨

通过文献复习及小组座谈就目前我国社区卫生服务发展中人力资源建设、筹资与补偿、政策、法规、管理和评价体系建设以及社区卫生服务需求与利用等方面存在的问题进行了分析,提出一系列促进社区卫生服务可持续发展的策略．为制定新的社区卫生服务发展政策提供依据。     

Mental health service utilization among the Arabs in Israel

National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the "cultural" over the "professional" in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.     

武汉市居民社区卫生服务需求调查

目的 了解湖北省武汉市社区居民卫生服务需求,为促进社区卫生服务工作提供科学依据。方法 采取现况调查方法,对武汉市10个社区2 026名居民进行社区卫生服务需求调查。结果 38.4%的社区居民将慢性病防治放在第1位,其次为健康体检与健康管理（19.0%）、健康教育（17.0%）;社区居民需求的健康保健信息依次为预防疾病知识（44.9%）、健康生活知识（16.6%）和健康饮食知识（12.7%）;喜欢的健康教育方式依次为专家授课（32.5%）、面对面咨询（30.5%）、阅读健康教育资料（18.2%）;愿意接受的家庭健康服务依次为居家疾病护理（37.0%）、预防保健（22.3%）和饮食营养（21.1%）。结论 武汉市居民社区卫生服务需求较为广泛,应重点加强社区卫生服务项目、健康保健信息、健教方式、家庭健康服务等建设。