上海市某社区≥35岁人群糖尿病患病率及影响因素分析

摘 要：目的：了解失独 （伤残） 家庭父母医养需求及影响因素,并基于家庭医生“1+1+1”签约服务来满足其医养需求。方法：应用生活自理量表 （ADL） 和老年抑郁量表 （GDS） 对上海市浦东新区某街道20个居委274名失独 （伤残） 家庭父母进行医养需求及签约服务调查,调查内容包括基本情况、生活自理能力情况、抑郁症状情况等。结果：68.2%的失独（伤残） 家庭父母具备生活自理能力,不同年龄、家庭医生“1+1+1”签约、高血压和糖尿病的失独 （伤残） 家庭父母的生活能力自理率比较,差异有统计学意义 （χ2值分别为 78.574、19.854、111.203 和 49.843,P 值均＜0.05）。52.2%的失独 （伤残） 家庭父母有抑郁症状,不同性别、年龄、婚姻及家庭医生“1+1+1”签约服务的失独 （伤残） 家庭父母抑郁症状检出率比较,差异有统计学意义 （χ2值分别为5.408、57.520、29.088和26.737,P值均＜0.05）。结论：随着年龄的增长,失独 （伤残） 家庭父母生活自理能力和抑郁症状趋于加重,家庭医生提供签约服务时,应予以关注并提供相关危险因素干预措施,防止疾病及并发症发生。     

HIV/AIDS患者的心理需求调查

目的 了解HIV／AIDS患者的心理需求。方法 对我国4个省111例HIV／AIDS进行流行病学问卷调查和个人深入访谈。结果 大部分感染者都表现出对结果的不相信，在知道感染后大部分感染者都选择不告诉其他人。对于是否愿意和其他感染者进行交流。在因吸毒和血液途径的感染者中均有较高的比例，分别是75．56％和87．10％，而且其中94．29％和100％的人将面对面交流作为首选。结论 HIV／AIDS患者承受的心理压力巨大，应采取有效措施加以改善。     

How do patients with cancer pain view community pharmacy services? An interview study

Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi‐structured interview which was audio‐recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.     

Equity in access to care in the era of health system reforms in Turkey

ObjectiveTo evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey.MethodsThe country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. The dependent variable had three categories: no unmet need, unmet need due to cost, and unmet need due to availability (waiting list and distance problems). Predictors of unmet need were assessed by a multinomial logistic regression analysis.FindingsThe prevalence of unmet need declined between 2006 and 2013. While educational inequalities in declared unmet need also decreased, the income gradient becomes more important. In 2013, controlling for other factors, the propensity to report unmet need was 10 times higher for those in the poorest-income quintile compared to the richest (versus 7 times in 2006).ConclusionOverall access to healthcare has gradually improved in Turkey in the health reform process, but 9% of people still declared unmet need due to cost in 2013, after the implementation of Universal Health Insurance. This was nearly four times the EU average. Unfavourable economic and labour market conditions can be challenges for effective universal health coverage.     

群体牙周治疗需要指数与血脂水平的相关性研究

目的 了解群体牙周治疗需要指数（CPITN）与血脂水平的关系。方法 1879名来大庆油田总医院进行健康体检者被纳入本项研究。所有实验对象均取静脉血检测胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）。牙周状况采用牙周治疗需要指数评价。校正了性别、吸烟情况、血糖、年龄、体重指数、舒张压等影响因素后，对牙周治疗需要指数与血脂水平进行相关性分析。结果 CPITN指数与血清总胆固醇、低密度脂蛋白存在正相关，且具有统计学意义。CPITN与血清高密度脂蛋白、甘油三酯不存在统计学意义的相关关系。结论 牙周病的严重程度与血清总胆固醇、低密度脂蛋白的水平有关，牙周病对血脂水平的影响可能是其促成动脉粥样硬化的病变基础。     

Structuring health needs assessments: the medicalisation of health visiting

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting.     

Developing services to support parents caring for a technology-dependent child at home

BACKGROUND: A group of children with complex health care needs have emerged as a result of medical advances and government policies emphasizing the community as the arena for care. Some of these children remain dependent on the medical technology that enabled them to survive and require care of a complex and intensive nature to be carried out by their parents at home. AIMS: To explore the experiences of families caring at home for a technology-dependent child; to examine their needs for practical and other support; and to examine how far services are currently meeting these needs. Methods In-depth interviews were conducted with the parents of 24 technology-dependent children and with 44 health, social care and other professionals. RESULTS: Services in the community were not sufficiently developed to support this group of families. Major problems were identified in the purchasing and provision of both short-term care/home support services and specialist equipment/therapies in the community. Service provision could be poorly planned and co-ordinated at an operational level and few families had a designated key worker. Parents felt that professionals did not always recognize either the emotional costs entailed in providing care of this nature or their expertise in caregiving. Information-giving to parents was often described as poor and participants reported that hospital professionals failed to negotiate the transfer of caregiving responsibility to parents. CONCLUSIONS: Services need to work in partnership with families and with each other at both strategic and operational levels, to develop integrated and co-ordinated services that can meet the needs of this group of families.     

Health of children looked after by the local authorities

Objectives. To assess the healthcare needs of looked-after children in East Surrey. Methods. Epidemiological, comparative and corporate approaches were used to study the healthcare needs of looked-after children. Information was obtained from published and unpublished sources, case note review, cross-referencing with records from specialist services, and interviews with stakeholders. Results. Of the 136 children whose case notes were reviewed, only 64% had undergone statutory medical examinations. Several physical health problems were identified, emotional and behavioural problems were present in 34% of children, 25% of school-aged children had a statement of special educational need, and 36% had ever used child and adolescent mental health services. Immunization coverage was lower than that of children who were not in care. Several unmet needs and gaps in service provision were identified. Conclusions. Children in care have a higher degree of physical and mental health needs than their not-in-care counterparts. The local service for children in care needs to be improved to meet these health needs and lead to better health and health-related outcomes for the children.