有关开展社区心理咨询的探讨

以会谈调查、临床资料总结、实地考察和文献分析相结合方法进行研究。结果表明:目前我国医院心理咨询的对象主要为病人,较基层的医院则正常人咨询比例较高,前者脱失率较高,就诊不便是重要原因之一。调查还发现,广州社区心理卫生服务尚未包括心理咨询,居民对心理卫生常识和心理咨询缺乏认识。因此建议应借鉴国外的先进经验,结合我国实际,开展有中国特色的社区心理咨询。     

Under fives mortality in the urban slums of Lucknow

The main objective of this study was to elicit proportional cause specific mortality in the underfives in the urban slums of Lucknow in North India. The families with under five mortality in the 28 randomly selected slums in 1993 were located from the records of the slum health workers and verbal autopsy was conducted to assign a cause of death. There were 71 deaths among 2796 children. The annual under five mortality was 25.4 and the under five mortality rate was 126.7. After the neonatal period, “high fever” that could not be classified into any other disease incorporated in the verbal autopsy instrument, was the most common symptom associated with death, seen in 21.1% cases (95% C.I.: 15.5–34.4%) followed by these diseases: pheumonia in 19.7%, diarrhea in 18.3% and measles in 11.4%. “High fever” as the leading symptom associated with death is being reported for the first time from the urban slums of India. There is an urgent need to identify the underlying etiologies of death due to “high fever” and the policy implications are that children with fever must receive immediate and continued medical attention till the symptom persists.     

Dietary salt and blood pressure

Research evidence on the role of dietary sodium in the etiology and pathogenesis of hypertension is briefly reviewed. This matter is assuming new importance at present, given new data on the efficacy of normalization of blood pressure for adults with so-called "mild" hypertension (average diastolic 90-104 mm Hg), hence the need for safe nutritional-hygienic alternatives to years-long drug treatment for millions of people with such hypertension. Two trials by the authors deal with some unresolved questions in this area. The first, a preliminary study, involved 21 lacto-ovo-vegetarian high school students living in a boarding school. With decrease in daily Na intake from 216 to 72 meq for the experimental compared with the control group, red blood cell Na concentration was significantly lower in the former; systolic pressure was slightly but not significantly lower. The second trial, the Primary Prevention of Hypertension, involves over 200 hypertension-prone persons aged 30-44, and explores the ability in the experimental group to reduce blood pressure and prevent development of hypertension by safe nutritional-hygienic means (weight reduction, dietary Na decrease, avoidance of excess alcohol, rhythmic exercise). Initial results at 6 months are presented. Trials on the prevention and control of hypertension by nonpharmacologic means, including reduced Na intake, and involving analyses of the inter-relationships among dietary Na, other dietary factors, Na metabolism, and blood pressure in samples from different population strata, are an important present-day research need.     

Can a community development model be used for health programmes in an industrialized country?

Injury resulting from accident is a serious public health problem in Sweden, as it is in the rest of the world. Theoretically, almost all incidents can be prevented. However, in practice, injury-prevention is a complex problem. A community-level intervention programme for prevention of accidents was developed in the municipality of Sollentuna, Stockholm County. The primary strategy has been to involve the community through representatives as well as through local organizations and groups. Project organization has been built up in cooperation with the municipal primary health-care department, local authorities, voluntary organizations and citizen agencies. A common opinion is that it is the actual process in a community programme which is important, that alters the type of involvement from a ‘top-down’ to a ‘bottom-up’ approach. Can a local community take over responsibility for running such a programme which has been initiated by an external authority or organization? We think that, at least for Swedish circumstances, the community development approach is far too optimistic in its expectation that community members should and can stay actively involved in programme decisions. Based on our experience, it does not seem possible to maintain a broad self-sustained programme solely with input from community members.     

社区糖尿病患者量化饮食和运动治疗的疗效观察

目的通过对糖尿病患者进行量化饮食治疗和运动治疗,探索社区糖尿病管理的有效模式,以有效控制血糖,降低医疗费用。方法选取社区内空腹血糖小于11.1mmol/L的2型糖尿病患者129人,按病情匹配分为强化管理组(64例)和普通管理组(65例)。强化管理组采用一对一的指导和监督,量化饮食和运动治疗,有针对性的进行健康教育和心理疏通。普通管理组为一般的健康教育和门诊治疗。观察两组干预一年后的病情控制情况和医药费用的情况。结果强化管理组平均空腹血糖为5.8mmol/L,比普通管理组的7.1mmol/L有明显降低,糖化血红蛋白强化管理组为5.9%,普通管理组为7.0%。强化管理组医药费平均每人每月下降32.25元,下降幅度为20.12%,普通管理组平均每人每月下降12.47元,下降幅度为4.54%。结论量化饮食和运动治疗在社区糖尿病干预中疗效优于普通干预组,且医药费用明显降低。     

药店实施GPP认证自愿性原则探讨

目的 :探讨药店实施GPP认证的自愿性原则 ,为保障GPP的顺利实施提出参考建议。方法 :从实施GPP认证的目的、行业整体服务水平、公正性和法律保障等方面对自愿性原则进行分析。结果与结论 :药店实施GPP认证的自愿性原则的可行性有待市场验证 ,但应尽快出台相关法律、法规和政策 ,并加大向公众宣传安全用药知识的力度。     

Smoking practices in New York City: The use of a population-based survey to guide policy-making and programming

To inform New York City’s (NYC’s) tobacco control program, we identified the neighborhoods with the highest smoking rates, estimated the burden of second-band smoke exposure, assessed the early response to state taxation, and examined cessation practices. We used a stratified random design to conduct a digit-dialed telephone survey in 2002 among 9,674 New York City adults. Our main outcome measures included prevalence of cigarette smoking, exposure to second-hand smoke, the response of smokers to state tax increases, and cessation practices. Even after controlling for sociodemographic factors (age, racelethnicity, income, education, marital status, employment status, and foreign-born status) smoking rates were highest in Central Harlem and in the South Bronx. Sixteen percent of nonsmokers reported frequent exposure to second-hand smoke at home or in a workplace. Among smokers with a child with asthma, only 33% reported having a no-smoking policy in their homes. More than one fifth of smokers reported reducing the number of cigarettes they smoked in response to the state tax increase. Of current smokers who tried to quit, 65% used no cessation aid. These data were used to inform New York City’s smoke-free legislation, taxation, public education, and a free nicotine patch give-away program. In conclusion, large, local surveys can provide essential data to effectively advocate for, plan, implement, and evaluate a comprehensive tobacco control program. Dr. Mostashari (the guarantor) made substantial contributions to the conception, design, and supervision of this paper, the analysis and interpretation of data, the drafting of the paper, critical revisions of the paper for important intellectual content, and the acquisition of data and funding for this research. Dr. Kerker made substantial contributions to the analysis and interpretation of data, the drafting of the paper and critical revisions of the paper for important intellectual content. Ms. Hajat made substantial contributions to the acquisition of data and critical revisions of the paper for important intellectual content. Dr. Miller made substantial contributions to the conception of this paper and critical revisions of the paper for important intellectual content. Dr. Frieden made substantial contributions to the conception, design, and supervision of this paper and critical revisions of the paper for important intellectual content.     

社区高血压病患者高血压知识态度行为及影响因素调查分析

目的 通过对社区高血压病现症患者高血压病相关知、信、行进行基线调查，并分析相关的影响因素，为开展社区高血压病防制提供基础资料。方法 随机抽取成都市武侯区玉林社区卫生服务中心已建立家庭健康档案的社区高血压病现症患者，由经专门培训的社区医生担任调查员，采取面对面访谈的方式进行调查，对调查资料进行非参数检验，单因素及多因素logistic回归分析。结果 高血压病KAP总得分及格率52．5％，相关知识得分及格率57．6％，态度得分及格率63．4％，行为得分及格率53．5％；KAP总得分与文化程度、职业、高血压病家族史有关；多因素Logistic回归分析提示，知识得分与调查对象年龄和文化程度有关；态度得分与知识得分相关；行为得分与态度得分和家人关心程度有关；高血压病相关知识主要来源是医疗单位(67．7％)，其次是电视(58．6％)；希望获知途径为电视广播(69．7％)，其次为讲座(54．5％)，专家咨询(52．5％)；希望了解的知识主要为治疗措施(79．8％)，其次是控制疾病发展的具体方法(71．7％)。结论 本次基线显示高血压病现症患者知识、态度和行为水平不高，揭示有必要针对社区高血压病现症患者的健康需求开展以高血压病综合防制为主的健康促进活动。干预重点可以放在较低文化层次人群、体力劳动者和有高血压病家族史的人群。     

Life Satisfaction in a Sample of Outpatients with Severe Mental Disorders: A Survey in Northern Italy

This paper presents a cross-sectional survey of subjective quality of life in a sample of 40 Italian patients with disabling mental disorders living in the community. The patients self-rated their quality of life by the Satisfaction with Life Domains Scale. They were satisfied in relation to basic needs, such as housing, food or clothing and appreciated to some extent the services received, but were very unhappy about their income and their intimate sexual relationships. This Italian sample appeared less satisfied than most samples of people with severe mental disorders investigated by the same instrument in other countries. This may be related to the high level of psychopathology and disability shown by patients for whom survival in the community is in itself an achievement. However, lack of money and poor sexual life are common concerns of long-term mentally ill. How to address such problems is a major challenge for community psychiatric services.     

同伴教育在高脂血症社区健康教育中的作用

目的　调查同伴教育在高脂血症社区健康教育中的作用。方法　选择北京市西城区 4个社区志愿参与本研究的常住居民进行血脂筛查 ,共筛查出高脂血症患者及血脂偏高者 2 40人 ,对其进行为期 6个月的高脂血症综合健康教育 ,并从其中抽取 40人同时进行同伴教育 (教育 2组 ) ,另 2 0 0人作为对照组 (教育 1组 )。在教育前后进行高脂血症相关知、信、行的问卷调查 ,并作分析比较。结果　教育 1组和教育 2组在健康教育前关于高脂血症的知、信、行测试得分分别为 43 5 4± 5 0 6和 40 2 1± 5 68,无显著差异。实施教育后教育 1组得分仅增加 2 65 ,明显低于第 2组增加分数 5 0 5 (P <0 0 5 )。结论　同伴教育对高脂血症患者的健康教育更为有效。