Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

福州市社区空巢老年人健康状况调查

目的了解空巢老年人的健康现状及其影响因素,为老龄工作提供科学依据。方法2002年4~5月进行入户调查,采用分层整群抽取福州市鼓楼、台江、仓山三个区60岁及以上的社区老年人,共得到有效样本1767例,其中空巢老人696名。空巢老人躯体健康、生活自理能力(ADL)、经济状况、精神健康、社会健康5个维度的健康状况及其影响因素的调查是本次研究的主要内容。结果福州市社区空巢老年人占老年人总体比例的39%,其中男性多于女性;由logistic检验得出空巢老年人健康状况受年龄、性别、原职业、是否赞成非家庭养老方式、锻炼程度等因素的影响。结论倡导空巢老年人形成良好的生活饮食习惯与自我保健意识,加强对空巢老年人慢性病的防治,丰富老年人的精神生活、社会生活,提高对空巢老年人经济支持,完善社区为老服务,从而改善空巢老年人的健康状况。     

生态运动与绿色主义福利思想：生态健康科学与新型公共卫生框架

人与自然、社会与自然关系既是经典的理论议题,又是紧迫重大的现实政策问题.本文从生态运动入手,系统介绍作为生态运动理论基础的绿色福利主义,并以生态健康科学为基本理论视角,简要探讨新型现代公共卫生政策框架及其革命性的现实、理论与政策涵义.     

心理健康教育模式在课堂教学中的建构

在实证的基础上论述了心理健康教育模式在课堂教学中的建构 ,以期增进学生的心理健康     

Can we remember differently? A case study of the new culture of memory in voluntary organisations

This article analyses the positive contribution that Slovenian voluntary, non–governmental organisations, users' organisations and community–based services in the field of mental health have made to the 'new culture of memory' of helpers and users. The conceptual differences between Slovenian psychiatric (institutional) treatment and voluntary community care are presented through the case study of Clare, a young woman who was diagnosed as a chronic schizophrenic. This example shows the importance of community care in voluntary organisations for the reduction of disability associated with mental disorders. The development of the new culture of memory in voluntary organisations and community–based services is not only the 'narrative turn' within social welfare, but also symbolises the 'implicit turn' in the relationship between the helper and the user. The real challenge of the new culture of memory in the process of help to disabled people (in respect of individuals working through traumatic memories) is that the helper can bear and support the user on a daily basis. During the process of their relationship, the deep implicit relational memories of both become activated and influence the change within the user as well as the helper.     

Medicine on the line? Computer‐mediated social support and advice for people with diabetes

The advent of thousands of Usenet groups on the Internet, covering a vast range of medical and welfare issues and ostensibly devoted to the mutual social support of participating members, has raised the potential for the development of new forms of 'virtual' health care. This article critically analyses the use by people with diabetes of one such Usenet group. It seeks to establish, first, the extent to which such a site provides some demonstrable measure of social support to its participants. This is approached by undertaking a structural analysis of the site to identify the extent of usage, and the nature of supporting interventions using a fivefold classification (instrumental, informational, esteem and social companionship and other). Second, the article attempts to identify any disparity between the lay health-knowledge in evidence and biomedical opinions proffered by the use of a panel of consultant diabetiologists. The results of the analysis suggest that the diabetes newsgroup provides an example of an active forum for largely well-informed participants who routinely use the media as an aid to the reflexive management of their medical condition. It also raises the prospect of a renegotiated relationship between medical knowledge and lay experience based upon shared learning     

上海市空气污染造成人群健康经济损失的研究

文章通过对上海市空气污染季节性状况的描述 ,分析了各种污染物的污染程度和变化趋势 ,并利用对上海某市级医院的实地调查数据 ,对空气污染物与医院呼吸系统疾病患者日门诊量之间的相关关系进行研讨 ,建立了多元分析模型 ,探讨了患者健康经济损失的计量方法 ,并对由空气污染造成呼吸系统疾病患者健康经济损失进行了估算。研究表明 ,在其他条件不变的情况下 ,NOX 日指数每增长 10 % ,被调查医院呼吸系统疾病患者的日门诊人次增加 7 7人次 ,而这些疾病患者由于患病产生的年度健康经济损失为 2 11万元。据此作保守的推断估计 ,上海市一年内因NOX 超标而发生的呼吸系统疾病门诊行为造成的健康经济损失可以达到 4 2亿元。同样 ,SO2 和TSP造成门诊患者的健康经济损失分别为 1 5亿元和 0 86亿元     

Child‐Care Usage and Mother‐Infant “Quality Time”

Mothers' time‐use patterns were compared in families in which infants spent more than 30 hours per week in child care (In‐Care group; n= 143) versus 0 hours per week (At‐Home group; n= 183) from birth to 6 months of age. In‐Care group mothers spent about 12 fewer hours per week interacting with their infants, for about 32% less time; fathers of these infants were more involved in caregiving. The groups did not differ in the quality of mother‐infant interaction. In the In‐Care group, quantity of interaction was related to greater separation anxiety and concerns about effects of maternal employment. Time‐use data were not related to child outcomes at 15 months of age. Results suggest that the effect of extensive time spent apart on the quantity and quality of mother‐infant interaction may be smaller than anticipated.