精神卫生法导向下的社区精神康复机构内涵建设

《中华人民共和国精神卫生法》的颁布和实施给我国现存的精神卫生服务体系带来了巨大的震撼,而作为链接“医院”与“社会”不可或缺的“过渡站”——社区精神康复机构势必会自觉或不自觉地纳入到其影响范畴之中.本文以上海市社区精神康复机构——阳光心园为例,对此影响进行具体剖析,以期能对社区精神康复机构内涵的建设和发展提供借鉴性意义.     

社区康复发展的历史及我国社区康复事业发展现状、问题及对策研究

本文通过回顾社区康复发展的历史,剖析《社区康复指南》,明确社区康复的定义及内涵,理清国内社区康复的发展脉络,针对我国社区康复发展过程中出现的问题提出合理化对策,探讨建立符合我国国情的本土化社区康复发展战略。     

高职社区康复专业“分段递进式人才培养模式”与实践教学改革探索

2002年,中国政府提出了"2015年残疾人人人享有康复服务"的宏伟目标,号召要切实地、有效地抓紧推进社区康复工作,并强调"社区卫生服务机构要将残疾人社区康复作为重要工作内容"[1],这大大提升了社区康复的重要性,也增加了对社区康复人才的需求。但在近年的快速发展过程中,社区康复专业培养的人才却越发不能适应实际的社区康复工作,各地社区     

加快培养新型社区康复护理人才的必要性

探讨加快培养新型社区康复护理人才的必要性。我们应充分认识未来对社区康复护理人才的需求,及时调整护理人才的培养模式,加快康复医学学科的建设,积极推进社区康复护理的发展,以满足社区对新型康复护理人才的需要。     

浅谈社区康复

社区康复是近年来发展起来的一种康复形式,目前世界各地对社区康复给予了极大的关注.在我国社区康复也在由政府组织实施,但总体上讲还不是大面积推行实施,所以全面寻找对残疾人实施康复的有效途径,最大限度地恢复残疾者的功能是我们推动社区康复工作发展的一个主要内容.社区是社会学中的一个概念,是聚居在一定地域中人群的生活共同体.社区康复是指依靠社区本身的人力资源,建设一个有行政领导参与,卫生人员、志愿人员及残疾者家属及本人参加的康复体系,做好此项工作对提高全民健康促进社会进步有深远意义.……     

社区精神疾病康复机构服务队伍现状分析

目的 了解上海市社区精神疾病康复机构服务队伍现状,分析存在的问题,并提出有益的建议.方法 以上海市某区"阳光心园"康复服务人员为调查对象,采用自行设计的康复机构服务人员的情况调查表进行调查及分析.结果 目前社区精神疾病康复服务队伍存在人员队伍基本结构失衡、专业康复医护人员紧缺、综合服务能力欠缺、康复服务模式发展滞后、精神康复服务理念陈旧等问题.结论 完善社区精神疾病康复应从调整人员结构、强化服务队伍建设、提高综合能力水平、吸引多专业团队合作、培育康复服务新理念等方面进行努力和提高.     

脑卒中社区康复管理模式与技术探讨

脑卒中是危害我国中老年人身体健康的主要原因,其高发病率、高死亡率和高致残率给患者家庭、社会带来沉重经济负担。近年来,经循证医学证明,社区康复是降低脑卒中致残率的有效方法,但目前我国基层社区康复技术陈旧,管理模式混乱,因此如何提升我国脑卒中社区康复技术逐渐成为研究热点。本文简述了目前国内外脑卒中社区康复管理模式和技术的现状,并提出了一些关于我国社区康复的发展对策,以期为我国脑卒中社区康复模式提供新思路。     

福州市老年人社区康复需求现状与分析

人口老龄化对我国卫生事业的发展提出新的挑战,在新医改的大背景下,本文调查了福州市部分社区老年人慢性病康复现状,调查表明现有的社区医疗服务无法满足老年人的康复需要,迫切需要整合现有的医疗卫生资源,加强对社区康复人员的技术指导,在加大政府投入的同时鼓励民间力量发展老年社区康复?     

我国康复机构组织建设研究综述

随着国内经济文化、社会保障以及医疗卫生事业的发展,康复医学的发展得到了越来越多的关注,各级政府和社会各界对康复支持力度逐年加大,国内陆续建立了国家级康复中心、省级、地市、县级复中心以及大量的社区康复机构。同时,全国二级以上综合性医院还成立了康复医学科,基本上形成了覆盖全国的康复机构网络。但和发达国家相比,由于多种原因,国内在康复机构的建设标准、管理模式、运营机制等方面还存在较大差距,制约着康复医学的快速发展和科学管理。通过研究、对照发达国家康复机构的管理特点,拟探讨国内康复机构今后在机构建设标准、运营管理模式等方面的发展方向,并提出可行性建议。     

康复机构组织建设与管理标准

我国已陆续建立了国家级、省级、地市级、县级康复中心以及大量的社区康复机构,基本上形成了覆盖全国的康复机构网络.但由于缺乏规范统一的行业管理标准,康复机构的发展受到较大限制.深入开展康复机构组织建设与管理研究,创新探索出适合我国国情的康复机构管理模式,规范康复机构建设和服务标准,对于指导我国各级各类康复机构发展具有重要的...     

Rehabilitation services in Papua New Guinea

It is now accepted that in developing countries community-based rehabilitation (CBR) is the most effective way to meet the needs of the disabled. The proportion of the population of Papua New Guinea (PNG) having access to CBR is not known. The purpose of this project was to clarify the extent of rehabilitation services in PNG. It was hoped that by establishing the extent of services, communication and cooperation between them would increase, leading to more efficient and effective use of the limited resources (human and otherwise) available for rehabilitation in PNG. A questionnaire was sent to all known existing rehabilitation services, all provincial health departments, provincial hospitals and church health services. A 47% response rate was achieved. Results showed that most provinces have some form of rehabilitation available but rehabilitation is not spread equally throughout PNG. Most of the services are based in the urban centres and the rural population is badly served except in the Highlands Region and the Sepik provinces, which appear to be more comprehensively served by CBR. The services that do exist are hampered by lack of human and material resources and difficulty accessing clients due to transport difficulties. There needs to be a greater movement of rehabilitation into the community with government backing. The greatest effort is being made by Callan Services for Disabled Persons based in Wewak with its group of Special Education Resource Centres that also carry out CBR. CBR would appear to be an appropriate way to address the needs of the disabled PNG population, but in order to be successful it requires greater backing and more trained personnel.     

吉林省残疾人社区康复现状及其对策研究

社区康复是以社区为基地开展残疾人的康复,它是符合我国国情、有利于大多数残疾人康复的有效途径。笔者以吉林省第二次全国残疾人抽样调查数据为依据,对吉林省社区康复现状、目前存在的主要问题及其对策进行了分析和探讨。笔者认为,社区康复尚未普及,残疾人社会保障体系有待进一步完善,通过此次研究,旨在为相关部门制定政策提供依据。     

Towards a method for informing the planning of community-based rehabilitation in Papua New Guinea

Disability is a major public health problem, particularly in developing countries, where there is a close link between poverty and disability. The complex nature of disability allows it to be addressed from a number of different perspectives. Community-based rehabilitation (CBR) is a holistic approach towards disability which is currently being supported in many parts of the world, including Papua New Guinea (PNG). Unfortunately CBR is frequently implemented in resource-poor contexts, which limits the scope for research. As a result little effort is put into determining a need before CBR programs are established, or into evaluating CBR programs following implementation. This research in the Middle Ramu, Madang Province, tested a method for acquiring information for the purposes of CBR planning in PNG. The method used an adapted form of the Ten Questions Screen for Childhood Disability. Quantitative and qualitative methods were further utilized to determine the types of disability presenting, the biomedical and perceived causes of the various disabilities, help-seeking behaviours, the disabled individual's participation in village activities, and the needs of both disabled individuals and their caregivers. A total of 158 disabled individuals were identified in a population of 4946 people and 20 in-depth interviews were conducted. The data obtained were analyzed to formulate an appropriate 'CBR package' that would cater for the specific needs of this population in the Middle Ramu. Evaluation of the basic survey method revealed that it was more sensitive than other methods previously tried in PNG, with an overall disability prevalence of 3.2% obtained. Qualitative methods allowed the fieldworkers to get a much deeper insight into the feelings and perceptions of disabled individuals. The methods tested for this research in the Middle Ramu could have application for CBR workers in other parts of PNG.     

LncRNA CBR3-AS1在骨肉瘤中的表达和临床意义及对肿瘤生物学的影响

摘要：目的：探讨LncRNA CBR3-AS1在骨肉瘤患者中的表达、临床意义及对肿瘤生物学的影响。方法：回顾性收集2012年1月到2014年1月于我院骨科诊治的骨肉瘤66例患者病理组织样本和临床资料,qRT-PCR法检测病理组织中LncRNA CBR3-AS1表达,并将患者分为LncRNA CBR3-AS1高低表达两组,卡方检验LncRNA CBR3-AS1表达情况与骨肉瘤临床参数的相关性,Kaplan-Meier 生存分析法比较LncRNA CBR3-AS1高低表达骨肉瘤患者生存率的差异。体外实验敲低LncRNA CBR3-AS1表达对骨肉瘤细胞系U-2 OS肿瘤生物学行为影响。结果：LncRNA CBR3-AS1在骨肉瘤组织和细胞系中高表达（P<0.001）;LncRNA CBR3-AS1表达与Enneking分期（P<0.001）、远处转移（P=0.004）和组织学分级（P=0.036）显著性相关;LncRNA CBR3-AS1高表达与骨肉瘤患者总生存率呈负相关（P <0.01）;LncRNA CBR3-AS1高表达是骨肉瘤患者的不良预后因素（HR= 1.558, 95％CI:1.041-2.641,P=0.013）;敲低LncRNA CBR3-AS1表达可抑制骨肉瘤细胞系MG-63细胞增殖、迁移和侵袭、并促进细胞凋亡（P<0.001）;骨肉瘤组织中LncRNA CBR3-AS1和CBR3mRNA表达之间正相关（r=0.44,P=0.036）,敲低LncRNA CBR3-AS1对骨肉瘤细胞CBR3 mRNA和蛋白质表达降低。结论：LncRNA CBR3-AS1具有调节骨肉瘤细胞增殖、迁移、侵袭和凋亡的致癌作用,是骨肉瘤患者预后独立危险因素。     

基于CBR和SVR的生化需氧量预测模型

针对污水处理过程生化需氧量（BOD）浓度难以实时监测的问题,建立了一种基于支持向量回归机（SVR）修正方法的案例推理（CBR）预测模型。该模型主要包括案例检索、案例重用、SVR修正、案例存储等4个部分,其中,SVR修正模型是利用历史数据构造修正案例库,并采用SVR训练而获得的,可以对传统CBR求解模型得到的BOD浓度建议值进行修正。实验表明本文模型的拟合误差优于支持向量机（SVM）、BP神经网络、RBF神经网络以及传统CBR方法,说明SVR修正方法的引入可以改善CBR的回归性能,提高CBR的学习能力。     

Endocannabinoids anandamide and its cannabinoid receptors in liver fibrosis after murine schistosomiasis

This study examined endogenous carmabinoid （ECB）-anandamide （AEA） and its cannabinoid receptors （CBR） in mice liver with the development ofschistosomajaponicum. Mice were infected with schistosoma by means of pasting the cercaria onto their abdomens. Liver fibrosis was pathologically confirmed nine weeks after the infection. High performance liquid chromatography （HPLC） was employed to determine the concentration of AEA in the plasma of mice. Immunofluo-rescence was used to detect the expression of CBR1 and CBR2 in liver tissue. Morphological examination showed typical pathological changes, with worm tubercles of schistosoma deposited in the liver tissue, fibrosis around the worm tubercles and infiltration or soakage of inflammatory cells. Also, CBR1 and CBR2 were present in hepatocytes and hepatic sinusoids of the two groups, but they were obviously enhanced in the schistosoma-infected mice. However, the average optical density of CBR1 in the negative control and fibrosis group was 13.28±7.32 and 30.55±7.78, and CBR2 were 28.13±6.42 and 52.29±4.24 （P〈0.05）. The levels of AEA in the fibrosis group were significantly increased as compared with those of the control group. The concentrations of AEA were （0.37±0.07） and （5.67±1.34） ng/mL （P〈0.05）. It is concluded that the expression of endocannabinoids AEA and its cannabinoid receptor CBR were significantly increased in schistosoma-infected mice. Endogenous endocannabinoids may be involved in the development of schistosoma-induced liver fibrosis.     

Carotid chemoreceptor reflex modulation by arginine-vasopressin microinjected into the nucleus tractus solitarius in rats

BACKGROUND: In addition to their role of sensing O2, pH, CO2, osmolarity and temperature, carotid body receptors (CBR) were proposed by us and others to have a glucose-sensing role in the blood entering the brain, integrating information about blood glucose and O2 levels essential for central nervous system (CNS) metabolism. The nucleus tractus solitarius (NTS) is an important relay station in central metabolic control and receives signals from peripheral glucose-sensitive hepatoportal afferences, from central glucose-responsive neurons in the brainstem and from CBR and arginine-vasopressin (AVP)-containing axons from hypothalamic nuclei. METHODS: In normal Wistar rats anesthetized with pentobarbital, permanent cannulas were placed stereotaxically in the NTS. Glucose changes were induced in vivo after CBR stimulation with sodium cyanide (NaCN-5 microg/100 g), preceded by an infusion of AVP [(10 or 40 pmol/100 nL of artificial cerebrospinal fluid) aCSF] or an antagonist for V1a receptors (anti-glycogenolytic vasopressin analogue-VP1-A) (100 pmol/100 nL of aCSF) into the NTS. RESULTS: CBR stimulation after an AVP infusion (larger dose) into the NTS resulted in a significantly higher arterial glucose and lower brain arterial-venous glucose difference. In the same way, VP1-A administration in the NTS significantly decreased the effects observed after AVP priming before CBR stimulation or preceding the CBR stimulation, alone. CONCLUSIONS: We propose that AVP in the NTS could participate in glucose homeostasis, modulating the information arising in CBR after histotoxic-anoxia stimulation.     

AT方案与GP方案治疗晚期乳腺癌近期疗效观察

目的比较AT方案与GP方案治疗晚期乳腺癌的临床疗效、毒副反应及临床受益反应（CBR）。方法Ⅲ-Ⅳ期乳腺癌患者70例，分为AT组（ADM＋TAX）38例，GP组（GEM＋DDP）32例。结果AT组有效率60．5％（23／38），CBR率55．3％（21／38）；GP组有效率56．3％（18／32），CBR率50．0％（16／32），组间疗效及CBR差异无显著性（P〉0．05），主要毒副作用为骨髓抑制、消化道反应和神经毒性，均为可逆性。结论AT方案和GP方案对于复发或有远处转移的晚期乳腺癌疗效确切，毒副作用可以耐受，均可作为一线治疗方案应用。     

动脉介入化疗配合口服化疗治疗胰腺癌的疗效观察

目的分析经动脉使用吉西他滨配合口服卡培他滨治疗中、晚期胰腺癌的近期疗效及安全性。方法对46例中晚期胰腺癌患者行经动脉灌注吉西他滨1000mg/m2,分别于第1、8d灌注;卡培他滨2500mg/m2,口服,2次/d,使用14d,21d为1个周期,2个周期后评定疗效。结果临床受益率(CBR)为71.8%(33/46),客观缓解率21.7%(10/46),中位生存期9.45个月,1年生存率13%(6/46),CA19-9治疗后平均下降32.4%。主要毒副反应为骨髓抑制及消化道反应。结论动脉介入吉西他滨配合口服卡培他滨治疗胰腺癌临床受益率高,有较好的客观缓解率,毒副反应较轻。     

甲磺酸阿帕替尼联合化疗在晚期乳腺癌患者治疗中的临床应用

目的：观察甲磺酸阿帕替尼（简称阿帕替尼）联合化疗在多线治疗失败的晚期乳腺癌患者中的临床疗效和安全性,阐明阿帕替尼在晚期乳腺癌患者治疗中的意义。方法： 25例晚期乳腺癌患者均为多线治疗进展者,其中三线治疗者5例（20%）,四线治疗者7例（28%）,五线及以上治疗者13例（52%）。所有患者均采用阿帕替尼联合化疗,根据病情及既往用药情况选择化疗方案。阿帕替尼剂量为250~500 mg,每日1次,口服,直至疾病进展或不能耐受发生不良反应为止。采用实体瘤疗效评价标准1.1（RECIST1.1）评价疗效,包括客观缓解率（ORR）、临床获益率（CBR）和无进展生存期（PFS）,采用国家通用研究所毒副反应标准4.0（NCI-CTC4.0）评价不良反应。结果： 25例晚期乳腺癌患者中位治疗线数为五线,总ORR为12%（3/25）,CBR为52%（13/25）,中位无进展生存期（mPFS）为6.00个月。治疗线数评价,三线治疗的5例患者中,2例疾病稳定（SD）,CBR为40%（2/5）;四线治疗的7例患者中,2例部分缓解（PR）,2例SD,CBR为57%（4/7）;五线及以上治疗的13例患者中,1例PR,6例SD,CBR为54%（7/13）。病理类型评价,三阴型患者中,3例SD,CBR为60%（3/5）;12例腔上皮型（Luminal型）患者中,1例PR,2例SD,CBR为25%（3/12）;HER-2阳性患者中,1例PR,6例SD,CBR为88%（7/8）。50岁及以上组患者近期疗效优于50岁以下组（P<0.05）,其余不同临床病理参数患者之间近期疗效比较差异无统计学意义（P>0.05）。接受阿帕替尼联合化疗患者耐受性良好,不良反应多为1或2级,主要表现为乏力、手足综合征、肝功能异常、低蛋白血症、贫血、食欲不振、血压升高和蛋白尿,其中最常见不良反应为乏力（80%）,其次为低蛋白血症（60%）、手足综合征（60%）和肝功能异常（60%）。结论：阿帕替尼联合化疗用于多线治疗进展的晚期乳腺癌患者仍有较好疗效,不良反应可耐受。