天津市脑卒中综合防控策略研讨会通知

正由天津市卫生计生委、天津医科大学联合举办的天津市脑卒中综合防控策略研讨会拟定于2017年12月2日在天津医科大学研究生院精术厅召开。会议旨在推进脑卒中高危人群筛查和脑卒中综合防控,对脑卒中筛查与防治策略、脑卒中流行病学特征与趋势、膳食营养与脑血管病防治、预防脑卒中民生工程工作进展、脑卒中临床治疗进行学术讲座。1.征文内容(1)论著、综述类:脑卒中预防、治疗、预后、健康管理,脑卒中防控政策研究,脑卒中研究国内外进展及动向,     

脑卒中精准康复

<正>随着医疗技术的发展和脑卒中防控政策的实施,脑卒中流行病学特征逐渐变化,过去10年间脑卒中病死率在发展中国家和发达国家分别下降20%和37%~([1])。流行病学调查显示,脑卒中病死率已降至疾病谱第3位,但其病残率逐渐升高,目前已高居疾病谱首位~([2]),约50%以上脑卒中患者预后重残,生活不能自理~([2-3])。我国是脑卒中高发国家,近年其发病率以每年8.7%的速度递增,是国民病死和病残的首要原因~([4])。脑卒中后病残带来的社会和家     

COVID-19常态化防控下反弹期脑卒中全流程管理

目的 探讨新型冠状病毒肺炎（COVID-19）常态化防控下反弹期的卒中多学科协助、适宜性绿色通道建设以及脑心健康管理等工作，以达到提高卒中救治效率及效果。方法通过加强防控知识学习，细化卒中质量体系建设并严格考核标准，充分建立适宜的绿色通道建设，张弛有度的缓冲病区管理模式以及深化脑心健康管理师在卒中管理中的作用为出发点，建立完善的脑卒中全流程管理模式。结果通过有效管理，疫情反弹状态下的卒中绿色通道时间把控基本达到疫前水平，COVID-19核酸检测时间在 30 min~2 h，防控知识和卒中知识显著提高。结论通过改善方法，脑卒中病人能得到及时高效的救治，采取有效防控措施能有效避免人群交叉感染。     

《中国卒中杂志》关于举办“脑卒中规范化管理培训项目”的第一轮通知

在中国,脑卒中已跃居为死亡原因的第二位及致残原因的第一位,成为严重威胁我国国民生活质量的一个灾难性疾病,故对其加大防治力度是非常必要的。目前,经过全世界脑卒中学者及其他学科专家的共同努力,出台了脑卒中的治疗规范。但在我国的临床实践中,由于各级医师知识层次不同,对于卒中的规范化治疗理解不同。为了在全国推广基于循证医学指导下的脑卒中规范管理,《中国卒中杂志》编辑部将举办脑卒中系列培训班,邀请掌握最前沿信息、具有丰富临床经验的著名专家为您诠释卒中的规范化管理以及各种特殊治疗的规范化管理的真谛。     

《中国卒中杂志》关于举办“脑卒中规范化管理培训项目”的第一轮通知

在中国,脑卒中已跃居为死亡原因的第二位及致残原因的第一位,成为严重威胁我国国民生活质量的一个灾难性疾病,故对其加大防治力度是非常必要的。目前,经过全世界脑卒中学者及其他学科专家的共同努力,出台了脑卒中的治疗规范。但在我国的临床实践中,由于各级医师知识层次不同,对于卒中的规范化治疗理解不同。为了在全国推广基于循证医学指导下的脑卒中规范管理,《中国卒中杂志》编辑部将举办脑卒中系列培训班,邀请掌握最前沿信息、具有丰富临床经验的著名专家为您诠释卒中的规范化管理以及各种特殊治疗的规范化管理的真谛。     

“脑卒中规范化管理培训项目”的第二轮通知

在中国,脑卒中已跃居为死亡原因的第二位及致残原因的第一位,成为严重威胁我国国民生活质量的一个灾难性疾病,故对其加大防治力度是非常必要的。目前,经过全世界脑卒中学者及其他学科专家的共同努力,出台了脑卒中的治疗规范。但在我国的临床实践中,由于各级医师知识层次不同,对于卒中的规范化治疗理解不同。为了在全国推广基于循证医学指导下的脑卒中规范管理,《中国卒中杂志》编辑部将举办脑卒中系列培     

“脑卒中规范化管理培训项目”第一轮通知

在中国,脑卒中已跃居为死亡的第二位原因及致残的第一位原因,因此,脑卒中已成为严重威胁我国国民生活质量的一个灾难性疾病,加大防治力度是非常必要的。目前,经过全世界脑卒中学者及其他学科专家的共同努力,在脑卒中的治疗方面已取得了巨大进步,脑卒中的治疗也有了自己的规范。但在我国的临床实践中,由于各级医师知识层次不同,对于卒中的规范化治疗     

脑卒中一级预防与健康教育

目前,脑卒中已成为影响我国居民健康的主要威胁,开展一级预防势在必行。健康教育是脑卒中一级预防的重要方式,包括健康生活方式、主要脑卒中危险因素和脑卒中预警征象的教育。众多研究表明,健康教育能够提高公众对疾病的认识程度,增加一级预防依从性,降低脑卒中发生率。专业医疗机构和医务工作者应成为健康教育的主要力量。     

血管内支架形成术在治疗颈动脉狭窄中的应用探讨与展望

脑卒中是人类死亡的三大病因之一,在我国其已成为第一大致残和第三致死病因。同时,其高发病率、高致残率、高病死率和高复发率是当代医学特别是神经科学亟须解决的课题。现代医学已证实约1/3的脑卒中是由颈动脉狭窄、栓子脱落所致。因此,治疗颈动脉狭窄已成为预防缺血性脑卒中的重要措施之一。随着人类对该疾病认识的不断深入和     

2015～2019年烟台市脑卒中高危人群危险因素暴露情况对比分析

目的 分析2015～2019年烟台市东厅街道社区卫生服务中心居民的脑卒中高危人群危险因素暴露变化情况,了解社区脑卒中防控项目成效,为烟台地区脑卒中筛查防治提供依据,指导今后的筛查防治工作.方法 根据国家卫生健康委脑卒中高危人群筛查和干预项目的筛选标准,采用整群抽样方法对2015、2017及2019年烟台市筛查点40岁以...     

The P15 – a multinational assessment battery for collecting data on health indicators relevant to adults with intellectual disabilities

Background Health disparities between adults with intellectual disabilities (ID) and the general population have been well documented but, to date, no dedicated assessment battery for measuring health disparity has been available. This paper reports on the development and testing of a multinational assessment battery for collecting data on a range of health indicators relevant to adults with ID. Methods An assessment battery (the P15) was developed following piloting, and administered to samples of adults with ID, in 14 EU countries. Samples were neither random, nor representative of the countries from which they were drawn. However, within the local health administration areas selected in each country, efforts were made to ensure samples were broadly representative of the typical living circumstances, ages and ability levels of the administrative population of adults with ID. The total sample comprised 1269 adults with ID, of whom 49% were female. The mean age was 41 years (range 19 to 90). Results Overall, feasibility, internal consistency and face validity of the P15 was acceptable. Conclusions With some refinement the P15 could be useful for collecting data on health indicators known to be particularly important for adults with ID. It is useable in a range of countries and has the potential to highlight health inequity for adults with ID at a national or local level. Larger scale epidemiological studies are needed to exploit the potential of the P15 to address health inequity in this group.     

The mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults: A short report

Objectives: Limited health literacy has been shown to be associated with poor health status. However, research to date has not elucidated the factors that mediate the relationship between low literacy and poor health outcomes. The purpose of this study was to examine the mediating effect of self-efficacy on the relationship between health literacy and health status in Korean older adults.

Method: A cross-sectional study of 103 community-dwelling Korean older adults was conducted from June 2007 to September 2007.

Results: The study found that low health literacy was associated with poorer physical and mental health status, and the effect of health literacy on physical and mental health status was mediated through self-efficacy.

Conclusion: The study suggests that interventions to improve the delivery of care for older adults with low health literacy need to include not only improving the readability of health-related materials, but also enhancing the self-efficacy of each individual.     

The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.     

Health screening for people with intellectual disability: the New Zealand experience

People with intellectual disability have considerable health needs and variable health care. The introduction of annual health screens for IHC residents in New Zealand resulted in some 73% of screened people requiring follow-up interventions. The introduction of the health screens raised a number of issues for management, staff, health professionals and clients who might subsequently be involved in an exercise of this type and magnitude. The importance of applying principles of management promoted by proponents of total quality management has been apparent throughout the whole exercise.     

Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample

OBJECTIVE: Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as activities of daily living). METHOD: The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchment Area Program. Interviews included criterion-based diagnosis of depression, assessment of cognitive status and standard survey questions on function. RESULTS: Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression. CONCLUSION: Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.     

Cost estimation of a health-check intervention for adults with intellectual disabilities in the UK

Background   High rates of health needs among adults with intellectual disabilities flag the need for information about the economic consequences of strategies to identify and address unmet needs. Health-check interventions are one such strategy, and have been demonstrated to effect health gains over the following 12-month period. However, little is known about their effects on service use and costs, and hence how affordable such interventions are.
Methods   We examined service use patterns and costs over a 12-month period for 50 adult participants with intellectual disabilities who received a health-check intervention and 50 individually matched control participants who received standard care only.
Results   The health-check intervention was cheap, and it did not have associated higher costs in terms of service usage. Indeed, mean cost of care for the adults who received standard care only was greater than for the adults who received the health-check intervention. The higher costs were due to differences in unpaid carer support costs.
Conclusion   This is the first study to report the associated service use, and costs of a health-check intervention to improve the health of adults with intellectual disabilities and reduce health inequalities. Results suggest this intervention is cheap and affordable compared with standard care, supporting clinical outcome evidence for its introduction into health care policy and implementation. However, further research is needed to confirm this finding with a larger sample.     

The development of the Perth Charter for the Promotion of Mental Health and Wellbeing

The Perth Charter for the Promotion of Mental Health and Wellbeing is an initiative of the organizing committee of the 7th World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioural Disorders. An iterative feedback process was used to develop and revise the charter principles in consultation with health professionals. A final online survey showed strong support for each of the eight principles, which were rated ‘essential’ (as distinct from ‘desirable’ or ‘not relevant’) by 73–96% of respondents. The principles were supported most strongly by practitioners, of whom 85–100% classified each as ‘essential’. It is hoped that mental health professionals find the Charter useful for advocating for greater resource allocation in their jurisdictions to mental health, in general and to mental health promotion in particular.     

Reassessing Treatment Environments After Two Decades: Client and Staff Perceptions of an Italian Community Mental Health Service Environment, Then and Now

Community-based psychiatric services and programs developed in accordance with the 1978 Italian psychiatric reform have now been in operation for a quarter of a century. The paper presents the results of a study in which three treatment environments of South-Verona, i.e. a general hospital psychiatric ward, a community mental health center (CMHC) and two residential facilities have been investigated using the Ward Atmosphere Scale (WAS) and the Community Oriented Programs Environment Scale (COPES). Staff and patient ratings have been collected in the three environments thus allowing comparisons between respondents and settings. For the ward and the CMHC, whose staff had already been interviewed almost twenty years before, a comparison between studies was also possible. Results seem to show that original policies, attitudes and staff commitment have successfully survived the passage of time with only minor adjustments and that the single-staff module of South-Verona may have effectively contributed in this respect.     

Clinic-Level Process of Care for Depression in Primary Care Settings

Multi-component models for improving depression care target primary care (PC) clinics, yet few studies document usual clinic-level care. This case comparison assessed usual processes for depression management at 10 PC clinics. Although general similarities existed across sites, clinics varied on specific processes, barriers, and adherence to practice guidelines. Screening for depression conformed to guidelines. Processes for assessment, diagnosis, treatment, and follow-up varied to different degrees in different clinics. This individuality of usual care should be defined prior to quality improvement interventions, and may provide insights for introducing or tailoring changes, as well as improving interpretation of evaluation results. Presentation  This work has been presented as a poster of the same title at the Annual Meeting of Academy Health in Orlando, FL, June 2007.