农村居民对精神卫生问题认知状况调查

目的：了解农村居民对精神卫生问题的认知状况。方法对680名农村居民采用自制精神卫生问题认识及态度调查问卷进行测评分析。结果80．9％的居民通过周围的真实病例了解精神卫生知识,94．2％的居民知晓精神疾病临床症状为幻觉、冲动伤人,仅18．8％的居民认为冷淡孤僻、注意障碍也是精神病的症状。认为精神疾病不具传染性、可以治愈、不会遗传的比例分别为97．0％、85．5％、66．1％。＞80．6％的居民对与少年儿童有关的精神卫生知识了解较好,67．1％的居民认为精神病人受到歧视。文化程度越高的居民对精神卫生问题的认知越高。结论农村居民对精神卫生问题有不同程度的认知,文化程度越高,对精神卫生问题的认知水平越高。     

连续油管带底封分段环空加砂压裂技术在和田河气田的应用

和田河气田储层低孔低渗,水平井一般要通过分段改造来提高产能。早期的封隔器滑套分段工艺施工程序复杂,不利于后期作业。在分析喷砂射孔、喷射压裂、定位和转层基本原理的基础上,介绍了连续油管带底封分段环空加砂压裂技术的工艺特点和现场实施流程,并以一口试验井为例,介绍了该技术的工艺设计方法和现场实施情况。试验井用3天时间完成了8段的加砂压裂,压裂后日产气35.5×10^4m3,增产效果显著。     

Noise perception,heart rate and blood pressure in relation to aircraft noise in the vicinity of the Frankfurt airport

Summary The aim of this study was to evaluate subjective noise perception and objective parameters of circulation in the vicinity of the Frankfurt airport. Two areas were selected in which aircraft noise was the predominant source of noise (and was) created by planes induced by take off but not during landing. Data of residents living in the two areas were observed over a period of twelve weeks, one area being exposed to air traffic noise for three quarters of the given time, the other for one quarter of the time. Methods Fifty three volunteers (age 50–52 ± 15 y) monitored their blood pressure and heart rate over a period of three months by using an automatic device with digitized readings. They also protocolled their own subjective perception of noise and sleep quality. Thirty one probands were living West of the airport (West group) and were exposed to a nocturnal equivalent continuous air traffic noise level of L_eq(3) = 50 dB(A) outside, during flight direction 25 to the West. Twenty two probands were living East of the airport (East group) and were exposed to L_eq(3) = 50 dB (A) during flight direction 07 to the East. During the opposite flight directions air craft noise corresponded to L_eq(3) = 40 dB(A) in both areas. Frankfurt airport operates direction 25 for about 75% of the time on average and direction 07 for 25% of the time. Results The average blood pressure was significantly higher in the West group with higher noise exposure. Morning systolic blood pressure was 10 mmHg and diastolic pressure 8 mmHg higher in the West group. Throughout the observation period, the East group showed a parallel between daily changes in noise and subjective noise perception. In the West group such a parallel did not appear. This reaction was considered to be the consequence of the high noise exposure of the West group. Conclusions It is concluded that a population exposed to a nocturnal equivalent continuous air traffic noise level of L_eq(3) = 50 dB(A) for three quarters of a given time has a higher average blood pressure compared to a population exposed to the same equal energy noise level for only one quarter of the time. Within the East group a parallel between noise exposure and noise perception was observed, while in the West group this parallel did not appear. The difference is considered to be the consequence of higher noise stress levels in the West group. The data are in accordance with recent epidemiological studies and indicate that a nocturnal aircraft noise of L_eq(3) = 50 dB(A) can have negative effects on subjective noise perception and on objective parameters of circulation.     

Relationships in pain: the experience of relationships to people living with chronic pain in rural areas

The aim of the study was to develop new understanding of the lived experience of relationships for rural people living with chronic pain. Rural residents have greater difficulty accessing health services and providers. This is especially important to those living with chronic pain who often find themselves isolated from professionals who could potentially offer support. A phenomenological study with seven participants who had experienced chronic non-malignant pain for 2-29 years (Mean = 13) was recruited via a number of approaches and data analyzed using van Manen's framework. The themes that emerged from the analysis were as follows: pain as silence; privacy as a way of protection; no place out here to get support; and dealing with health-care professionals who do not understand. Lack of specialist services and support in rural areas means people with chronic pain are placed in even more vulnerable situations. Nurses remain at the forefront of service delivery in rural areas; hence, their role in management of people with chronic pain is vital in supporting them to maintain meaningful contact with others, including health professionals.     

An interprofessional programme to culturally sensitise students to the needs of patients and realities of practice in rural areas

The University of North Dakota programme, Students/residents Experiences And Rotations in Community Health (SEARCH), was implemented to address recruitment and retention problems and stereotypes associated with practicing in rural areas by providing an opportunity for health profession students to gain experience living and practicing in rural areas and observing interprofessional practice. Each health profession student in the programme (n = 181) from 2001 to 2011 (excluding 2009) kept a four-week journal detailing daily or weekly interactions, general thoughts, and experiences. Students who participated were from medical, psychology, dental, social work, nurse practitioner, and physician assistant professions. Results were grouped into three major themes around whether the experience increased their knowledge of healthcare issues in rural areas in North Dakota, increased their knowledge about interprofessional teams, and expanded their rural awareness. Overall, students valued this interprofessional experience, learned how to work in collaborative teams, and reported having a better understanding of the needs and problems in rural healthcare. Recruitment and retention of healthcare professionals in rural healthcare exhibit many challenges. The SEARCH programme has helped to alleviate some of these challenges; however, continued support for these programmes is necessary to sustain the delivery of interprofessional healthcare in rural areas.     

The evaluation of an online orientation to rural mental health practice in Australia

The aim of this study was to develop and evaluate an online, interprofessional education programme for clinicians commencing work in rural mental health services in New South Wales, Australia. Twenty-eight participants, including nurses, psychologists, social workers and occupational therapists, completed a 24-week education programme (Introduction to Rural Mental Health Practice programme) that orientated clinicians to working in rural settings. The online programme included an orientation to online learning and clinical skills such as risk assessment, therapeutic communication and de-escalation skills applied in rural settings. Twenty-four participants provided pre- and post-evaluation responses that were matched and analysed using paired t-tests to identify any significant differences in mean scores across the domains of interest. Fifty per cent (n= 13) of participants had a background in nursing and 49% were allied health clinicians (psychologists, social workers and occupational therapists). Statistically significant improvements (P < 0.05) were detected in participant confidence in responding to common mental health problems, knowledge about the role of different services in rural mental health care, perceived safety of work and perceived self-efficacy in dealing with challenging or aggressive behaviours. The Introduction to Rural Mental Health Practice programme was successful in orienting clinicians to rural mental health but the small sample size highlights the need to evaluate the programme with a larger cohort of rural clinicians. The attrition at the early stages of the study highlights significant challenges in the retention of rural clinicians in online education programmes. Factors that promoted participation and retention included the provision of study leave and orientation to the online environment.     

Use of Psychiatric Nurse Practitioner Students to Provide Services in Rural School-Based Health Clinics

Seventy to eighty percent of youth receiving mental health services receive these services in schools. Nurses have been identified as the second major provider of mental health services in the schools, yet little has been written about the role of psychiatric mental health nurses in rural school-based clinics or how they were trained in this role. This paper describes an innovative clinical experience for graduate students to shape the role of advanced psychiatric mental health nurses in rural, minority schools using evidence-based approaches. The authors describe the context, theoretical frameworks, role development, outcomes, and lessons learned.     

Nurse practitioners: a comparison of rural-urban practice patterns and willingness to serve in underserved areas

PURPOSE: To determine nurse practitioners' (NPs) practice patterns and willingness to practice in underserved areas in both rural and urban settings in a largely rural state. DATA SOURCES: A census of all NPs holding a Pennsylvania license and providing addresses in Pennsylvania or one of the contiguous states was conducted in 1996. The ZIP codes of practice sites were matched with 1990 census data. CONCLUSIONS: Nurse practitioners in rural areas are more likely than their urban counterparts to provide primary care in primary care practice settings, they see more patients per week, and they are more likely to be the principal provider of care for a higher percentage of their patients. Experience with managed care contracts is greater for urban NPs as is their willingness to practice in urban underserved areas. Rural NPs were more willing to practice in rural underserved areas than their urban counterparts. IMPLICATIONS FOR PRACTICE: Access to primary care continues to be a concern in rural areas. The increasing market penetration of managed care and the deficit of primary care providers in rural environments may lead to increased opportunities for NPs in the rural health care delivery system.     

Prevalence and characteristics of patients with risky alcohol consumption presenting to emergency departments in rural Australia

Objective: This study measures the prevalence of problematic alcohol consumption in patients of EDs in rural areas of Australia, relative to the general population in the same rural communities. It also identifies the characteristics associated with risky drinking in rural ED patients. Methods: Surveys containing the Alcohol Use Disorders Identification Test (AUDIT) and questions corresponding to the 2001 Australian Alcohol Guidelines were completed by 1056 patients presenting to five EDs in rural areas of New South Wales, and 756 residents of the same five communities. Results: Relative to the general community, ED patients were statistically significantly more likely to engage in risky alcohol consumption according to the AUDIT (39% vs 20%), alcohol consumption posing a high risk of short‐term harm (26% vs 18%) and alcohol consumption posing a high risk of long‐term harm (7% vs 3%). Although being aged under 40 years of age, being unmarried, not completing school and being assigned less urgent triage categories were associated with risky alcohol use among ED patients, rates of risky consumption were high across all patient subgroups. Conclusions: Risky drinking, across a number of measures, is overrepresented in patients of rural Australian EDs relative to the general community, and this type of consumption is not limited to certain subgroups of patients. There is a need for interventions that address both heavy single occasion drinking and excessive regular consumption in patients of rural Australian EDs, with universal interventions recommended rather than targeted programmes.     

基于TOPSIS法的四川省市级城市基层公共卫生服务中社区居民感受度的横断面调查

目的了解四川省市级城市基层公共卫生服务中心社区居民感受度,为进一步加强薄弱地区措施提供参考。方法采用分层系统抽样法,借助四川省基本公共卫生服务监管平台,在21个市级的五类重点人群档案中分别等距抽取40份,即每个市级抽取200人作为调查对象。采用电话调查方法,调查居民知晓率、满意度、依从性,应用TOPSIS法综合评价四川省市级城市基层公共卫生服务中社区居民感受度,并通过聚类分档进行评价。结果共调查接受过基层医疗卫生机构健康管理的社区居民4 200人。四川省基层公共卫生服务社区居民服务知晓率为76.31%,健康知识知晓率为69.45%,服务便利性的满意率为69.42%,技术水平的满意率为67.96%,服务态度的满意率为69.74%,服务对改善健康的满意率为69.13%,继续接受服务的意愿率为68.17%,健康生活方式建议依从率为68.31%,服药依从率为85.14%。21个市级的Cj值平均为0.523 6,序号4的市级Cj值最高为0.751 9,序号10的市级Cj值最低为0.276 3。对评价结果进行聚类分档结果显示,不同档次间差异均无统计学意义。结论四川省21个市级基层公共卫生服务中心社区居民感受度各不相同。应加强对薄弱地区的措施,缩小各市级城市间的差距,切实提高社区居民的感受度。     

The effect of a single visit to a health coach on perceived health in 50-year old residents in a high-income country – a randomised controlled trial

ObjectiveTo evaluate the one-year-effect of a single visit to a health coach on perceived health and exercise level in 50-year-old citizens.DesignOne factor design randomised controlled trial.SettingParticipants were randomly selected from the Swedish Population Register.Subjects50-year-old residents of the town of Alingsås, Sweden (n = 105).InterventionThe intervention group (n = 52) received a single one-hour visit to a health coach. The control group (n = 53) received no intervention.Main outcome measuresChange over 12 months in the SF-36 dimensions physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health, physical component summary and mental component summary. Reported health transition at follow-up. Change in exercise level.ResultsThe control group changed their perceived health more favourable than the intervention group in the following dimensions of the SF-36; general health (p = 0.0055–0.025), role-emotional (p = 0.034–0.040) and mental component summary (p = 0.033–0.073).ConclusionA single visit to a health coach does not improve perceived health or exercise-level in 50-year-old citizens. On the contrary it may make perceived health worse.

Key points

• Research on health coaching has emerged in the last 20 years, but is diverse and the characteristics of a successful health coaching intervention are still unknown.
• There is a lack of randomised controlled trials evaluating long-term effectiveness of health coaching.
• This randomised controlled trial concludes that a single visit to a health coach does not improve, but rather impairs, perceived health in 50-year olds.

     

新型农村合作医疗带给乡镇卫生院护理工作的机遇与挑战

新型农村合作医疗制度启动两年来，为农民解决了看病难、看病贵、因病致贫的难题，给乡镇卫生院护理工作的发展带来了机遇。目前乡镇卫生院护理人员配置不足，医疗环境欠佳，卫生院病源结构发生了变化，护士素质与形势的发展不相适应。因此，乡镇卫生院需要健全各项规章制度，提高护理人员的基本素质，改善医疗环境，加大对护理人员的资金投入，加强对病人的健康教育，真正为群众提供安全、有效、方便、廉价的医疗卫生服务。