结核病控制应加强机构间协作

结核病控制工作是一个需要公共卫生机构与医疗机构密切协作的艰巨任务.然而,长期以来两者之间工作目标的不一致,已经影响了结核病人的转诊和有效管理.从组织学的角度探讨两者之间的关系的现状、现有结核病控制制度的作用有限性和组织创新的必要性,并对建立两者之间良好的关系,促进结核病控制工作提出了建议.     

结核病的再燃和控制新策略

由于忽视结核病控制工作、耐药菌株的出现、流动人口的增加以及艾滋病的流行导致了结核病在全球范围内再燃,中国是全球22个结核病高负担国家之一.世界卫生组织提出了控制结核病流行的有效新策略-DOTS.政府承诺、综合医院积极配合、归口管理、健康教育、加强培训等是确保DOTS实施的有效措施.     

流动人口结核病知识水平的定性调查

为了解农村流动人口结核病及相关知识的需要,在重庆市的渝中区和九龙坡区,进行了12组共73位农村流动人口参加的专题小组讨论。发现他们对结核病及相关知识的了解不够,结核病防治的意识较差。因此,加强健康教育是促进流动人口结核病控制必要的和可行的措施。     

流动人口结核病知识水平的定性调查

为了解农村流动人口结核病及相关知识的需要,在重庆市的渝中区和九龙坡区,进行了12组共73位农村流动人口参加的专题小组讨论.发现他们对结核病及相关知识的了解不够,结核病防治的意识较差.因此,加强健康教育是促进流动人口结核病控制必要的和可行的措施.     

从社会医学角度看我国结核病的防治

结核病目前在我国仍是一个重大的公共卫生问题。针对目前我国结核病防治过程中存在的一些问题以及DOTS策略的实施,从社会医学的角度思考认为,结核病的防治不仅仅是公共卫生问题,更是一个社会问题。传统的结核病防治思路有待商榷和完善,DOTS策略的实施应当紧密结合社会各因素,这为今后更好开展结核病防治工作提供了参考。     

乡村医生发现可疑结核病症状者研究综述

结核病仍然是严重危害我国人群健康的传染病,如何有效发现结核病病例是制约目前结核病控制项目是否成功的瓶颈。乡村医生在结核病病例发现方面具有至关重要的作用,如何提高其作用已成为研究的热点。本文对现阶段乡村医生发现可疑结核病症状者的方式及现状进行综述,并提出提高乡村医生在结核病病例发现中作用的措施。     

疼痛和不公正知觉的相互关系

结合认知神经科学的研究成果,梳理了疼痛和不公正知觉之间的关系,以及两者之间的中介变量和调节变量,并提出了可能的干预方案。疼痛和不公正知觉之间存在互为因果的关系。疼痛可以加剧个体的不公正知觉,不公正知觉被激活后,也会加剧个体的疼痛感,从而形成一个恶性循环。其中,情绪在两者之间起中介作用。此外,公正世界信念和医患关系可以调节两者之间的关系,医患关系还可以与情绪相互作用,再影响不公正知觉。所以,可对疼痛患者的情绪、信念以及与医护人员的关系进行干预,从而促进疗效,提高患者的生活质量。     

知识型员工工作压力与工作满意感状况及其关系研究

工作压力与工作满意感是影响工作行为绩效的重要心理因素。本研究探讨分析了知识型员工的工作压力与满意感状况及其两者之间的关系。研究结果表明 :①在工作压力构成中 ,知识型员工内源性工作压力较高 ,外源性工作压力较低 ;②知识型员工具有较高的工作满意感 ;③知识型员工的工作内源压力与工作满意感之间具有显著的正相关关系 ;④知识型员工的工作外源压力与工作满意感之间具有显著的负相关关系     

从社会医学角度看我国结核病的防治

结核病目前在我国仍是一个重大的公共卫生问题.针对目前我国结核病防治过程中存在的一些问题以及DOTS策略的实施,从社会医学的角度思考认为,结核病的防治不仅仅是公共卫生问题,更是一个社会问题.传统的结核病防治思路有待商榷和完善,DOTS策略的实施应当紧密结合社会各因素,这为今后更好开展结核病防治工作提供了参考.     

论结核病防治纳入医疗保险的可行性

我国是世界上22个结核病高负担国家之一.结核病是因病致贫、因病返贫的主要疾病之一.直接面视下短程督导化疗(DOTS)被认为是所有卫生干预项目中费用最低、效果最好的策略.对抗结核病需要横跨政府各部门的合作,只有共享资源、采用最佳规范和手段,才能有效控制结核病.以镇江市为例阐述医疗保险部门参与结核病防治的必要性和可行性.     

Pedestrians perceptions for utilization of pedestrian facilities – Delhi,India

Pedestrian fatalities from 2001 to 2009 in Delhi, India show that pedestrians have the largest share in total road fatalities. Though, facilities like pedestrian underpasses and overpasses are provided to cross the road at several locations, all too often pedestrians do not use them. This study was designed to analyze the pedestrians’ perceptions for underutilization of pedestrian facilities.Five hundred pedestrians were interviewed at seven different locations based on available pedestrian facilities such as zebra crossing, pedestrian underpasses and overpasses. Analysis of usage of these facilities showed that usage of underpasses and zebra crossing is less by female respondents. To know the safety and convenience perception of pedestrians with respect to a specific facility, ordinal logit model was used in this study. Results showed that convenience perception is statistically significant (at 95% CI) for the use of zebra crossings.The conclusions drawn from this study can be used to improve the state of pedestrian facilities in Delhi for prioritization of the facilities based on stated preferences.     

The role of attitudes in perceptions of bicycle facilities: A latent-class regression approach

While many professionals support bicycling for transportation to reduce traffic congestion and improve public health, many potential cyclists see the risks from traffic injuries as a major barrier. The purpose of this paper is to investigate the impact of bicycle facilities on perceptions of bikeability, and how these perceptions vary among different groups. Data comes from surveys (N = 2157) deployed in ten study neighborhoods as part of two research projects. Respondents were asked to rate a series of images of hypothetical roadways in terms of perceived comfort, perceived safety, and willingness to try bicycling. Latent-class regression was used to model these responses, with bicycle facility type and roadway characteristics as explanatory variables and sociodemographics and attitudinal factors (car preference, bike enjoyment, risk tolerance, and anti-exercise) as covariates for class membership. A recurring theme among the presented solutions is the emergence of two pro-bicycle classes - risk-embracing and risk-cautious - together with a pro-car class. Results indicate that the impact of protected bicycle facilities on perceptions are much higher for the pro-bike/risk-cautious group. The major implication of these findings is that there likely exists a sizeable segment of the population that, although perhaps just as interested in bicycling as the typical pro-bicycle class, is more cautious in their perceptions of comfort and safety. Those belonging to this subgroup generally view minimal facilities as much more unsafe and uncomfortable than their risk-accepting counterparts, but have comparable perceptions regarding high-quality protected bicycle facilities.     

Estimating preferences for different types of pedestrian crossing facilities

This paper reports the results of a study to understand the preferences of pedestrians towards using different types of road crossing facilities. A preliminary qualitative study found that people’s perceptions about crossing facilities are shaped by aspects such as safety, convenience, crossing time, accessibility, and personal security. The main quantitative study consisted of a stated preference survey implemented in three neighbourhoods in English cities near busy roads. Participants were first asked to indicate how comfortable they felt using different types of crossing facilities. Footbridges and underpasses were systematically rated below signalised crossings. Participants were then asked to choose between walking different additional times to use certain types of crossing facility or avoid crossing the road altogether. The analysis of the choices using a mixed logit model found that on average participants are willing to walk an additional 2.4 and 5.3 min to use a straight signalised crossing and avoid using footbridges and underpasses, respectively. Women and older participants were willing to walk longer additional times to avoid those facilities. Participants only avoid crossing the road if the additional time to use straight signalised crossings is at least 20.9 min. The estimated values for the willingness to walk were slightly smaller when using a conditional logit model. The study provides information that is useful for policy decisions about the frequency and the type of pedestrian facilities provided to cross busy roads.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Correlates of tobacco use among tuberculosis patients in South Africa: A brief report

This study examined tobacco use by tuberculosis (TB) patients through socio-health variables. The sample comprised 724 TB patients (mean age 37.1 years, SD = 11.3; males = 71.4%) receiving care from 40 primary health facilities across South Africa. They completed a questionnaire at baseline and also at a six-month follow-up. Multivariate logistic regression analysis using generalised estimation equation (GEE) modelling found that daily or almost daily tobacco use significantly reduced over time overall. In terms of socio-health variables, males and those with a comorbid chronic disease had had signficantly higher usage of tobacco over the observation period.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

Modeling the impact of traffic conditions and bicycle facilities on cyclists’ on-road stress levels

Past research efforts have shown that cyclists’ safety, stress, and comfort levels greatly affect the routes chosen by cyclists and cycling frequency. Some researchers have tried to categorize cyclists’ levels of traffic stress utilizing data that can be directly measured in the field, such as the number of motorized travel lanes, motorized vehicle travel speeds, and type of bicycle infrastructure. This research effort presents a novel approach: real-world, on-road measurements of physiological stress as cyclists travel across different types of bicycle facilities at peak and off-peak traffic times. By matching videos with stressful events, it was possible to observe the circumstances of those stressful events. The stress data was normalized, and the method was carefully validated by a detailed analysis of the stress measurements. Novel statistical results from a multi-subject study quantifies the impact of traffic conditions, intersections, and bicycle facilities on average stress levels.     

Emotional intelligence and health‐related quality of life in institutionalised Spanish older adults

This study explores the relationship between emotional intelligence (EI) and health‐related quality of life (HRQoL) in a sample of Spanish older adults who are institutionalised in long‐term care (LTC) facilities. One hundred fifteen institutionalised individuals (47.82% women; 88.3 ± 7.9 years) from southern Spain completed a set of questionnaires that included measures of EI, health and personality. Data were analysed via hierarchical regression. After controlling for personality and sociodemographic variables, the EI dimensions, emotional comprehension and emotional facilitation, accounted for part of the variance in several HRQoL facets. These dimensions could have an important role in the HRQoL of residents in LTC. Moreover, the use of a performance measure addresses the limitations of previous studies that have relied on self‐report measures. These aspects underscore the importance of the results of this study.     

Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.