初探健康管理与我国糖尿病的预防与控制

近年来,我国糖尿病发展的势头迅速,成为糖尿病患病率增长最快的国家之一,给社会和经济带来了巨大的负担.文章针对我国的糖尿病的流行现状及其带来的经济负担,分析了实施糖尿病健康管理的现实意义,并借鉴美国健康管理的经验,构思了我国社区的促进糖尿病防制的健康管理模式.     

糖尿病与乳腺癌关系研究进展

近年来随着生活水平的提高,饮食结构的改变,糖尿病的发病率不断升高,其并发症严重危害人们的健康.对于女性来说,乳腺癌发病率已上升为危害女性健康的首位恶性肿瘤,给女性带来了严重的心理压力.糖尿病与癌症相关性研究逐渐引起重视.有研究表明,糖尿病会增加乳腺癌的发病率,但也有研究表明二者之间的关系存在争议,所以需要进一步的流行病学调查研究.本文对近年来关于糖尿病与乳腺癌关系的流行病学调查以及糖尿病与乳腺癌之间可能的作用机制作一综述.     

糖尿病防治中适度医疗干预与人体自然力的协调统一

以糖尿病为代表的慢性代谢性疾病近年来在我国发病率呈持续增高趋势。如何有效预防、控制糖尿病不仅是医疗问题,也是社会问题。由于不健康的生活方式,导致在现有的临床治疗措施下,糖尿病的发生与进展依然未能得到有效控制。在糖尿病的防治中,已有大量证据证实生活方式干预能够有效减少、减轻糖尿病的发生,延缓自然病程。倡导以有指导的健康生活方式为主体的人体自然力扶持,以此作为糖尿病防治的基石,并与适度的临床医疗干预互相协调,共同构成现代社会的防治措施。     

系统思维在糖尿病防治中的应用

随着人们生活水平的提高,糖尿病日益成为威胁人类健康的主要疾病。在整体观的指导下,人们对于糖尿病采取综合全面的治疗。同时,整体优化的原则在防治中被充分运用。近年来,我国建立了2型糖尿病发病因素分析方式与概率预测模型。     

系统思维在糖尿病防治中的应用

随着人们生活水平的提高,糖尿病日益成为威胁人类健康的主要疾病.在整体观的指导下,人们对于糖尿病采取综合全面的治疗.同时,整体优化的原则在防治中被充分运用.近年来,我国建立了2型糖尿病发病因素分析方式与概率预测模型.     

健康教育及分层管理在糖尿病足病防治中的作用——3年随访观察

为探讨早期糖尿病足病健康教育及分层管理措施对糖尿病患者足病的防治作用,对初诊糖尿病患者进行了足部风险评估,分为正常、低危、中危、高危不同程度糖尿病足病风险人群,然后对不同风险人群组实施系统性、长期性兼个体化的糖尿病足病防治健康教育和分层管理3年.研究发现,糖尿病足病发生发展状况明显改善,与糖尿病足病相关的溃疡复发率相对风险降低52.30％,再住院率相对风险降低43.28％,溃疡发生率降低61.99％.因此,早期糖尿病足病健康教育和分层管理的防治策略可提高患者对足部的自我管理和护理能力,对糖尿病足病的发生发展起到了有效的防治作用.     

健康教育及分层管理在糖尿病足病防治中的作用——3年随访观察

为探讨早期糖尿病足病健康教育及分层管理措施对糖尿病患者足病的防治作用,对初诊糖尿病患者进行了足部风险评估,分为正常、低危、中危、高危不同程度糖尿病足病风险人群,然后对不同风险人群组实施系统性、长期性兼个体化的糖尿病足病防治健康教育和分层管理3年.研究发现,糖尿病足病发生发展状况明显改善,与糖尿病足病相关的溃疡复发率相对风险降低52.30％,再住院率相对风险降低43.28％,溃疡发生率降低61.99％.因此,早期糖尿病足病健康教育和分层管理的防治策略可提高患者对足部的自我管理和护理能力,对糖尿病足病的发生发展起到了有效的防治作用.     

社区卫生服务与其高端医疗资源共享体系创新

从公共管理新视角,重点探讨城市社区卫生服务与其高端医疗资源基于区域健康信息互操作的发展战略,旨在为促进我国医疗卫生体制改革,创新提出"新型和谐的城市卫生服务体系",实现资源共享,适应我国社会经济发展和居民健康需求,为政府管理及其公共政策提供信息支持服务.     

四种糖尿病防治指南的比较与分析

《中国糖尿病防治指南》的制定对我国糖尿病防治事业来说是具有里程碑式的意义。我国终于有了自己的糖尿病防治指南。现今各国糖尿病学界不同组织几乎制定了各自的防治指南。对来自国际糖尿病联盟、美国糖尿病学会、亚洲-太平洋地区2型糖尿病政策组以及中华医学会糖尿病学分会等组织所制定的糖尿病防治指南,在出版形式、内容和适用性以及代表性等不同的侧面进行了比较。总体情况看国际糖尿病联盟按不同资源水平制定了不同的防治标准,判定标准明确,适用性较广,但指南的直观可读性较差;美国糖尿病学会的指南以内容丰富、全面著称,适用于较高层次的专业工作者,但稍欠可推广性;亚州-太平洋2型糖尿病政策组的指南简明、易懂,可读性佳,比较适合东南亚人群;《中国糖尿病防治指南》内容全面、精简概括,符合中国国情。     

再论烟草经济与健康经济：增设烟草健康附加税势在必行

再论烟草经济与健康经济──增设烟草健康附加税势在必行湖北省卫生厅（４ｓ００７７）阮小明我国作为世界头号种烟、产烟和吸烟大国，虽然给国家带来巨额的利税收入，却对人们的健康造成了日益严重的危害。在烟草经济和健康经济到底孰轻孰重的问题上，世界各国都开始了积...     

糖尿病教育在2型糖尿病防控工作中的重要性

近年来,由于糖尿病的高患病率、高致残率和高死亡率带来沉重的社会和经济负担。预防糖尿病发生、改善糖尿病患者现况等均提示推广普及糖尿病教育具有重要意义。通过糖尿病教育可以全面改善患者临床控制指标、知识水平、自我管理水平和自我效能水平,且从卫生经济学角度分析显示其投入相对较小的成本即可达到良好的效果和效用,因而在糖尿病防控体...     

Cultural issues in disease management for chinese americans with type 2 diabetes

The purpose of this study is to highlight culturally unique experiences and responses to type 2 diabetes among Chinese immigrant families. Patient and spouse narratives from 16 different families were elicited in a series of group interviews on this topic. Using interpretive phenomenology, 5 primary cultural considerations in diabetes management emerged from the narratives: (1) conceptualization of diabetes, illness and health, (2) significance and meaning of food, (3) perceptions of Chinese and Western medicines, (4) exercise and physical activity, and (5) effects of the disease on family dynamics. The relation of these cultural considerations to an interdependent view of the self, collectivistic social orientation, Chinese cultural beliefs and norms, and acculturation processes are discussed. Clinical recommendations for culturally appropriate disease management strategies are outlined.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research

Diabetes is a chronic condition that affects both members of a couple. However, relatively few studies have focused on the entire couple system as the unit of observation when examining the psychosocial impact of this disease. This narrative review examines the literature between 1980 and 2010 that uses the couple as the unit of observation. A total of 49 articles were identified for review. Articles were grouped by their central themes or outcomes: (1) sexual functioning, (2) relationship adjustment and support, (3) culture and spirituality, (4) treatment/education programs, and (5) diabetes as a risk factor. Research and clinical implications such as increasing the utilization of dyadic analytical strategies and the importance of assessing illness burden from each partners’ perspective are discussed. Identified benefits of incorporating the couple dyad for future research and clinical practice included: (1) understanding the influence of variables such as a non-diabetic partner and gender have on diabetes adjustment and management, (2) the role disease severity and management of diabetes by the partner living with diabetes has on spousal support and non-diabetic partner emotional wellbeing, (3) the interdependent nature of couple outcomes in the areas of adjustment to sexual dysfunction, perceived illness burden, and couple satisfaction, as well as, (4) disease as both an individual and a shared experience among couples.     

哮喘教育和管理工作中的一些新的启示与思考

简要叙述了目前哮喘防治中存在的问题,提出必须彻底转变哮喘防控模式,简单介绍了我们自己的哮喘教育和管理的具体做法及其效果,最后就哮喘的防控和管理提出一些值得思考的问题,包括建立和谐医患关系,减轻医疗经济负担,建立新型疾病防控模式和医疗服务体系等。     

Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.     

Family climate of routine asthma care: associating perceived burden and mother-child interaction patterns to child well-being

This preliminary report links the literatures on family asthma management practices and on the characteristics of family interaction patterns thought to influence children's adjustment to a chronic physical illness. Specifically, this study of 60 families with a child with asthma examined the extent to which perceived burden of routine asthma care affected child mental health via its influence on parent-child interaction patterns. Mothers completed a measure of asthma management routine burden, mother and child were observed in a 15-minute interaction task, and children completed measures of child anxiety and asthma quality of life (QOL). Perceived routine burden significantly predicted child anxiety and QOL through its effect on mother-child rejection/criticism. The same pattern did not hold for mother intrusiveness/control. The results are discussed in terms of how overall family climate and regulation of routines affects child well-being. Implications for clinical practice and limitations of the study are provided.     

Patient and health care provider views of depressive symptoms and diabetes in American Samoa

High Type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, 6 focus groups were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen health care staff interviews were conducted to gain insight into diabetes care in American Samoa. Focus groups and health care staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and health care staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural stigma associated with depression and the importance of establishing rapport before discussing it. Health care providers in American Samoa need training to increase their awareness of depressive symptoms' negative impact on diabetes management in patients who screen positive for depression. All providers must approach the subject in a supportive context after establishing rapport. This information will be used for cultural translation of a community health worker and primary care-coordinated intervention for adults with diabetes in American Samoa, with the goal of creating an effective and sustainable intervention.     

网络心理教育在1型糖尿病青少年患者自我管理中的作用

探讨网络心理健康教育在1型糖尿病青少年患者中的实证效果,选取1型糖尿病青少年100例,随机分成对照组和干预组各50例.干预组实施网络健康教育,通过网络视频,讲授糖尿病的相关知识,进行定期随访;对照组采用常规健康管理模式,只发放糖尿病知识宣传册由1型糖尿青少年患者和家属自己学习.干预组糖尿病青少年患者自我管理、生活质量、心理状态情况有明显改善,干预后糖化血红蛋白水平下降,对照组上述指标无明显改变.网络心理教育课程是一种新型的有效的健康教育管理模式,能够让1型糖尿病青少年患者病情稳定,同时减少并发症的发生.     

Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes

Family context is thought to influence chronic disease management but few studies have longitudinally examined these relationships. Research on families and chronic illness has focused almost exclusively on European American families. In this prospective study we tested a multidimensional model of family influence on disease management in type 2 diabetes in a bi-ethnic sample of European Americans and Latinos. Specifically, we tested how baseline family characteristics (structure, world view, and emotion management) predicted change in disease management over one year in 104 European American and 57 Latino patients with type 2 diabetes. We found that emotion management predicted change in disease management in both groups of patients as hypothesized, while family world view predicted change in both ethnic groups but in the predicted direction only for European Americans. Examining family context within ethnic groups is required to elucidate unique cultural patterns. Attending to culturally unique interpretations of constructs and measures is warranted. The import of family emotion management, specifically conflict resolution, in disease management deserves further study to support clinical intervention development. Examining multiple domains of family life and multidimensional health outcomes strengthens our capacity to develop theory about family contexts and individual health.