重庆市城乡卫生资源配置现状及对策研究

城镇化是当前的热点问题，而城镇化中的卫生问题引起了学界的广泛关注。重庆是西部唯一的直辖市和国家中心城市，自身具有大城市带大农村的典型城乡二元结构特征，对重庆市城镇化过程中城乡卫生资源配置现状及对策的研究对全国其他省市具有借鉴意义。本文运用文献查询和专家咨询法，对主要卫生指标进行对比分析，运用基尼系数评价城乡、区域间卫生资源配置的公平性，针对存在的主要问题，提出建议。     

21世纪健康城市展望--上海的挑战

城市化为更好的生活与健康提供了前景.我们开始注意到由于未持续发展模式所造成的负面影响.全球化快速的变化使许多城市在物资、服务与人口流动上造成了困难,不论他们是旅游人员,农村流动人口,还是被迫离家的群体或难民.未来,保证城市的健康将成为保证整个人类社会健康的关键.为迎接21世纪的挑战,健康城市应提到全球健康的议程中,这一议程可称为"健康的城市化",包括五个行动领域.对于上海来说,这是个很好去参与"健康的城市化"目标的时机.     

A BEHAVIORAL SYSTEM FOR ASSESSING AND TRAINING CARDIOPULMONARY RESUSCITATION SKILLS AMONG EMERGENCY MEDICAL TECHNICIANS

Many deaths from cardiopulmonary arrest can be prevented by the prompt and effective administration of cardiopulmonary resuscitation (CPR). In this study, we examined the standard training program for teaching CPR to emergency medical technicians (EMTs). We developed an alternative experimental program whereby the behaviors involved in CPR were assessed easily and in greater detail. This assessment provided the basis for a system in which effective CPR skills were reinforced and problems were corrected. Subjects who were trained in CPR according to this experimental program performed more effectively than subjects in the standard program. In addition, retention (maintenance) measures indicated that experimental subjects continued to perform well, often more effectively than professionally employed EMTs.     

EFFECTS OF COMMUNITY-BASED,VIDEOTAPE, AND FLASH CARD INSTRUCTION OF COMMUNITY-REFERENCED SIGHT WORDS ON STUDENTS WITH MENTAL RETARDATION

Community-referenced sight words and phrases were taught to adolescents with mild and moderate mental retardation using three instructional methods in two locations. Words were presented on flash cards in a school setting, on videotape recordings in a school setting, and on naturally occurring signs in the community. During each session, participants were taught one third of the words in each of these conditions and were then tested at the community sites. A constant prompt delay procedure was used to promote stimulus control to the experimenter's cue initially and then to transfer control to the textual stimuli used for training. A multiple baseline across participants design was employed. Results showed rapid acquisition of the community-referenced sight words in all three training conditions and generalization from the flash card and videotape conditions to the community sites.     

How parents view professional behaviors: A cross-professional analysis

This study examined the responses of more than 900 parents of children with serious emotional disorders to survey questions about the importance and frequency of professional behaviors and compared these responses across professions. The findings indicated that parents with lower income and less education tended to work more with social workers, counselors, and teachers, less with psychologists and psychiatrists. Professional behaviors concerned with the parent-professional relationship, honesty, non-blaming attitude, supportiveness, and inclusion in decision-making were considered important by most parents regardless of the professional with whom they worked. Parents rated professions differently on the importance of evaluation, home visits, and providing child-raising information, probably reflecting expectations that parents have about the roles and training of professionals. The behaviors that parents considered important also tended to occur frequently. Significant differences across professions were found with respect to the frequency of providing information on child rearing, advocacy, home visits, providing information on resources, and help with coping, although these behaviors were considered relatively less important by parents. An examination of discrepancies between what parents considered important and what they experienced suggested that parents' expectations were only partially met. Implications for practice, professional education, and research are discussed.Editor's Note: We acknowledge the sampling issue raised by the low survey return rate in this study and the resulting threat to generalizability of findings. Nevertheless, the study is judged to merit publication as one of the first efforts to examine empirically parents' views of their relationships with mental health professionals. Our hope is that this report will serve to stimulate further scientific investigation on the topic—Donald Oswald (AE).     

Preconceptional family health evaluation: A regional education program for family planning clients and health professionals

The Preconceptional Family Health Evaluation Program was a regional project developed and funded for 2 years by the New England Regional Genetics Group (NERGG) to educate family planning health professionals about genetics, and to offer family planning clients preconceptional identification of genetic and environmental exposure risks. To meet these goals, genetic education was provided on a regional basis to 45 family planning professionals. A self-administered family health risk questionnaire adaptable to individual family planning settings was developed. Five hundred and twenty-nine family planning clients voluntarily completed the questionnaire. Cigarette smoking (35%) and alcohol use (57%) were two major categories of risks identified. The Preconceptional Family Health Evaluation Program was well received by all participants and provided an effective means for regional education of family planning health professionals. As a result of the program, state program planners, clinical genetics services, and family planning health professionals developed a strong relationship that will serve future educational and genetic risk screening efforts.     

Wrapping community-based mental health services around children with a severe behavioral disorder: An evaluation of project wraparound

During the past two decades there has been a significant increase in community-based mental health and educational services for children and youth with serious emotional and behavioral problems and their families. However, in the vast majority of programs there are no reliable longitudinal data on the adjustment of the children that are served. Project Wraparound was a community-based individualized treatment program which served children and youth with severely maladjusted behavior and their families by providing intensive home and school-based services. The purpose of this paper is to provide a longitudinal analysis of client and family adjustment data. Data on client adjustment within the home and characteristics of the home environment were obtained at intervals of 3 months, 6 months, and 1 year. Data on client adjustment in school was obtained at four points over a period of 2 years. The results from 19 cases indicate that substantial change occurred on measures of the home environment and client adjustment in the home with no significant change in adjustment in the school. Implications of the findings are discussed.     

Adolescents' perceptions of outpatient mental health services

Thirty-three adolescents from three mental health service settings were interviewed regarding their perceptions of the purpose, goals, expectations, frustrations and benefits of mental health experiences. They provided satisfaction ratings and importance rankings of seven domains of satisfaction: (a) Convenient/Accessible, (b) Meeting Needs, (c) Staff Competence, (d) Personal Relationship with Staff, (e) Effectiveness of Treatment, (f) Comfort/Appropriateness of Center, and (g) Costs and Paperwork. In addition, participants completed the Client Satisfaction Questionnaire (CSQ-8). Results indicated that, in general, the adolescents were very satisfied with the services they received. Gender, race/ethnicity and treatment site were not related to satisfaction scores, nor was the adolescent's perceived choice in seeking services. Some significant gender differences were found both in terms of the rankings of satisfaction domains, as well as in the adolescents' perceptions of their reasons for initiating counseling and the perceived goals and benefits of counseling. Additional differences in perceptions of services were found for treatment site and race/ethnicity. In general, adolescents were able to generate informative, sophisticated responses to questions regarding their perceptions of mental health services, and demonstrated that they are capable of evaluating services they receive.     

Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.