论文摘要Abstract.pdf

论文摘要 论文摘要 Abstract K2 The 20th Century One Hundred Years of Progress for Medical Social Educational and Legal Issues related to Childhood Health and Disability For those with or at risk for developmental disabilities the 20th century was remarkable for improvements made in the areas of disability prevention medical treatment and rehabilitation Public health measures lessened or eliminated the morbidity and mortality risk for many conditions and new medical treatments led to prolongation of life expectancy and improvement in the quality of life for numerous health conditions of childhood At the same time powerful forces in the social educational and legal communities emerged to develop new concepts of 1 Wellness Inclusion and Independence making life more successful fulfilling and meaningful for millions of young people as they continued to develop and grow into adulthood These changes in medical social educational and legal norms are frequently taken for granted today but they represent herculean and heroic efforts by dedicated professionals and consumers to a degree unattainable in previous generations 20 世纪 幼儿健康与残疾相关之医疗 社会 教育 法律等问题百年历程世纪 幼儿健康与残疾相关之医疗 社会 教育 法律等问题百年历程 对那些患有或有可能患有发展障碍的人来说 20 世纪在医疗 康复 残疾 预防等方面有了非凡的进步 在许多情况下 公共健康举措减少或消除了发病率 和死亡率的风险 并且新的医疗手段使得预期寿命延长 儿童健康状况得到改善 同时 强大的社会 教育和法律力量显现出来并发展了安康 包容和独立性等新 观念 许多年轻人继续发展并成长 生活也更成功 满足和有意义 在今天 这 些医学 社会 教育及法律规范方面的变化经常被认为是理所当然的 然而它们 蕴含着前几代人的巨大努力和贡献 A1 Self Help and Self Management the keys to the community rehabilitation for persons with chronic illness This paper attempts to share the working model as well as the outcome of CRN in Hong Kong Some reports indicated that CRN participants overall quality of life improved significantly in terms of mental health sense of control over their health self care ability and social support A pre and post study indicated a reduction in hospitalization of an average of 3 3 days for each respondent N 205 The achievement clearly demonstrated that CRN is cost effective and would be a great complement to institutional care The evaluation of the chronic disease self management program in a Chinese population was conducted in 2004 CDSMP 2 participants demonstrated significantly higher self efficacy in managing their illness used more cognitive methods to manage pain and symptoms and felt more energetic than the subjects in the comparison group The CDSMP participants also demonstrated changes in their profile of coping strategies having a tendency to adopt the cognitive methods of diverting attention reinterpreting pain ignoring sensations and making positive self statements 自我帮助与自我管理 慢性病患者社区康复的关键自我帮助与自我管理 慢性病患者社区康复的关键 本文旨在分享香港社区康复网络 CRN 的模型和结果 相关研究结果显示 社区康复网络的参与者在精神健康 健康控制感 自理能力和社会支持等整体生 活质量方面有显著改善 另一项前后对照研究显示每个被调查者的住院日平均缩 短了 3 3 天 N 205 这些成果都清晰地显示出 CRN 是经济有效的 并将成为 机构照料的重要补充部分 2004 年实施的中国人口慢性病自我管理评价计划显 示 该计划的参与者较对照组在疾病管理方面表现出较高的自我效能 在疼痛和 其它症状管理方面运用较多的认知方法 并且精力也更为充沛 项目参与者还表 现出应对方法上的改变 更倾向于采用注意分散 疼痛重释 感情忽略等认知方 法来达到一个积极的自我状态 A2 From Individual Tragedy to Community Services the Strategic Transition of the Model of Disabled People Welfare in China People with disabilities are an important component of vulnerable groups It is a special group which needs the protection from the government social care and community service Life quantity of people with disabilities is a key indicator for the measurement of social civilization and the modern welfare system This paper will from the history comparative perspective discuss issues in various levels including social values service organizations for the people with disabilities content and scope of the services policies structure and legal protection etc It s the first time that summarizing the China disabled Persons welfare policy as a model of individual 3 tragedy and community services and in dept describing and analyzing the strategic transition from the individual tragedy to community services stating the features of China s development of the cause of the disabled welfare system 从从 个人不幸个人不幸 到到 社区照顾社区照顾 中国残疾人福利典范的战略转变 中国残疾人福利典范的战略转变 残疾人是弱势群体重要组成部分 是需要国家保护 社会关爱和社区照顾的 特殊群体 残疾人生活质量是衡量社会文明和福利制度现代化的主要指标 本文 从历史比较角度 从社会价值观念 残疾人服务组织体系 残疾人服务内容与范 围 残疾人政策框架与法律保护等层面 首次将中国残疾人福利政策概括为个人 不幸与社区照顾典范 并深度描述和分析个人不幸向社区照顾典范的战略转变 阐述中国残疾人福利事业发展制度特征 A4 Research on the conditions and developments of china s disabled community service The development strategy and policy choice of disabled community service based on Social Model of Disability This report analysis the ten aspects and main problems of disabled community service on the basis of the data of the Second China National Sample Survey on Disability that includes the distribution ratio of the disabled population and families in China s urban and rural communities the rate of disability card holders the needs of community service community rehabilitation station and rehabilitation coordinator with the situation the conditions of the disabled who gained help the coverage of the community public service organizations the conditions of community facilities 4 accessible to disabled without obstacle disabled associations the conditions of elder disabled in urban and rural communities and the education of disable children This report proposes the strategic development objectives and related policy recommendations of China s disabled community services based on the Social Model of Disability in the past 20 years That should transform the Medical Model to the Social Model of disabled quickly incorporate effectively the disabled community service into the planning of urban and rural community development reform the model of disabled development and social resource distribution put more resources to community and strengthen the integration efforts to the community center expend the contents and coverage of community services increase the functions of disabled community develop the service organizations and volunteers groups for disabled people We hope to establish the disabled community service system called dumbbell model which is as the target of urban and rural disabled people as the guide of the public service based on community service network as the direction of putting family care into the community 我国残疾人社区服务状况和发展研究我国残疾人社区服务状况和发展研究 基于 残疾社会模式 的残疾人社区服务发展战略与政策选择 基于 残疾社会模式 的残疾人社区服务发展战略与政策选择 本报告在第二次全国残疾人抽样调查统计数据分析的基础上 全面分析了我 国城乡社区残疾人口和家庭户的分布及比例 残疾证持有率 社区服务需求及其 满足状况 社区康复站和康复协调员的配备状况 残疾人享受救助情况 社区公 共服务机构覆盖情况 社区残疾人无障碍设施建设状况 社区残疾人协会建设情 况 以及城乡社区老年残疾人状况和残疾儿童受教育状况等十个方面的残疾人社 区服务的基本状况及存在的主要问题 依据近二十年来国际残疾人事业的 残疾 社会模式 范式 提出加快实现从残疾的 医疗模式 向残疾的 社会模式 转变 切实落实将残疾人社区服务纳入城乡社区建设规划 改革残疾人事业发展 的社会资源配置模式 加强公共资源配置向社区倾斜和以社区为中心的整合力 5 度 积极拓展残疾人社区服务内容和覆盖面 健全城乡社区残疾人协会的组织和 功能 并培育和发展残疾人服务的社会组织和志愿者队伍 最终建立 以城乡残 疾人为对象 政府公共服务为引导 社区服务网络为基础 家庭照顾社会化为方 向 的 哑铃型 残疾人社区服务体系 B2 Psychosocial Acute Treatment in Early Episode Psychosis American and European Models John R Bola Ph D University of Southern California USA Klaus Lehtinen M D Tampere University Hospital Tampere Finland Johan Cullberg M D Ersta Sk ndal University College Stockholm Sweden Luc Ciompi M D Social Psychiatric University Clinic Switzerland International Forum on Disability and DevelopmentBeijing China December 10 15 2007 Objective This paper reviews the psychosocial acute treatments for early episode schizophrenia spectrum psychoses developed in the United States and Europe that 6 may be considered for use in Asia Methods Psychosocial treatments not immediately medicating all subjects and with published empirical evaluations were included We review theoretical orientations describe treatments compare and contrast the treatment approaches Results Soteria in the United States Soteria Bern in Switzerland the Finnish Need adapted Treatment and the Swedish Parachute Project are reviewed Except in Finland each program developed a special therapeutic milieu as an alternative to acute hospitalization Finnish Need adapted treatment focused on creating health promoting interactional environments in hospital wards and families by applying an integrated therapeutic approach build upon systemic family therapy The Soteria program focused on developing peer based social support networks Soteria Bern more directly involved families in treatment Conclusions Each treatment has been evaluated with comparable to somewhat better 2 to 5 year outcomes in treating first episode schizophrenia spectrum patients In addition 32 to 43 of intent to treat patients did not receive antipsychotic medications over the first 2 3 years of treatment thereby reducing medication dependence and side effect exposure Developers of acute psychosocial treatments may want to consider incorporating elements of these successful treatment models 对精神病早期发作的社会心理急性治疗对精神病早期发作的社会心理急性治疗 美国和欧洲的模式美国和欧洲的模式 目标目标 这篇论文综述了在美国和欧洲研发出的针对首次发作的精神分裂症谱系病 人的急性社会心理治疗 从而提出将其考虑用在亚洲 方法方法 社会心理疗法不对 所有对象立即施以药物 并且应用各种已发表的实证评价 我们回顾理论取向 描述治疗 对比和比较各种治疗方法 结果结果 对在美国的 Soteria 在瑞士的 Soteria Bern 芬兰的适应需要治疗和瑞典 Parachute 项目进行了回顾 除了在芬 兰 每个项目都发展了一种特别的治疗环境以作为急性住院治疗的备选方案 芬 兰的适应需要治疗通过应用基于系统家庭治疗的整合的治疗方法 聚焦于在医院 的病房和家庭中创造促进健康的交互环境 Soteria 项目聚焦于发展基于同伴的 社会支持网络 结论结论 对于首次发作的精神分裂症谱系病人 每一种治疗方案的 2 年到 5 年的结局都稍优于对照 32 到 43 的意向治疗病人在治疗的前 2 7 3 年没有服用抗精神病药 因此减少了药物依赖和药物副作用 急性社会心理治 疗的发展者可以考虑整合这些成功的治疗方案中的有用元素 B3 A Community Based Participatory Research Approach to Improve the Mental Health of Older Adults Academic institutions government and non government organizations can become effective research partners whose efforts help support and create policy changes that address the priority health issues of their local communities In San Diego California the needs for services of older adults with mental illness were assessed through a qualitative research project conducted collaboratively by a university County government and a community based organization The results from this study not only provided an in depth analysis of the needs of older adults in San Diego but also supported the development of a funding proposal to the State of California Mental 8 Health Department for local services Consistent with the goals of the State of California Mental Health Services Act to engage multiple stakeholders in the planning process for new and innovative mental health programs input was gathered for this study from key informants and representative samples of three groups of primary stakeholders of such services These included clients and potential clients clinicians and program administrators and family members advocates of clients This Community Based Participatory Research approach allowed us to combine knowledge with action to achieve social change for the improvement of mental health outcomes in older adults Additionally the process of engaging community organizations and County government in the planning development and implementation of this research study has empowered such organizations with the skills and knowledge needed to conduct further qualitative studies to address concerning health issues of other populations Please send correspondence to Dahlia Fuentes MSW MPH dfuentes usc edu or Lawrence A Palinkas Ph D palinkas usc edu Both authors are with the School of Social Work University of Southern California Los Angeles CA 90089 0411 一项基于社区的参与式研究 以改善老年人的精神健康一项基于社区的参与式研究 以改善老年人的精神健康 学术机构 政府和非政府组织可以成为有效的研究伙伴 因为在它们的努力 下 可以造就政策的改变 从而实现在当地社区优先解决健康问题的这一目标 在加州的圣地亚哥 一个由大学 州政府和社区组织共同制订的定性研究计划 提出了老年精神疾病患者的服务需求 这一研究结果不仅对生活在圣地亚哥的老 年人的需求进行了深入分析 同时也对向美国加州精神健康步部门提出的 资助 地方服务业发展的建议起到了一定支持作用 根据加州精神健康服务法案的宗 旨 使多重的利益相关者加入到新的和创新性精神健康方案的计划过程中 使这 些服务的三组主要利益相关者 包括关键性被调查者和代表性样本投入到这一研 究 这些人包括客户 潜在客户 临床医生 项目管理人员以及家庭成员 客户 的倡导者 这一基于社区的参与式研究方法使我们可以将知识和实践相结合 从 9 而取得老年人精神健康情况的改善这一社会转变 同时 社区组织和州政府参与 到这一研究的计划 发展和实施 可以使这些组织能够获得相关技巧和知识 从 而引导进一步的针对其他人口健康问题的定性研究 B4 The Recent Trend and Prevalence of Physical Disability among Older Adults in the United States Implications for late life disability in China Objective This study aims to explore the recent trend and prevalence of physical disability among American older adults to examine relative social policies and programs for American disabled elders and to draw potential implications for late life disability among Chinese elders Methods The paper first reviewed the disability trend among American elderly persons during the 1980s and 1990s based on 6 US national surveys Relying on the most recent national surveys American Community Survey 2006 N 1 486 368 the second part of the paper examined the current physical disability prevalence among American older adults aged 65 and over and explored the disparities by major socio demographic groups Results From the survey suggested that the oldest old women and those with the least education have the greatest physical disability Conclusions and Implications Examining the late life disability among older adults in U S sheds insight into both the policy and study for 10 disability issues in older adults in both countries Differences across surveys in how questions were worded and in defining the physical limitations may contribute to the different prevalence rates in the two countries The implications of the observed l disability trend among American older adults were also discussed in the paper 美国目前老年人肢体残疾患病状况及趋势 对中国老年阶段残疾的启示美国目前老年人肢体残疾患病状况及趋势 对中国老年阶段残疾的启示 背景和目标背景和目标 这一研究旨在探究当前美国老年人身体残疾的流行趋势 调查与美 国老年残疾人相关社会政策和方案 从而对中国老年人的残疾晚年提供潜在的借 鉴指导作用 方法方法 这篇论文首先根据美国国家调查数据 回顾了19世纪80年代 和90年代美国老年人的残疾趋势 之后 在论文的第二部分 根据最近的国家调 查 2006年美国社区调查 N 1 486 368 提出了最近美国65岁及以上老年 人的残疾趋势 及主要社会人口群体之间的差异 结果结果 现有数据表明 高龄老 人 妇女和那些只具备最低限度教育的人 身体的残疾情况相对严重 结论和推 断 结论和推 断 调查当前美国老年人身体残疾的流行趋势有助于深入了解两国老年人残疾问 题的政策和研究 在调查过程中的一些差异 如问题的措辞和身体缺陷的定义 可能会使两国的调查数据产生误差 对于已经观察到的美国老年人残疾趋势的相 关推论在论文中也会被讨论 C2 Ageing Urbanization and Trend of Disability in China Introduction Will the trend of disability in China fall in the mode of Compression or Expansion paralleling to the changes of life expectancy profiling of chronic diseases and patterns of decreased mortality To answer such questions a systematic analysis was conducted using the data obtained from the two cross section surveys conducted in China in 1987 and 2006 representing 1 5 and 1 93 of the total Chinese population Method By reference to the definition of WHO on ageing people aged 60 years old and over was defined as the elderly person The age specific disability rate and the corresponding 95 confident interval by both gender and types of residence classified by urban and rural areas were calculated The results of the two cross 11 sectional national wide surveys in 1987 and 2006 were compared Results The population of the elderly persons with disability in China was 20 51 millions in 1987 and increased to 43 93 millions in 2006 occupying 39 71 and 52 90 of the total population size of the disabled persons in 1987 and in 2006 respectively In addition disability rate of the elderly persons increased from 21 93 in 1987 to 24 03 in 2006 with a crude rate difference of 2 10 Conclusion Disability is one of the inevitable consequences of aging process As China is the country with the largest population size of aged disabled persons in the world especially in rural areas and experiences the process of rapid aging the issue of disability of older persons will become the most serious public health problem China faces the challenging of how to improve the life quality at the late life of the old disabled people and to prevent older persons from disability or to delay the onset age of disability while the country s population is marching into aging rapidly 中国老年人残疾现状及防制对策研究中国老年人残疾现状及防制对策研究 背景背景 利用两次全国残疾人抽样调查的数据 系统分析中国老年人口的残疾 现状及其趋势将为我国有针对性的制定老年残疾防制措施提供科学证据 方法方法 以两次残疾人调查数据为基础 对老年人口 60 岁及以上人口 的年龄别残疾 率进行统计分析 并比较不同性别 区域的残疾率 所有计算采用 SAS version 9 1 软件完成 结果结果 2006 年调查结果显示 农村老年人口的残疾率为 25 88 高于城市 20 52 老年人口中残疾现患率以农村女性为最高 26 64 城市男性最低 20 21 老年人口残疾率由 1987 年的 21 93 上升到 24 03 老年残疾人口总数由 1987 年 2051 万增加到 4393 万 城市老人的残疾率较 1987 年下降 而农村老人 60 75 岁的残疾率却高于 1987 年 结论结论 农村老年人口的残 疾现状是最严重的 由于此部分人群的人口数最大 而且他们处于社会与经济地 12 位的弱势 因此 改善农村老人的医疗卫生状况 促进其康复保健功能对于提高 老年人口的生存质量将是至关重要的 C3 The Analysis of the trend and status of older adults with disabilities in China China has the most older persons in the world so there are also quite a number of old disabled persons It is governmental and social responsibility to pay attention to the old disabled persons and improve the development of the old disabled persons undertaking Using the data of The Second China National Sample Survey on Disability this article analyses the actuality and trend of the old disabled persons and puts forward some suggestions 我国残疾老人发展趋势及残疾状况分析我国残疾老人发展趋势及残疾状况分析 13 我国是老年人口最多的国家 也是残疾老年规模相当多的国家 关注残疾老 人 推动残疾事业的发展 是政府和社会义不容辞的责任 本文利用第二次残疾 人抽样调查的资料 对我国老年残疾的现状和未来发展进行分析 并提出一些建 议 C4 Comparison of the Distribution of Barrier free Facilities on Provincial Level in China This paper made a descriptive analysis of the distribution of barrier free facilities of 31 provinces in China based on the data from the Second China National Sample Survey on Disability The conclusion is that the distribution of barrier free facilities on provincial level is positively correlated to the economic development level rather than the distribution of disabled persons according to provinces Furthermore regulations and laws made for managing and protecting barrier free facilities can effectively promote the construction and maintain of local free barrier facilities 14 我国各省市 自治区无障碍设施分布分析我国各省市 自治区无障碍设施分布分析 本文的分析是基于全国第二次残疾人抽样调查有关数据 对全国各省 自治 区 直辖市无障碍设施的建设进行的描述性统计分析 得出我国各省区无障碍设 施建设分布的主要是基于各省经济发展水平分布而非残疾人分布的结论 同时笔 者还发现各省对于管理和维护无障碍设施单独立法可以大大的促进当地无障碍 设施的建设和维护 C5 A correlation study on factors affecting the need of needy salvation of the older disabled in China Background The older disabled aged 60 and over account for more than 52 8 percent of the whole disabled in China and about 80 percent of them neither being on work nor having pension It is the second biggest need of needy salvation of the older disabled among the 13 needs what they mentioned Objective To analyze the correlating factors affecting the need of needy salvation of the older disabled in China Method Pearson correlation Results The percentage of need of needy salvation is negatively related to age the percentage