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Role of education in preserving traditional cultures and as development factor 教育在保存传统文化和作为发展因素方面的作用
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90001-2
Sixten S.R. Haraldson

Independent of international assistance, the socioeconomic development and improvement of national health have been insignificant in several poor countries during the last 10–20 years. The main problems of these countries are multidisciplinary matters, both regarding causative factors and solutions.

In the field of health, high priority medical problems are not found in the curative sector of medicine but rather within prevention, with environmental sanitation, water supply, family planning and nutrition. These are the most profitable fields for internal support as well as international assistance, offering lasting development effects and acceptable cost-benefit relations.

Primary school education is of major importance in that it provides local tribal youngsters to be selected for training as auxiliary health workers for staffing of the chain of rural dispensaries, which seems to be the key to national health development, and to the WHO goal “health for all by the year 2000.”

In several developing countries, locally recruited youth with 5–7 years of primary education already constitute indispensable links between professional health services and delicate issues such as birth control and a — usually illiterate — rural population.

Illiteracy is considered the main obstacle for general socioeconomic and national health development in poor countries. Primary education is a threshold and a bottleneck which has to be overcome before a fruitful cooperation with local rural people can be organized, and before the rather worn-out — but seldom applied — slogan “help to self-help” can become a reality. This approach so guarantees consideration of “the total man in his total environment.”

在没有国际援助的情况下,过去10至20年间,几个贫穷国家的社会经济发展和国民健康状况的改善微不足道。这些国家的主要问题是多学科问题,既涉及病因,也涉及解决办法。在保健领域,高度优先的医疗问题不在医学的治疗部门,而是在环境卫生、供水、计划生育和营养方面的预防部门。这些是国内支助和国际援助最有利的领域,具有持久的发展效果和可接受的成本效益关系。小学教育非常重要,因为它为挑选出来的当地部落青年提供培训,使他们成为农村医务室工作人员的辅助保健工作人员,这似乎是国家保健发展和卫生组织“到2000年人人享有保健”目标的关键。在若干发展中国家,当地征聘的受过5-7年初等教育的青年已经成为专业保健服务与诸如节育和农村人口(通常是文盲)等微妙问题之间不可或缺的联系。文盲被认为是贫穷国家总体社会经济和国民健康发展的主要障碍。小学教育是一个门槛和瓶颈,必须克服它,才能组织与当地农村人民富有成效的合作,才能使“帮助自助”这一相当陈旧但很少应用的口号成为现实。这种方法保证了对“整个环境中的整个人”的考虑。
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引用次数: 3
Appeal by West German physicians to physicians in the USA 西德医生对美国医生的呼吁
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90006-1
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引用次数: 0
The effects of implementation problems on certificate of need decisions in Illinois 伊利诺斯州实施问题对需求证明决定的影响
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90002-4
David C. Colby, Charles E. Begley

There has been a lack of appreciation of the complexities of implementing certificate of need (CON) programs and, further, the effects of those implementation problems on the program's effectiveness. This study describes implementation problems and presents some evidence of their impact on approval rates in one state. Start-up phase problems included non-reviewable projects, exempted projects and pre-emptive actions by the hospitals to avoid the regulations. It is estimated that these problems raised the program's approval rate by 12 percent and resulted in approximately $310 million of capital costs and an unknown increase in operating costs.

Two problems of continuing implementation are identified. The first concerns the availability and specification of the standards and criteria for project review. The second problem is the lack of significant compliance mechanisms.

The Reagan administration has made massive cuts in support for health planning and CON programs. The rationale for these cuts is based on the belief that CON has not been effective in reducing the escalation of hospital costs. This article indicates some of the reasons for its impotence.

人们一直缺乏对实施需求证明(CON)计划的复杂性的认识,而且缺乏对这些实施问题对计划有效性的影响的认识。本研究描述了实施问题,并提出了一些证据,证明它们对一个州的批准率的影响。启动阶段的问题包括不可审查的项目、豁免的项目和医院为逃避规定而采取的先发制人的行动。据估计,这些问题使该项目的批准率提高了12%,导致大约3.1亿美元的资本成本和未知的运营成本增加。确定了继续执行的两个问题。第一个问题涉及项目审查的标准和准则的可用性和规格。第二个问题是缺乏重要的遵守机制。里根政府大幅削减了对健康计划和CON项目的支持。这些削减的理由是基于这样一种信念,即CON未能有效地减少医院费用的上升。本文指出了其无能为力的一些原因。
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引用次数: 4
Preventive services: An educational or political issue? 预防服务:是教育问题还是政治问题?
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90004-8
Allen C. Meadors

A major concern about health care in the United States, as we move into the 1980s, is the spiraling cost of such services. Thoughts and efforts surrounding the issues of how to control those costs have ranged from the establishment of different payment mechanisms and “professional services review” of care quality to means of avoiding the need for health care in the first place. If we are to alternate our approach to traditional health care, then we must bring the consumer back into the position of responsibility. This will call for a rethinking of our attitude toward intervention and prevention measures.

This article looks at some of the issues and controversy which presently surround the implementation of the “prevention” concepts. The author suggests the answer lies with increased participation from both patient-consumer and the health professional.

当我们进入20世纪80年代时,美国医疗保健的一个主要问题是这种服务的成本不断上升。围绕如何控制这些费用的问题的想法和努力包括建立不同的支付机制和对护理质量进行"专业服务审查",以及从一开始就避免需要保健的方法。如果我们要改变传统医疗保健的方式,那么我们必须让消费者重新承担起责任。这将要求我们重新思考我们对干预和预防措施的态度。本文着眼于目前围绕“预防”概念实施的一些问题和争议。作者建议,答案在于增加患者-消费者和卫生专业人员的参与。
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引用次数: 2
Index 指数
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90008-5
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引用次数: 0
GMENAC report on U.S. physician manpower policies: Recommendations and reactions GMENAC报告美国医生人力政策:建议和反应
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90005-X
Stephen E. Peterson, Alvin E. Rodin

After four years of study in the United States, the Graduate Medical Education National Advisory Committee (GMENAC) concluded that an excess of approximately 70,000 physicians will exist in 1990. Faced with a future surplus, GMENAC recommends that U.S. medical schools decrease enrollment levels by 10 percent relative to the 1978–79 level and severely restrict entrance of foreign medical graduates. Flaws identified in the GMENAC approach relate to the use of the delphi technique, the future role of nonphysician providers, and a lack of reliable data. The GMENAC report may provide impetus for an abrupt shift from expansionism to reductionism in U.S. physician manpower policy. Long range physician manpower planning has erred in the past, necessitating periodic reevaluation of national policy. A continuing balance between supply and demand, although ideal, can probably never be attained. Thus small adjustments in total supply and specialty mix will always be necessary. The GMENAC report, which is the most comprehensive study of U.S. physician manpower to date, requires serious consideration in this context.

研究生医学教育全国咨询委员会(GMENAC)在美国进行了四年的研究后得出结论,到1990年将有大约70,000名医生过剩。面对未来的盈余,GMENAC建议美国医学院将招生人数相对于1978-79年的水平减少10%,并严格限制外国医学毕业生的入学。GMENAC方法中发现的缺陷与德尔菲技术的使用、非医师提供者的未来角色以及缺乏可靠的数据有关。GMENAC报告可能会为美国医生人力政策从扩张主义到简化主义的突然转变提供动力。长期医生人力规划在过去曾出现过失误,因此需要定期对国家政策进行重新评估。供需之间的持续平衡虽然是理想的,但可能永远无法实现。因此,总供应量和专业组合的小幅调整总是必要的。GMENAC报告是迄今为止对美国医生人力资源最全面的研究,在这方面需要认真考虑。
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引用次数: 9
Developments in medical education: Issues and responses 医学教育的发展:问题和对策
Pub Date : 1983-04-01 DOI: 10.1016/0165-2281(83)90003-6
Kenneth R. Cox, Arie Rotem

The increase in scientific knowledge has led inexorably to the fragmentation of medicine and medical education. Doctors are trained to work and teach within their discipline. Managing the process of planning, implementing and evaluating teaching among the disciplines requires knowledge and skills in organization and management. The tasks are at the levels of the individual teachers, the department and the faculty, and of the committees they generate. The challenge for the individual teacher and of the organization is to coordinate their cooperative activities in the interest of the students and the promotion of health. Since no individual teacher is responsible for the whole organization, the central responsibility for this centripetal management lies with the Dean.

科学知识的增长不可避免地导致了医学和医学教育的分裂。医生被训练在他们的学科范围内工作和教学。管理学科间教学的计划、实施和评估过程需要组织和管理方面的知识和技能。这些任务是由个别教师、系和教员以及他们所产生的委员会来完成的。教师个人和组织面临的挑战是为了学生的利益和促进健康而协调他们的合作活动。由于没有任何一个老师对整个组织负责,因此这种向心化管理的主要责任在于院长。
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引用次数: 1
Improving the selection of family medicine residents through development of multi-dimensional policy models 通过多维度政策模型的开发,改善家庭医学住院医师的选择
Pub Date : 1982-10-01 DOI: 10.1016/0165-2281(82)90004-2
Barnett R. Parker, Bron D. Skinner

The annual cost of training a single family medicine resident may now exceed $50,000. This, together with the fact that normally only a small fraction of those applying for family medicine residency is selected for admission, creates a decision problem of enormous import to affected institutions. Despite these considerations, the applicant evaluation and selection process remains relatively subjective, with results often disappointing. In the current paper, a preference-based approach is proposed that first models the evaluation/selection process on the basis of well-defined cognitive and noncognitive criteria. It is suggested that validation of this model be based on future performance levels of both the accepted and rejected cohorts during and following their residencies. Discrepancies between future success levels and predicted outcomes may then be translated into appropriate control actions designed to: (1) improve the definition/measurement of selection criteria; (2) enhance the evaluation/selection policies and decisions of the admissions committee; and (3) better inform potential applicants of the department's program and selection philosophies. The approach is applied to two recent, accepted cohorts of the University of North Carolina Department of Family Medicine. Preliminary results indicate that the procedure is capable of improving the in-residency success levels of selected applicants, and that these levels can be better predicted than when no formal, i.e., analytic, process is followed.

培训一名家庭医学住院医师的年费用现在可能超过5万美元。这一点,再加上通常只有一小部分申请家庭医学住院医师的人被选中入院,对受影响的机构造成了一个极其重要的决策问题。尽管有这些考虑,申请人的评估和选择过程仍然相对主观,结果往往令人失望。本文提出了一种基于偏好的方法,该方法首先在定义明确的认知和非认知标准的基础上对评估/选择过程进行建模。建议对该模型的验证应基于住院期间和之后接受和拒绝队列的未来表现水平。未来成功水平与预测结果之间的差异可以转化为适当的控制行动,旨在:(1)改进选择标准的定义/测量;(2)加强招生委员会的评估/选拔政策和决定;(3)更好地告知潜在申请人该部门的项目和选择理念。该方法被应用于最近被接受的北卡罗来纳大学家庭医学系的两个队列。初步结果表明,该程序能够提高选定申请人的住院成功率,并且这些成功率比不采用正式程序(即分析程序)时可以更好地预测。
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引用次数: 5
Some challenges in the management of community Health Education 社区健康教育管理面临的挑战
Pub Date : 1982-10-01 DOI: 10.1016/0165-2281(82)90003-0
Thomas C. Timmreck

Health Educators are often expected to fill managerial roles yet are not always trained in management skills. The Health Educator's role is constantly changing but training has not always kept up, especially in the area of management. Job descriptions are often less than adequate and coordination between the jobs and the training institution could be better. Health Educators, due to frustration caused by inadequte role definition, may choose administration as a career as it is easier identified. Barriers to successful management can also be frustrating for the Health Educator, i.e., political constraints, lack of skills, etc. Planning should be a major activity of any Health Education program in order to ensure a successfully managed Health Education project.

健康教育工作者通常被期望担任管理角色,但并不总是接受过管理技能方面的培训。健康教育工作者的角色在不断变化,但培训并不总是跟上,特别是在管理领域。工作描述往往不够充分,工作和培训机构之间的协调可以更好。健康教育工作者由于角色定义不充分而感到沮丧,可能会选择行政管理作为一种更容易确定的职业。对健康教育者来说,成功管理的障碍也可能令人沮丧,即政治限制、缺乏技能等。为了确保健康教育项目的成功管理,计划应该是任何健康教育项目的主要活动。
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引用次数: 2
Health care delivery in the United States 美国的医疗保健服务
Pub Date : 1982-10-01 DOI: 10.1016/0165-2281(82)90007-8
Bernard S. Bloom
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引用次数: 7
期刊
Health policy and education
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