社區(qū)衛(wèi)生演變模型外文翻譯

1、<p>　　本科畢業(yè)設(shè)計（論文）</p><p>　　外 文 翻 譯</p><p><b>　　原文：</b></p><p>　　The evolution of the Fenway Community Health model</p><p>　　Field Action Reports <

2、/p><p>　　Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to t

3、he AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LOBT) care led to expansion of medical services to address broader community concerns, ranging from substance use

4、to parenting issues to domestic and homophobic violence, as well as specialized</p><p>　　Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenw

5、ay's clinical departments recorded 50 850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical program

6、s, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. </p><p>　　Fenway has established standards for impro

7、ved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of compr

8、ehensive LGBT health services that have a local impact. </p><p>　　The mission of Fenway Community Health is to enhance the physical and mental health of the general community, with an emphasis on services fo

9、r LGBT individuals. Fenway is 1 of only 9 LGBT-specific community health centers in the United States. Fenway's services include primary medical care and specialty HIV/AIDS, obstetrics, gynecology, gerontology, podia

10、try, and dermatology services; mental health and addiction services; complementary therapies including chiropractic, massage, acupuncture, and </p><p>　　Fenway has developed unique programs for community hea

11、lth education and promotion, community-based research, health policy advocacy, and leadership in ongoing and emerging LGBT health care coalitions. These programs have been evaluated by external monitors, including federa

12、l agencies, and have been replicated elsewhere in the United States. Fenway has also developed an active professional educational program, participating in the training of medical students, residents, social workers and

13、other </p><p>　　Medical Department </p><p>　　The medical department is the largest Fenway clinical department. It includes an integrated clinical practice of physicians teamed with other primary

14、 care providers (nurse-practitioners, physician's assistants, registered nurses, and licensed practical nurses) and medical social workers, who deal with issues ranging from health insurance access to housing and pro

15、vide triage for mental health services, as well as a freestanding community-based physician practitioner model. Primary care providers </p><p>　　Mental Health and Addiction Department </p><p>　　

16、Staff psychiatrists, psychologists, and social workers offer a wide range of mental health services, including individual, group, couples, and family therapy and psychiatric medication evaluation and management, which in

17、cludes 24-hour beeper coverage to handle emergencies. The department oversees one of the largest HIV counseling and testing sites in New England and offers support groups for individuals living with HIV as well as indivi

18、duals who are HIV-negative and need support in maintaining l</p><p>　　Fenway has developed a program of services for survivors of domestic and homophobic violence, including urgent medical care; short-term c

19、risis counseling and longer-term therapy for survivors, their partners, and other loved ones; referrals to LGBT-sensitive medical and legal professionals; and advocacy to ensure that cases are aggressively investigated a

20、nd prosecuted. The staff has also provided education, mining, and consultation to first responders (emergency medical technicians, police, and </p><p>　　Wellness Programs and Community Education </p>

21、<p>　　Over the years, Fenway has developed an integrated program of community education and health promotion to complement its primary clinical services. Current activities include HIV risk reduction and health prom

22、otion programs for infected persons, with specialized activities oriented toward different communities (e.g., African-American women, younger Latino men). Many of these programs are conducted both in Spanish and in Engli

23、sh. They include small group sessions, outreach, referral, and collabor</p><p>　　Fenway offers smoking cessation education (including educational presentations to schools and agencies), support groups, and a

24、cupuncture. Fenway also maintains the largest gay and lesbian help and crisis intervention telephone hotline in New England. The hotline is staffed 7 nights per week and provides confidential information, referrals, cris

25、is intervention, and support to callers nationwide. A special hotline addresses the concerns of LGBT youth. Fenway sponsors community health education wor</p><p>　　Research and Evaluation Department </p&g

26、t;<p>　　Fenway initiated one of the nation's first community-based AIDS research programs in 1983 and received its first state and federal funding in 1984. Fenway's initial research endeavors derived from

27、the need to better understand the AIDS epidemic that was emerging in the gay community in the early 1980s. The first AIDS diagnosis among Fenway patients was made in 1981, and prospective epidemiological studies soon fol

28、lowed. The first estimates of HIV prevalence and incidence in New England were deri</p><p>　　Close to 100 peer-reviewed publications have been generated by Fenway's collaborations with laboratory, clinic

29、al, behavioral, and public health researchers at Harvard, Tuffs, and Brown universities. Fenway has been a leader in HIV prevention research and was recently awarded a contract from the National Institute of Allergy and

30、Infectious Diseases to serve as the primary agency for a consortium including investigators at Brown University and in southern India. </p><p>　　The research and evaluation department consists of more than 3

31、0 highly trained and experienced staff, including physicians, a senior survey research methodologist and behavioral scientist, clinical psychologists, public health professionals, data analysts, regulatory affairs specia

32、lists, health educators, nurses, interviewers, and outreach workers. Fenway has an institutional review board, as well as several community advisory boards that help the research and clinical programs staff evaluate th&l

33、t;/p><p>　　Along with its increased expertise in studying the health care concerns of men who have sex with men, Fenway has developed a lesbian health research agenda, commensurate with the expansion of clinica

34、l programs for women and reflecting the community's interest and support. Studies have ranged from the assessment of lesbians' access to care to a study of sexually transmitted diseases among lesbians to the eval

35、uation of different techniques of alternative insemination. A recent study of health care</p><p>　　Program Support and Sustainability </p><p>　　Fenway Community Health started as a free clinic,

36、supported partially through donations by clients and partially through subsidies from the city of Boston. Over the past 3 decades Fenway has become a sophisticated muitidisciplinary center that is supported through a var

37、iety of sources, including patients' private insurance as well as Medicare and Medicaid for the payment of medical and mental health services (Figure 1). Other government-sponsored programs are available for individu

38、als who qualif</p><p>　　The health education, service evaluation, and research components of the health center are usually funded by federal grants--including grants from the Centers for Disease Control and

39、Prevention, the Health Resources and Services Administration, the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration--and by the Massachusetts Department of Public Health. Ho

40、wever, there is a substantial shortfall in funding for Fenway's wide array of programs, and the c</p><p>　　Next Steps </p><p>　　Fenway Community Health has evolved over the past 3 decades fr

41、om a community health center to a model demonstrating how community-based LGBT services can be integrated with other innovative and culturally specific programs. The infrastructure that evolved to respond to the complex

42、biopsychosocial challenges of AIDS helped to jumpstart the development of a large number of activities that addressed the other health concerns of the LGBT community. We hope that the sustainability of Fenway's non-A

43、ID</p><p>　　Although other communities may not choose to replicate or be able to provide all of the programs that are available at Fenway, we hope this report will encourage local discussions that will facil

44、itate the development of comparable programs in other settings. The premise of Fenway Community Health is not that LGBT individuals cannot receive competent care from beterosexual health care providers or in settings whe

45、re LGBT patients are not a primary focus. Rather, Fenway's unique, culturally specifi</p><p>　　In the future, Fenway Community Health will continue to disseminate information learned during the establish

46、ment of its unique programs and to train health care providers and administrators in other settings to establish programs similar to those that Fenway has proven successful in addressing the specific health care needs of

47、 LGBT individuals. </p><p>　　Acknowledgments </p><p>　　We wish to acknowledge the hard work of dedicated staff, board members, and volunteers of Fenway Community Health, particularly those who g

48、ave their talents, time, and energy in the early years. Henia Handler, Louise Rice, and Matt Iwanowicz assisted with the preparation of this report. </p><p>　　Mayer K; Rogers T; Bradford J; .American Journal

49、 Of Public Health，2001, Vol. 91 (6), pp. 892</p><p><b>　　譯文：</b></p><p>　　芬微社區(qū)衛(wèi)生演變模型</p><p><b>　　實地行動報告</b></p><p>　　芬微社區(qū)衛(wèi)生中心是由社區(qū)活動積極分子于1971年在其附

50、近的波士頓、馬薩諸塞州建立起來的，在十年內(nèi)迅速擴大它針對于同性戀艾滋病問題的醫(yī)療服務(wù)。在女同性戀者、男同性戀者、雙性戀者和變性人的醫(yī)療關(guān)懷問題上面，專業(yè)知識和文化理解在逐漸增長，這導(dǎo)致了為解決更多社會關(guān)注的醫(yī)療服務(wù)范圍的擴大，從藥物的使用問題到家庭的養(yǎng)育問題，同性暴力，以及為女同性戀者、雙性戀者和變性人個體設(shè)置的專門程序。</p><p>　　芬微開始是一個基層社區(qū)診所。在1975年，該中心記錄了5000名病人的

51、就診情況；在200年，芬微的臨床部門記錄了8361名病人50850次的就診情況，包括超過1100次個體關(guān)于艾滋病的檢測。該中心現(xiàn)在有超過170名工作人員負(fù)責(zé)臨床項目，包括社區(qū)教育、研究、管理、規(guī)劃和發(fā)展。在過去的幾年里，芬微每年的年度預(yù)算已經(jīng)超過一千萬美元。</p><p>　　芬微已經(jīng)確立了為提升關(guān)于同性戀健康問題的文化理解的標(biāo)準(zhǔn)，并在同性戀健康問題上所特有的憂慮方面上的建立項目去教育普通社會成員。這個健康中心

52、可以提供一個全面的同性戀醫(yī)療服務(wù)模型，在地方上具有一定影響力。芬微社區(qū)衛(wèi)生中心旨是為一般的社區(qū)居民提供生理和心理上的健康輔助，以及強調(diào)為同性戀者提供服務(wù)。 芬微是九個美國同性戀特殊醫(yī)療衛(wèi)生中心之一。 芬微的服務(wù)包括基礎(chǔ)的醫(yī)療服務(wù)和專業(yè)艾滋病毒、產(chǎn)科、婦產(chǎn)科、老年病學(xué)、四肢、皮膚方面的醫(yī)療服務(wù)；心理健康問題和戒毒問題的醫(yī)療服務(wù)；輔助療法包括脊椎推拿療法、按摩、針灸和營養(yǎng)療法，健康促進計劃，社區(qū)教育項目，防止家庭暴力和同性暴力的項目，子女養(yǎng)

53、育問題的項目以及包括替代受精的家庭計劃服務(wù)。</p><p>　　芬微已經(jīng)發(fā)展了獨一無二的項目，其包括社區(qū)健康教育提升、社區(qū)基礎(chǔ)研究、健康政策宣傳和在正在發(fā)展中的同性戀者醫(yī)療服務(wù)聯(lián)盟的領(lǐng)導(dǎo)工作。這些項目已經(jīng)被外部監(jiān)督機構(gòu)，包括聯(lián)邦機構(gòu)評估，已經(jīng)在美國其他地方推廣開展。芬微還發(fā)展了有效的專業(yè)教育項目，參與培訓(xùn)的醫(yī)療專業(yè)的學(xué)生，居民，社會工作人員、其他專職醫(yī)療專業(yè)人員、相關(guān)健康專業(yè)人士以及很多動作人員都被任命在當(dāng)?shù)貙?/p>

54、業(yè)學(xué)校內(nèi)。</p><p><b>　　醫(yī)學(xué)部</b></p><p>　　這個醫(yī)學(xué)部是芬微最大的臨床部門。它包括一個綜合的診所實踐活動，以醫(yī)生組成，包括其他基礎(chǔ)護理提供者（護士，醫(yī)生，醫(yī)生助手，注冊護士和持證護士）和醫(yī)療社會工作人員，處理從健康保險到住房的問題，提供為精神問題的治療方法，也是一個獨立的以社區(qū)為基礎(chǔ)的醫(yī)療實踐模型。 基礎(chǔ)的護理提供者可以隨時向顧客提供現(xiàn)

55、場精神檢測和其他預(yù)防服務(wù)，包括強調(diào)減少程序，營養(yǎng)輔導(dǎo)和濫用藥物治療。需要住院治療的病人會被在貝絲雅各醫(yī)療中心的芬微醫(yī)療護理提供者跟蹤服務(wù)。</p><p><b>　　心理健康和戒毒所</b></p><p>　　精神科的工作人員，心理學(xué)家以及社會工作人員提供一系列的精神健康服務(wù)，包括個人、團體、夫婦和家庭治療以及精神類藥品評價管理，其中包括24小時呼叫機處理緊急情況

56、。這個部門管理一個位于新英格蘭最大的艾滋病毒咨詢和檢測站，提供艾滋病人個體攜帶艾滋病毒的個體的團體支持，需要維持低風(fēng)險行為的支持。</p><p>　　芬微已經(jīng)制定了一項計劃服務(wù)于國內(nèi)和同性暴力的幸存者，包括緊急醫(yī)療服務(wù)、短期危機咨詢和長期幸存者治療，他們的伙伴和其他親人，轉(zhuǎn)送到同性戀敏感醫(yī)療和法律專業(yè)人員，宣傳以確保案件能積極被調(diào)查和起訴。工作人員還提供了教育、采礦和專家會診向這些第一反應(yīng)者（緊急醫(yī)療技術(shù)人員，

57、警察和政府官員）。</p><p><b>　　常規(guī)程序和社會教育</b></p><p>　　多年來，芬微已經(jīng)制定了一個綜合社會教育和健康促進計劃去補充其主要臨床服務(wù)。目前的活動包括為感染人群減少艾滋病毒風(fēng)險和健康促進計劃，有專門的活動面向不同的社區(qū)（例如，美國非洲婦女，年輕的拉丁美洲人）。許多這些項目用英語和西班牙語執(zhí)行。他們包括小組會議、推廣、查詢和與當(dāng)?shù)匦l(wèi)生組

58、織合作。 芬微提供戒煙教育（包括關(guān)于學(xué)校和機構(gòu)的教育介紹），支持團體和針灸治療。芬微還維持著在新英格蘭最大的男女同性戀者幫助和危機干預(yù)電話熱線。熱線的工作人員一周工作七夜，提供機密信息、介紹、危機干預(yù)并支持全國范圍內(nèi)的來電人士。 一個特別的熱線處理著年輕的同性戀者的憂慮。 芬微贊助社區(qū)健康教育工作研討、論壇和講座，已經(jīng)處理關(guān)于更新艾滋病治療、預(yù)防和自我保健戰(zhàn)略以及其他社區(qū)健康問題，例如肝炎。</p><p>&l

59、t;b>　　研究和評價部門</b></p><p>　　芬微最初是國家在1983年的第一個社區(qū)基礎(chǔ)型艾滋病研究項目，在1984年收到了一個國家聯(lián)邦資金。 芬微最初的研究是在十八世紀(jì)早期，致力于研究來自于在同性戀中發(fā)生的艾滋病泛濫問題。.在芬微的病人中，第一個艾滋病人被確診是在1981年，艾滋病流行病學(xué)研究隨之而來。第一個關(guān)于艾滋病預(yù)防和發(fā)生率的評估就來自位于新英格蘭的芬微研究。</p>

60、;<p>　　接近一百個經(jīng)過同行評議的出版物已經(jīng)由芬微與其他實驗室、診所和在哈佛大學(xué)、布朗大學(xué)的公共衛(wèi)生研究者合作出版。芬微已經(jīng)在艾滋病預(yù)防研究方面成為領(lǐng)導(dǎo)者，在最近與來自國家過敏和傳染病協(xié)會訂立合同，在布朗大學(xué)和印度南部作為財團的主要機構(gòu)。</p><p>　　這個研究和評估部門由超過三十個訓(xùn)練有素并且富有經(jīng)驗的工作人員組成，包括醫(yī)生、一名高級調(diào)查和研究―行為科學(xué)家、臨床心理學(xué)家、公共衛(wèi)生專業(yè)人員

61、、數(shù)據(jù)分析、管理事務(wù)專家、健康教育人員、護士、面試者和推廣人員。 芬微有一個機構(gòu)審查委員會，就像若干社會資訊委員會那樣幫助研究和臨床項目工作人員評估目前研究議程對于社會期望和需要的反應(yīng)能力。</p><p>　　隨著其不斷增加的在研究男同性戀者之間的性關(guān)系的健康憂慮問題方面的專業(yè)知識，芬微已經(jīng)制定了一個女同性戀者健康研究議程，符合逐漸擴大的女性診所項目，反映了社會的關(guān)注和支持。研究從女同性戀者的接近性到女同性戀者

62、性傳播疾病到替代受精的不同技術(shù)評估。</p><p><b>　　項目支持和可持續(xù)性</b></p><p>　　芬微社區(qū)衛(wèi)生中心開始是一家免費診所，以顧客的捐贈和部分來自于波士頓的財政支持維持。在過去的三十年里，芬微已經(jīng)成為一個先進的中心，支持通過各種渠道，包括病人私人保險以及醫(yī)療和醫(yī)療補助支付醫(yī)療費用和心理保健服務(wù)。其他政府主辦的項目可供符合特定程序的個體申請。還

63、有一個免費的醫(yī)療池，沒有一個人因為無法支付而被拒絕。</p><p>　　健康教育、服務(wù)評價和成為研究組成部分的衛(wèi)生中心通常由聯(lián)邦授予資金，包括來自于美國疾病控制和預(yù)防中心,衛(wèi)生資源及服務(wù)管理、美國國家衛(wèi)生研究院,藥物濫用和精神健康服務(wù)管理局和馬薩諸塞州的公眾健康部門提供資金。該中心繼續(xù)爭取獨立捐助者，公司和基金會和進行籌款活動。芬微在波士頓-紐約艾滋病人踏單車活動中是一個主要的受益者。</p>&

64、lt;p><b>　　下一步驟</b></p><p>　　芬微社區(qū)衛(wèi)生中心在過去的三十年里從一個社區(qū)衛(wèi)生中心轉(zhuǎn)變?yōu)橐粋€表明社區(qū)基礎(chǔ)同性戀者醫(yī)療服務(wù)能與其他創(chuàng)新和文化上的具體程序整合的模型。 基礎(chǔ)設(shè)施演變?yōu)閼?yīng)付復(fù)雜的艾滋病有助于推動一系列其他健康問題的威脅活動的發(fā)展的挑戰(zhàn)。我們希望芬微的非艾滋病健康計劃能持續(xù)下去直到公共衛(wèi)生官員認(rèn)識到同性戀者的特殊需要。</p><

65、p>　　即使其他社區(qū)可能不會選擇復(fù)制或提供所有芬微所提供的項目服務(wù)，可是我們希望這個報告能夠鼓勵當(dāng)?shù)赜懻摚龠M發(fā)展類似項目的其他設(shè)置。芬微社區(qū)衛(wèi)生中心的前提不是同性戀者不能接受保健提供者的服務(wù)或者同性戀者不是主要的焦點。相反地，芬微的獨特性，文化上的具體程序可以作為為同性戀者個體在全國各地提供醫(yī)療服務(wù)。目標(biāo)是為同性戀者個體，不管在哪里，使得接受文化上的理解和臨床服務(wù)成為可能。</p><p>　　在將來，芬