社区资源互惠模式与运作ppt课件

1、社區資源互惠方式與運作 Round table與談人張進順 DDS, MPH, PhD.台灣口腔衛生學會理事長 2021年台灣安康促進學校學術研討會 98/10/22產、官、學、社整合方式全民口腔衛生運動舉辦全市美齒小姐選拔及 學童健牙活動 基隆市國中、小學童B型肝炎篩選及流行病學調查與宣導大 型計劃(對象近六萬名國中、小學童)基隆市四十歲以上婦女安康篩選與照顧計劃老人安康檢查與照顧計劃殘障者之安康檢查與照顧計劃養老、防老、尊老活動及晨間社區衛教計劃台灣山地鄉口腔醫療保健服務計畫 青少年牙周疾病防治計畫 糖尿病共同照護網口腔安康照護計畫校牙醫師進駐健促校園服務計畫 胜利推動安康計畫之中心思念與

2、方法實踐渥太華憲章中安康促進的五大行動綱領實踐根本安康照護的四大執行战略遵守實證基礎之有效介入措施整合口腔衛生議題于普通衛生計畫事前評估、事中監測、事後評價Ottawa Charter for Health Promotion WHO 1986Five action areas:Building healthy public policyCreating supportive environmentsStrengthening community actionDeveloping personal skillsRe-orientating health services Oral health

3、 promotion is defined as the use of these actions to pursue oral health goalsSprod et al 1996Implementation strategies of PHCIntersectoral CollaborationIntrasectoral CollaborationCommunity ParticipationPolitical SupportComprehensive primary oral health care Source: WHO, 1978Evidence-Based Oral Healt

4、h Promotion 表一策略健康影響實證的類型潛在的健康獲益建立健康的公共政策(Building healthy public policy)提倡/推動。社區意識的提升可以導致健康的公共政策的發展V-專家意見2-可能有利建置支援的環境(Creating supportive environments)飲水加氟/食鹽加氟齲齒的預防和控制I-良好的系統性回顧1-有利含氟牙膏提供即時性的齲齒控制I-良好的系統性回顧1-有利在疾病明顯發作之前能提供一種診斷服務的機會(就醫方便性)在健康行為有影響力改變和牙齒的齲的預防和控制IV-設計良好的觀察系統2-可能有利。早期偵查和預防措施介入有潛在性的益處代

5、糖的使用齲齒的預防和控制II-至少有一篇好的隨機控制試驗3-在有利和不利的效應之間。臨床試驗已經建立效力，但是因副作用而限制用途。場所途徑。使用場所和社會環境可以促進並且支援身體健康。對健康行為有影響力改變。II-至少有一篇好的隨機控制試驗2-可能有利以學校為基礎對健康行為改變有影響力。IV-設計得很好的觀察研究2-可能有利以工作場所為基礎對健康行為改變有影響力。IV-設計得很好的觀察研究4-未知好處加強社區活動(Strengthening community action)社區發展V-專家建議。2-可能有利團體介入基層衛生人員，藥劑師，婦幼護士對健康行為改變有影響力。V-專家建議。4-未知有

6、利學齡前兒童和父母對健康行為改變有影響力，可以預防和控制齲齒III-良好設計的介入性研究1-有利青少年對健康行為改變有影響力IV-良好設計的觀察性研究2-可能有利老人對健康行為改變有影響力V-專家意見4-未知有利Evidence-Based Oral Health Promotion 表二策略健康影響實證的類型潛在的健康獲益發展個人技能(Developing personal skills)口腔衛生指導牙菌斑控制。(包 括使用牙間刷、牙線)對健康行為改變有影響力，以及牙周疾病的預防和控制I-至少一篇良好系統性回顧1-有利牙間刷牙周疾病的預防和控制I-至少一篇良好系統性回顧1-有利刷牙合併使用含

7、氟牙膏齲齒的預防和控制I-至少一篇良好系統性回顧1-有利定期看牙醫在健康行為改變有影響力IV-設計良好的觀察性研究2-可能有利戒菸建議口腔癌的預防和控制I-至少一篇良好系統性回顧1-有利飲食的建議在健康行為改變有影響力V-專家意見2-可能有利運動中護牙套防止口腔的創傷IV-設計良好的觀察性研究2-可能有利氟化物(自我使用，例如，含氟 漱口水，氟化物，氟錠，滴劑)齲齒的預防和控制I-至少一篇良好系統性回顧1-有利健康服務再次定向(Re-orientating health services)氟化物(例如使用氟膠，氟漆等 等)齲齒的預防和控制I-至少一篇良好系統性回顧1-有利使用溝隙封閉劑。 對易

8、受影響的牙齒表面的耐酸黏 著的薄層應用齲齒的預防和控制I-至少一篇良好系統性回顧1-有利牙結石清除牙周疾病的預防和控制I-至少一篇良好系統性回顧2-可能有利Evidence-based Effective Oral Health InterventionsEvidence base summary of oral health interventions (1) WHO, 2005TopicReferenceReview typeSummary findingsWater fluoridationSalt FluoridationLocker (1999) (10)McDonagh et al

9、 (2000) (11)Systematic reviewsLevel of Evidence I; Strength of Recommendation A. Quality of studies low to moderateEstimated caries preventive effect 14% reductionEffect tends to be greatest in primary dentitionTopical fluoridesMarinho et al. (2002) (12)Marinho et al. (2002) (13)Marinho et al. (2003

10、) (14)Marinho et al. (2003) (15)Marinho et al. (2003) (16)Marinho et al. (2004) (17)Marinho et al. (2004) (18)Cochrane reviewsLevel of Evidence III; Strength of Recommendation A.Specific reductions in caries rates were estimated to be 24% for fluoride toothpaste, 26% for mouth rinses, 28% for gels a

11、nd 46% for varnishes. Overall estimate of benefit was 26% in permanent dentition and 33% in primary dentitionEvidence base summary of oral health interventions (2) WHO, 2005TopicReferenceReview typeSummary findingsFissure sealantsAhovuo-Saloranto et al. (2004) (19)Cochrane review; Level of Evidence

12、I;Strength of Recommendation A.Caries reductions ranging from 86% at 12 months to 57% at 48 months were achieved. The level of effectiveness is dependent upon the baseline caries rateDental health educationBrown (1994) (20)Schou & Locker (1994) (21)Kay & Locker (1996) (22)Sprod et al. (1996) (23)Kay

13、 & Locker (1997) (24)Effectiveness reviewMajority of interventions health education in natureShort-term improvements in oral health knowledge achieved, but effects on behaviour and clinical outcomes limitedProvision of health information alone did not produce long-term behaviour changesSchool-based

14、toothbrushing campaigns ineffective at improving oral hygieneNo evidence on effectiveness of dietary intervention to reduce dental cariesMass media campaigns are ineffective at promoting either knowledge or behaviour changeStudy design and evaluation quality generally poorEvidence base summary of or

15、al health interventions (3) WHO, 2005TopicReferenceReview typeSummary findingsPeriodontal healthWatt & Marinho (2005) (25)Systematic reviewInterventions all involved health educationShort-term reductions in plaque and gingival bleeding achieved in many studies. Clinical and public health significanc

16、e of these changes questionableEvaluation quality generally poorScreening for oral cancerKujon et al. (2003) (26)Cochrane reviewsVery few high-quality studies were identifiedOne randomized controlled trial found no difference in age=standardized oral cancer mortality rates for screened groupNo evide

17、nce to support or refute the use of visual examination or other methods of screening for oral cancer Evidence-Based Oral Health PromotionEVIDENCE-BASED ORAL HEALTH PROMOTIONSTRATEGY HEALTH IMPACTSTYPE OF EVIDENCEBUILDING HEALTHY PUBLIC POLICYAdvocacyat all levelsCommunity awareness raisedExpert opin

18、ionCREATING SUPPORTIVE ENVIRONMENTSWater FluoridationSalt Fluoridation Prevention & control of cariesGood systematic Fluoride toothpastesreviewsSucrose substitutesPrevention & control of caries1 or more good RCTsAccess to Clinical ExamInfluences behavioral change Well-designed studies Use of workpla

19、ces etc toInfluences behavioral change1 or more RCTspromote & sustain good oral healthSTRENGTHENING COMMUNITY ACTIONCommunity developmentInfluences behavioral changeExpert adviceGroup health education Influences behavioral change Observational studies(Primary health workers; and expert advicePre-sch

20、ool children & parents;Adolescents; Older persons)EVIDENCE-BASED ORAL HEALTH PROMOTIONSTRATEGY HEALTH IMPACTS TYPE OF EVIDENCEDEVELOPING OF PERSONAL SKILLSOral hygiene instruction Plaque control (inc. flossing) Health behavior change Good systematic reviews & prevention, control perio. Tooth brushin

21、g Prevention, control caries Good systematic reviews(with fluoride toothpaste)Access to regular dental care Health behavior change Good observational studiesDietary advice Health behavior change Expert opinionSmoking cessation advice Prevention, control oral cancer Good systematic reviewsMouth guards Prevention oral trauma Good observatio