社區(qū)衛(wèi)生演變模型外文翻譯

1、<p>　　本科畢業(yè)設(shè)計(jì)（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(shí)地行動(dòng)報(bào)告</b></p><p>　　芬微社區(qū)衛(wèi)生中心是由社區(qū)活動(dòng)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(lái)的，在十年內(nèi)迅速擴(kuò)大它針對(duì)于同性戀艾滋病問(wèn)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(wèn)題上面，專(zhuān)業(yè)知識(shí)和文化理解在逐漸增長(zhǎng)，這導(dǎo)致了為解決更多社會(huì)關(guān)注的醫(yī)療服務(wù)范圍的擴(kuò)大，從藥物的使用問(wèn)題到家庭的養(yǎng)育問(wèn)題，同性暴力，以及為女同性戀者、雙性戀者和變性人個(gè)體設(shè)置的專(zhuān)門(mén)程序。</p><p>　　芬微開(kāi)始是一個(gè)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(mén)記錄了8361名病人50850次的就診情況，包括超過(guò)1100次個(gè)體關(guān)于艾滋病的檢測(cè)。該中心現(xiàn)在有超過(guò)170名工作人員負(fù)責(zé)臨床項(xiàng)目，包括社區(qū)教育、研究、管理、規(guī)劃和發(fā)展。在過(guò)去的幾年里，芬微每年的年度預(yù)算已經(jīng)超過(guò)一千萬(wàn)美元。</p><p>　　芬微已經(jīng)確立了為提升關(guān)于同性戀健康問(wèn)題的文化理解的標(biāo)準(zhǔn)，并在同性戀健康問(wèn)題上所特有的憂慮方面上的建立項(xiàng)目去教育普通社會(huì)成員。這個(gè)健康中心

52、可以提供一個(gè)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(qiáng)調(diào)為同性戀者提供服務(wù)。 芬微是九個(gè)美國(guó)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(zhuān)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(wèn)題和戒毒問(wèn)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(yíng)養(yǎng)療法，健康促進(jìn)計(jì)劃，社區(qū)教育項(xiàng)目，防止家庭暴力和同性暴力的項(xiàng)目，子女養(yǎng)

53、育問(wèn)題的項(xiàng)目以及包括替代受精的家庭計(jì)劃服務(wù)。</p><p>　　芬微已經(jīng)發(fā)展了獨(dú)一無(wú)二的項(xiàng)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(xiàng)目已經(jīng)被外部監(jiān)督機(jī)構(gòu)，包括聯(lián)邦機(jī)構(gòu)評(píng)估，已經(jīng)在美國(guó)其他地方推廣開(kāi)展。芬微還發(fā)展了有效的專(zhuān)業(yè)教育項(xiàng)目，參與培訓(xùn)的醫(yī)療專(zhuān)業(yè)的學(xué)生，居民，社會(huì)工作人員、其他專(zhuān)職醫(yī)療專(zhuān)業(yè)人員、相關(guān)健康專(zhuān)業(yè)人士以及很多動(dòng)作人員都被任命在當(dāng)?shù)貙?zhuān)

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

55、場(chǎng)精神檢測(cè)和其他預(yù)防服務(wù)，包括強(qiáng)調(diào)減少程序，營(yíng)養(yǎng)輔導(dǎo)和濫用藥物治療。需要住院治療的病人會(huì)被在貝絲雅各醫(yī)療中心的芬微醫(yī)療護(hù)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(huì)工作人員提供一系列的精神健康服務(wù)，包括個(gè)人、團(tuán)體、夫婦和家庭治療以及精神類(lèi)藥品評(píng)價(jià)管理，其中包括24小時(shí)呼叫機(jī)處理緊急情況

56、。這個(gè)部門(mén)管理一個(gè)位于新英格蘭最大的艾滋病毒咨詢(xún)和檢測(cè)站，提供艾滋病人個(gè)體攜帶艾滋病毒的個(gè)體的團(tuán)體支持，需要維持低風(fēng)險(xiǎn)行為的支持。</p><p>　　芬微已經(jīng)制定了一項(xiàng)計(jì)劃服務(wù)于國(guó)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(jī)咨詢(xún)和長(zhǎng)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(zhuān)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(zhuān)家會(huì)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(huì)教育</b></p><p>　　多年來(lái)，芬微已經(jīng)制定了一個(gè)綜合社會(huì)教育和健康促進(jìn)計(jì)劃去補(bǔ)充其主要臨床服務(wù)。目前的活動(dòng)包括為感染人群減少艾滋病毒風(fēng)險(xiǎn)和健康促進(jìn)計(jì)劃，有專(zhuān)門(mén)的活動(dòng)面向不同的社區(qū)（例如，美國(guó)非洲婦女，年輕的拉丁美洲人）。許多這些項(xiàng)目用英語(yǔ)和西班牙語(yǔ)執(zhí)行。他們包括小組會(huì)議、推廣、查詢(xún)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(jī)構(gòu)的教育介紹），支持團(tuán)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(jī)干預(yù)電話熱線。熱線的工作人員一周工作七夜，提供機(jī)密信息、介紹、危機(jī)干預(yù)并支持全國(guó)范圍內(nèi)的來(lái)電人士。 一個(gè)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(wèn)題，例如肝炎。</p><p>&l

59、t;b>　　研究和評(píng)價(jià)部門(mén)</b></p><p>　　芬微最初是國(guó)家在1983年的第一個(gè)社區(qū)基礎(chǔ)型艾滋病研究項(xiàng)目，在1984年收到了一個(gè)國(guó)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(lái)自于在同性戀中發(fā)生的艾滋病泛濫問(wèn)題。.在芬微的病人中，第一個(gè)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(lái)。第一個(gè)關(guān)于艾滋病預(yù)防和發(fā)生率的評(píng)估就來(lái)自位于新英格蘭的芬微研究。</p>

60、;<p>　　接近一百個(gè)經(jīng)過(guò)同行評(píng)議的出版物已經(jīng)由芬微與其他實(shí)驗(yàn)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(lái)自國(guó)家過(guò)敏和傳染病協(xié)會(huì)訂立合同，在布朗大學(xué)和印度南部作為財(cái)團(tuán)的主要機(jī)構(gòu)。</p><p>　　這個(gè)研究和評(píng)估部門(mén)由超過(guò)三十個(gè)訓(xùn)練有素并且富有經(jīng)驗(yàn)的工作人員組成，包括醫(yī)生、一名高級(jí)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(zhuān)業(yè)人員

61、、數(shù)據(jù)分析、管理事務(wù)專(zhuān)家、健康教育人員、護(hù)士、面試者和推廣人員。 芬微有一個(gè)機(jī)構(gòu)審查委員會(huì)，就像若干社會(huì)資訊委員會(huì)那樣幫助研究和臨床項(xiàng)目工作人員評(píng)估目前研究議程對(duì)于社會(huì)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(wèn)題方面的專(zhuān)業(yè)知識(shí)，芬微已經(jīng)制定了一個(gè)女同性戀者健康研究議程，符合逐漸擴(kuò)大的女性診所項(xiàng)目，反映了社會(huì)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(píng)估。</p><p><b>　　項(xiàng)目支持和可持續(xù)性</b></p><p>　　芬微社區(qū)衛(wèi)生中心開(kāi)始是一家免費(fèi)診所，以顧客的捐贈(zèng)和部分來(lái)自于波士頓的財(cái)政支持維持。在過(guò)去的三十年里，芬微已經(jīng)成為一個(gè)先進(jìn)的中心，支持通過(guò)各種渠道，包括病人私人保險(xiǎn)以及醫(yī)療和醫(yī)療補(bǔ)助支付醫(yī)療費(fèi)用和心理保健服務(wù)。其他政府主辦的項(xiàng)目可供符合特定程序的個(gè)體申請(qǐng)。還

63、有一個(gè)免費(fèi)的醫(yī)療池，沒(méi)有一個(gè)人因?yàn)闊o(wú)法支付而被拒絕。</p><p>　　健康教育、服務(wù)評(píng)價(jià)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(lái)自于美國(guó)疾病控制和預(yù)防中心,衛(wèi)生資源及服務(wù)管理、美國(guó)國(guó)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(mén)提供資金。該中心繼續(xù)爭(zhēng)取獨(dú)立捐助者，公司和基金會(huì)和進(jìn)行籌款活動(dòng)。芬微在波士頓-紐約艾滋病人踏單車(chē)活動(dòng)中是一個(gè)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(guò)去的三十年里從一個(gè)社區(qū)衛(wèi)生中心轉(zhuǎn)變?yōu)橐粋€(gè)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(dòng)一系列其他健康問(wèn)題的威脅活動(dòng)的發(fā)展的挑戰(zhàn)。我們希望芬微的非艾滋病健康計(jì)劃能持續(xù)下去直到公共衛(wèi)生官員認(rèn)識(shí)到同性戀者的特殊需要。</p><

65、p>　　即使其他社區(qū)可能不會(huì)選擇復(fù)制或提供所有芬微所提供的項(xiàng)目服務(wù)，可是我們希望這個(gè)報(bào)告能夠鼓勵(lì)當(dāng)?shù)赜懻?，促進(jìn)發(fā)展類(lèi)似項(xiàng)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(diǎn)。相反地，芬微的獨(dú)特性，文化上的具體程序可以作為為同性戀者個(gè)體在全國(guó)各地提供醫(yī)療服務(wù)。目標(biāo)是為同性戀者個(gè)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(lái)，芬