參段預防–殘障的限制與壓縮、復健.pptVIP

參段預防 – 殘障的限制與壓縮、復健 季瑋珠 參級預防或末段預防 藉各種臨床治療的方法，使患者早日康復，或使發生殘障者能恢復部份正常的身體、心理、社會、經濟等功能。又可分： 1. 限制殘障 (disability limitation)；殘障壓縮（compression of disability） 2. 復健 (rehabilitation) 是預防醫學長久以來不被重視的部份。 為什麼參級預防仍然是預防？ 參級預防是預防更壞的情況發生，而使已經患病的人身體心理和社會功能維持在某一狀態，或發揮潛能，恢復到某一程度。 三、殘障的發生與預防 殘障的定義 身心障礙者保護法1997.4.23.公佈 視覺障礙、聽覺機能障礙、平衡機能障礙 聲音機能或語言機能障礙 肢體障礙 智能障礙 重要器官失去功能、顏面傷殘 植物人、癡呆症、自閉症、慢性精神病 多重障礙、其他經中央衛生主管機關認定者 Definition of disability Protection Law for Physically and Mentally Disabled People 身心障礙者保護法1997.4.23.公佈 個人因生理或心理因素至其參與社會及從事生產活動功能受到限制或無法發揮，經鑑定符合中央衛生主管機關鎖定等級之下列障礙並領有身心障礙手冊者為範圍： 殘障的定義 依照時間 暫時性vs. 永久性 修辭學與倫理學的考量： 殘障、殘疾、失能、受挑戰（…. challenged） 依照範圍 impairment: organ system disability: performance handicap: social environment 殘障發生的原因 遺傳 先天與後天 傳染性與非傳染性疾病 災害與事故傷害 環境污染 自然老化等 殘障的預防 視各種疾病的自然史及造成殘障的原因而定 原因的消除 積極的治療 復健 殘障或功能障礙的測量 疾病的負擔（burden of disease）或殘障調整存活年數（disability-adjusted years，DALY） Murray and Lopez Global Burden of Diseases 健康相關的生活品質（health-related quality of life）或生活品質調整存活年數（quality-adjusted life years，QALY） Global Burden of Diseases/DALY Aims: 1. to aid in setting health service (both curative and preventive) priorities 2. to aid in setting health research priorities 3. to aid in identifying disadvantaged groups and targeting health interventions 4. to provide a comparable measure of output for intervention, programme and sector evaluation and planning Single indicator for health General concepts: 1. To the extent possible, any health outcome that represents a loss of welfare should be included in an indicator for health status. 2. The characteristics of the individual affected by a health outcome that should be considered in calculating the associated burden of disease should be restricted to age and sex 3. Treating like health outcomes as like. 4. Time is the unit of measure for the burden of disease. Indicators Incidence perspective: Mortality, Incidence, Prevalence Specific value choices in designing an indicator of burden The duration of time lost due to premature dea