Roghmann K J
Health Serv Res. 1985 Feb;19(6 Pt 2):887-943.
This background review has attempted to pinpoint problems and issues of intervention strategies to promote health among children. Some traditional interventions as they are now provided in preventive service packages, for example, are critically assessed; new interventions like neonatal intensive care, prenatal diagnosis, periconceptional vitamin supplementation, and nutritional supplementation during later pregnancy are welcome; supportive outreach services through nurse home visitors to bring proved technologies to those in greatest need, while they may not be new have shown renewed effectiveness. Recently recognized problems like the "new morbidity," and newly recognized prevention potentials like the great prospects for accident prevention, adequate school health programs, and special adolescent care programs are promising areas for preventive services effectiveness. We do not claim that a comprehensive list has been presented. Rather, an attempt has been made to challenge some traditional preventive techniques, e.g., preoperative x-rays, to stimulate thinking about new organizational forms of care delivery, and to keep an open agenda. As a result, the reader will feel a "lack of closure"--challenges without definitive answers. The general assertion is that personal preventive care is only weakly related to health and that preventive care delivery is not a simple technical problem. Let me summarize the main points. First, the lack of evidence and comprehensiveness. Other reviews of preventive care packages could have been discussed. The presentation by Fielding [164] in the Institute of Medicine's background papers to Healthy People also includes service listings for pregnant women, normal infants, preschool children, schoolchildren, and adolescents. The Lifetime Health-Monitoring program by Breslow and Somers [165] set goals and services that have already become practice patterns for large parts of the country. Many more cost-effectiveness studies of immunizations and screenings could have been cited. The point, however, is not whether technologies with the potential for prevention exist, but whether these technologies have been used and are now used effectively for that purpose, and whether their performance in the real world represents the best use of scarce and expensive resources. Scientific evidence of organized delivery effectiveness is rare.(ABSTRACT TRUNCATED AT 400 WORDS)
本背景综述试图明确促进儿童健康的干预策略中存在的问题。例如，对目前预防性服务套餐中提供的一些传统干预措施进行了批判性评估；新生儿重症监护、产前诊断、孕期维生素补充以及孕晚期营养补充等新干预措施受到欢迎；通过护士家访提供支持性外展服务，将已证实的技术带给最有需要的人群，这些服务虽可能并不新颖，但已显示出新的成效。近期认识到的问题如“新发病症”，以及新发现的预防潜力如事故预防、完善的学校健康项目和特殊青少年护理项目的广阔前景，都是预防性服务有效性的有前景领域。我们并非声称已列出了一份全面的清单。相反，我们试图对一些传统预防技术提出质疑，例如术前X光检查，以激发对新的护理提供组织形式的思考，并保持开放的议程。结果，读者会感到“缺乏定论”——只有挑战而没有明确答案。总体而言，个人预防性护理与健康的关联较弱，且预防性护理的提供并非一个简单的技术问题。让我总结一下要点。首先，缺乏证据和全面性。本可讨论其他预防性护理套餐综述。菲尔丁在医学研究所为《健康人民》撰写的背景文件中的陈述，也包括了针对孕妇、正常婴儿、学龄前儿童、学童和青少年的服务清单。布雷斯洛和萨默斯的终身健康监测项目设定的目标和服务，已在该国大部分地区成为实践模式。本可引用更多关于免疫接种和筛查的成本效益研究。然而，关键不在于是否存在具有预防潜力的技术，而在于这些技术是否已被使用且目前是否有效地用于该目的，以及它们在现实世界中的表现是否代表了对稀缺且昂贵资源的最佳利用。有组织的护理提供有效性的科学证据很少。（摘要截选至400字）
