Transcript 1先進國家身心障礙者口腔醫療保健照護概況1

2008 身心障礙者口腔照護日
凝聚力量!
為身心障礙者口腔照護願景努力!
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先進國家身心障礙者口腔醫療
保健照護概況
12.13.2008 黃淳豐
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D N A 時代
•柳澤敬子 日作家
•研究是人類心靈智慧的遺產,正因為如此它應該
是日新又新的.但是,當人類的貪婪還有科技研發
掛勾的時候,也就是問題的根源.
•基因發生突變表示人類基因正設法藉由多樣化來
適應環境,基因多樣化就會衍生疾病.就全體人類
而言沒有所謂有害基因,如果我們認為那是有害
基因,是因為我們的社會不好.身障者替帶我們背
起了重擔!
柳澤敬子曾表示，「任何研究，都不應該違反自然。當基因庫發
生突變時，就表示人類的基因正設法藉由多樣化來適應環境。」
「當基因在多樣化的情況下，一定會帶來疾病，所以會有一定比
例的新生兒有嚴重的先天性瑕疵。如果有人生來殘缺，碰巧不是
你或我，那是因為殘缺者代我們背起了重擔，我們必須竭盡所能
對他們伸出援手。」 邱麗文
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世界人權宣言
•人人生而自由，在尊嚴和權利上
一律平等。
•人人各賦理性與良知 ，應以手足
精神相對。
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DISABILITY AND REHABILITATION
WHO ACTION PLAN 2006-2011
•VISION:
All persons with disabilities live in
dignity, with equal rights and
opportunities
身障者有其尊嚴平等權利與機會
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「國際接軌---權利躍進」
• 聯合國「身心障礙者權利公約」(The Convention on the
Rights of Persons with Disabilities)， 2006年8月在
108個締約國同意下通過，並於2008年5月3日正式生效
• 身心障礙者人口數在2007年底已達102萬760人，約佔全國
人口的4.45%，政府於2007年7月11日公佈「身心障礙者權
益保障法」
健康權 教育權 就業權 經濟安全權 人身安全權
第24條:直轄市,縣(市)衛生主管機關應依據身心障礙者人
口數及就醫需求,指定醫院設立身心障礙者特別門診.
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DISABILITY AND REHABILITATION
WHO ACTION PLAN 2006-2011
MISSION:To enhance the quality of life for persons with disabilities through
national, regionaland global efforts to:
• Raise awareness about the magnitude and consequences of disability
• Facilitate data collection and analyse or disseminate disability-related
data and information
• Support, promote and strengthen health and rehabilitation services for
persons with disabilities and their families
• Promote community based rehabilitation (CBR)
• Promote development, production, distribution and servicing of assistive
technology
• Support the development, implementation, measuring and monitoring of
policies
• to improve the rights and opportunities for people with disabilities
• Build capacity among health and rehabilitation policy makers and service
providers
• Foster multisectoral networks and partnerships
1.對身障者認知2.蒐集分析解釋相關身障資訊3.支持促進與增強對身障者和家屬健康
與復權之服務4.促進以社區為基礎之復權5.促進輔助技術之發展製造散佈與服務6.支
持政策發展推行執行與監測7.為身障者爭取權利與機會8.對身障健康與復權政策擬定
者與提供服務者提升其能力(賦能)9.促進與其他領域結盟與合作關係
套入口腔醫療保健或其他照護
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DISABILITY AND REHABILITATION
WHO ACTION PLAN 2006-2011
1.對身障者認知
2.蒐集分析解釋相關身障資訊
3.支持促進與增強對身障者和家屬健康與復權之服
務
4.促進以社區為基礎之復權
5.促進輔助技術之發展製造散佈與服務
6.支持政策發展推行執行與監測
7.為身障者爭取權利與機會
8.對身障健康與復權政策擬定者與提供服務
者提升其能力(賦能)
9.促進與其他領域結盟與合作關係
套入口腔醫療保健或其他照護
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美國身心障礙者重要法案之陳述
•2001 P.L.107-110
沒有落後的孩子法案(No Child Left Behind Act；
NCLB)
加強《中小學教育法案》並擴大了聯邦政府對中
小學教育的管理。並指明特殊教育教師必須具備
高的品質；特殊教育的學生必須參加州內所舉辦
的統考
(陳麗如 長庚大學 教育學程中心助理教授)
身心障礙孩童是國家孩子
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美國身心障礙者重要法案之陳述
•美國直接對身心障礙者服務之法案主要有
四類 :
一為教育法案，二為復健法案，
三為權益法案，四為輔助性科技法案。
(陳麗如 長庚大學 教育學程中心 助理教授)
為了對障礙者的服務更符合時代趨勢，我國相關人
員在掌握特殊教育工作時，亦可參考美國相關的法
案內涵，以使特殊教育的服務工作更全面性，精神
更能適當地發揮。
台東特教 93 年6 月 第19 期 第41-47 頁
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2020健康國民白皮書計畫
970125全國衛生行政會議總結報告
身心障礙組
目標與策略
何時誕生身心障礙者口腔健康白皮書?
• 初級預防
婚前健檢與各項新生兒服務之落實、促進身心障礙者
之健康
• 二級預防
通報系統及早期診斷、療育人力之提供、維持身心障
礙者之健康狀態，避免惡化
• 三級預防
輔具開發及復建支持、持續治療及就醫可近性、提供
機構照護或協助居家照護網絡、成立身心障礙特別門診
• 建立身心障礙醫療使用及相關研究
國家衛生研究院衛生政策研發中心郭耿南主任
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2020健康國民白皮書計畫
(970125全國衛生行政會議總結報告)
身心障礙組建議:
•應以生命歷程觀點來探討
•未來將依聯合國ICF制度，重新歸類與
鑑定身心障礙人口。
? ? ?
國家衛生研究院衛生政策研發中心郭耿南主任
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美 國
• 2008 人口 305,508,000
• 2007 GDP Per capita $ 45,251
• 學習環境
Problem Based Learning (PBL) ,Case-Based Learning
Specific task appropriate skills
Community service ,research and discovery
• 校外服務:預防保健教育與服務,社區服務
• 建議:更多專業人員一起關懷身障人士,醫學院教育納入相
關身障課程,鼓勵學生參與社區服務幫助身障者.
Pro. Eugene Sekiguchi (USC南加大,USA.)
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口腔健康在美國
•如果你無法保持口腔健康，那麼你將不能稱為一
個健康的人。忽視口腔健康問題將遭到不必要的
痛苦及疼痛，而且可能導致嚴重的併發症，增加
社會成本以及財政支出，並降低生活品質。更強
調”口腔健康並不只是健康的牙齒”，口腔健康
是整體健康的一部份，如果口腔不健康，那就不
算真正的健康“。
美國公共衛生及人力資源部總監報告
• 口腔健康照護專業專職人員的需求
口腔醫學院 口腔衛生學系系主任 黃純德 引述
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身障者就醫便利性
To Increase Access for
Special Needs Patients
More oral health professionals must care for
special needs patients
Dental school curriculum must include more
didactics and clinical experience for treatment of
special needs patients.
Community service clinical learning is an efficient
way for students to learn to treat special needs
patients.
(And it should be mandated that all practicing
dentists have basic knowledge so they are able
to treat special needs patients.)
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•更多口腔健康專業人
員參與
•牙醫養成教育課程包
括更多教誨性與臨床
經驗
•社區身障者服務與臨
床經驗學習對醫學教
育養成具相當影響力
(我們要求一般開業牙
醫師應該有基本治療
身障者能力)
Pro.Eugene Sekiguchi (USC南加大,USA.)演講資料
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牙科鑒定制度
相關牙科領域標準制定
CODA Accreditation
Commission on Dental Accreditation
(CODA)
The Commission on Dental Accreditaion
serves the public by establishing,
maintaining and applying standards that
ensure the quality and continuous
improvement of dental and dental related
education and reflect the evolving practice
of dentistry. The scope of the Commission
on Dental Accresitation encompasses dental,
advance dental and allied dental education
programs
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Pro. Eugene Sekiguchi (USC南加大,USA.)演講資料
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從出生到死亡口腔教育與經驗
Queen’s Care Mobile Clinic
USC Mobile Clinic
Union Rescue Mission
BIRTH
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Children’s Hospital of LA
School Sealant Project
Children’s Dental Center
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LAC/USC Medical Center
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Solis Dental Arts Center
Lifeline & Dental
Educational
Experiences,
November 2002
VA Health Systems,
Long Beach
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70
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Hollenbeck Home
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DEATH
Pro. Eugene Sekiguchi (USC南加大,USA.)演講資料
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美國身障者牙醫養成教育課程
Curriculum for Treatment of
Special & Medically Compromised
Patients at the USC School of
Dentistry
Eugene Sekiguchi DDS, MSEE, BSEE
Professor
A ssociate Dean for International, Professional and Legislative A 32
ffairs
Director of the A dvanced Standing Program for International Dentists
Pro. Eugene Sekiguchi (USC南加大,USA.)演講資料
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校外服務學習
Extramural Service
PREVENTI ON Learning MOBI LE CLI NI C
Educating Local Children
on Oral Health
17 TRAILERS
& COACHES
Sealant Process as shown to
school kids
Pro. Eugene Sekiguchi (USC南加大,USA.)演講資料
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服務學習
學習服務中心
USCSD Objectives: Service Learning “Community Clinical Education”
• Develop community programs in partnership with nonnon-profit
and forfor-profit sectors including school districts,
governmental agencies, public benefit organizations and
other health care professionals.
• Develop a variety of mobile (mobile clinics), portable
(preschool, KK-12 school site programs) and stationary
(operatories in clinics or hospitals) to provide oral health
care delivery experiences for all students.
• While providing service, learn and experience the variety of
cultural interactions and influences on oral health.
• 與營利或非營利單位,
包括學校,政府機關,
公營事業組織,健康
照護專業等發展社區
合作計劃
• 研發攜帶式牙醫診療
設備,提供學生口腔
健康照護學習機會
• 當我們提供服務時,
學習與經歷不同文化
相互激盪對口腔健康
之影響
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Pro. Eugene Sekiguchi (USC南加大,USA.)演講資料
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To find disability organizations or agencies
in your area, click on your home state:
Alabama Alaska Arizona Arkansas California
Colorado Connecticut Delaware District of Columbia
Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas
Kentucky Louisiana Maine Maryland Massachusetts
Michigan Minnesota Mississippi Missouri Montana Nebraska
Nevada New Hampshire New Jersey New Mexico
New York North Carolina North Dakota Ohio Oregon
Pennsylvania Rhode Island South Carolina South Dakota
Tennessee Texas Utah Vermont Virginia Washington
West Virginia Wisconsin Wyoming
美國各州從網站得到身障照護資訊
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• Dental Care for People With Disabilities
Currently...
Over 20 percent of the U.S. population has a
disability. These disabilities can be present at
birth and last throughout life or they can develop
later in life. Disabilities can range from mild to
severe and may affect the mind or the body or both.
People with disabilities usually have more dental
problems than those who do not have a disability.
Some people with disabilities need no help with
brushing or flossing. Others may need just a
little help. Some may depend completely on others
to provide their dental care. It is very important
to look at the person's specific needs to help
find what works best for their dental care.
舉例維吉尼亞州健康部關心身障者口腔預防保健網站內容
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• What are some dental concerns for those with
disabilities?
• Cavities - seen often in those who have problems
brushing and flossing
• Gum disease - seen often in those who have
problems bushing and flossing
• Harmful oral habits - grinding teeth, pushing on
teeth with tongue
• Trauma to the mouth or teeth - damage from falls
or seizures
• Side effects of medications - some dry the mouth
or cause gum tissue to over grow
身心障礙者關心哪些口腔問題?
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• What can be done to help those with disabilities with dental
care?
• Use toothpaste that has fluoride in it
• Have dental sealants placed by a dentist
• Ask about the side effects of medicines that you are taking
• If possible, switch to medicines that have fewer oral side
effects
• Swish with water after taking liquid medicines containing
sugar
• Drink a lot of water each day
• Eat a well-balanced diet, limit sugary sweets and snacks
• Adapt tooth brushes to make them easier to hold
• Use electric toothbrushes, floss and floss handles
我們能為身心障礙者做些什麼口腔照護?
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www. disability resources org.
(U.S.A.)
• DECOD Referral Service
• Dentistry for the Disabled Child and Adult
• National Oral Health Information Clearinghouse
(NOHIC)
• Federation of Special Care Organizations in
Dentistry - Academy of Dentistry for Persons with
Disabilities (ADPD)
• International Association for Disability and Oral
Health (IADH)
身心障礙者資源組織機構
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Americans with Disabilities Act of
1990 (George H. W. Bush )
•The Americans with Disabilities Act (ADA)
is a federal law the prohibits
discrimination against a person with a
disability who is seeking employment or
access to services, including dental
services. The law was enacted in
1990. Under Title 3 of this law, a private
dental office is considered a place of
public accommodation. As of January 26,
1992, this law requires dentists to serve
persons with disabilities.
美國身障法案,立法要求牙醫師服務身障者
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Americans with Disabilities Act
of 1990
• The law requires that you treat the person with a
disability on the same basis as you treat nondisabled patients. If, however, the disabled
patient requires a procedure for which you would
ordinarily refer a non-disabled patient, you may
legally refer the disabled patient as well.
• You are required to make reasonable modifications
to facilitate access to your office by persons
with diabilities unless it can be shown that
taking those steps would result in an "undue
burden" or fundamentally alter the nature of the
services you provide
美國身障法案以相同方式對待身障者和一般人
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Americans with Disabilities Act
of 1990 (July 26)
•美國身心障礙福利法（ADA）的定位是相當於身心
障礙者基本權利保障的憲法，任何其他法案的精
神如果與這個法案的精神、規定相違背或不一致
的地方，必須以ADA 法案為最後的判準依據
（Silverstein 2000），總而言之美國政府是以
ADA 法案做為整個身心障礙者政策的最高指導原
則，而聯邦政府的具體做為是訂定該法規範的最
低實踐標準，各州政府依此準則自訂當地的實行
細則。(身心障礙者人權與福利政策發展
嚴嘉楓 林金定)
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