hce_nchu
112年
英文
第 38 題
📖 題組：
PASSAGE 4 Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities. The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives. Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their *whānau* to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their *whānau*. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care. Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies. Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their *whānau* in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and **refinement** of structural changes to ensure the efficacy for *whānau* Māori.
PASSAGE 4 Bipolar Disorder (BD) is one of several serious mental health conditions that has a significant impact on a person’s life, and contributes to a high degree of health burden worldwide. Research suggests that some Indigenous populations experience higher community prevalence rates of BD, including Māori the Indigenous peoples of New Zealand. A recent systematic review of BD in Indigenous peoples noted an extremely limited evidence base, recommending Indigenous research designed to identify the impact of systemic factors on current health inequities. The New Zealand health system, while planning reform, is currently structured hierarchically. This includes: primary care delivered by doctors in General Practice (GPs); community-based services; outpatient and inpatient hospital services delivered regionally by 20 District Health Boards (DHBs); and non-governmental organizations (NGOs). Mental health care for BD generally requires a GP referral to DHB services, and can include periods of inpatient or community-based treatment delivered by multi-disciplinary teams (MDT) within a psychiatric care model. The composition of services and teams can differ between DHBs, meaning experiences of care may change depending on where in New Zealand a person lives. Based on a qualitative Kaupapa Māori Research methodology, a recent study analyzed critique from Māori patients with Bipolar Disorder (BD) and their *whānau* to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. Three themes reflected patients’ critique of structural features of the New Zealand health system and their impact on service provision for Māori with BD and their *whānau*. The operational-accessibility sub-theme included patients’ critique of the hours of service operation, including clinic hours, visitation times, and ward rounds; as well as processes for scheduling appointments, and the impact of these processes on access to BD services for Māori. In addition, patients identified constraints through insufficient resources in specific services or environmental features of facilities that limited their access to culturally safe, competent and equitable health care. Structural factors also influenced accessibility of staff with specialist skills to treat Māori with BD, like psychiatrists, psychologists and Māori mental health workers. Patients recognized that staffing-accessibility reflected current recruitment and retention priorities, meaning improved accessibility for Māori required prioritization of staff with proven clinical and cultural competencies. Transformational change therefore requires a commitment to monitor and address institutional racism driving inequitable access to effective care for Māori with BD and their *whānau* in the health system. As New Zealand prepares for significant health system reform, a commitment to equity and implementation of previously recommended structural change is needed, along with ongoing evaluation and **refinement** of structural changes to ensure the efficacy for *whānau* Māori.
The word “refinement” as it is used in paragraph 5 most nearly means _______.
- A reduction
- B cultivation
- C refutation
- D denotation
- E deterioration
思路引導 VIP
當政府在推行一項新的社會制度時，如果初步實施後發現某些細節還不夠完美，需要透過不斷的微調、修正，將原本粗糙的草案打磨得更精緻、更成熟，這種「讓事物從初階狀態發展到更完美狀態」的過程，你會用什麼概念來形容它呢？
🤖
AI 詳解
AI 專屬家教
同學觀察得非常敏銳，恭喜你準確捕捉到了這個詞彙在學術語境中的深意！這類題目不僅考驗單字量，更考驗你對文章整體基調的掌握。
語境推論與詞義連結
在文章最後一段，作者討論的是紐西蘭醫療系統的「轉型變革」（transformational change）。文中提到，除了要對改革進行持續的評估（evaluation）之外，還必須對結構性變革進行 refinement，以確保其對毛利族群的實質成效。從上下文邏輯來看，這是一個將制度「精益求精」的過程。選項中的 cultivation 除了常見的「耕作、栽培」外，在社會科學或政策討論中，常用來指涉對制度、品質或關係的「培育、改進與精煉」，與 refinement 追求「更細緻、更完善」的目標不謀而合。
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