政府采购协定（GPA）框架下引入ISO 9000体系认证的疾控后勤管理模式构想△

在政府采购协议（GPA）框架下，结合已有的物资管理系统构建适应疾控系统后勤管理的ISO　9000认证体系，实现后勤管理的标准化、科学化和精细化建设。该文从未来GPA适用性出发，构建适应疾控后勤服务管理的ISO　9000体系，大幅度提高采购的效率和范围，并与物资管理信息系统有机结合，形成一个完整、科学、标准化、量化的后勤管理质量管理体系。     

我国与GPA成员方及印度制剂产业外贸竞争力比较研究

产业的外贸竞争力决定其国际市场份额。对我国与GPA成员方以及印度的制剂产业外贸竞争力比较研究发现：我国制剂出口的国际市场占有率不足1%,贸易竞争优势指数为负值,显示性比较优势指数长期处于较低水平,制药产业外贸竞争力不仅与GPA成员相差悬殊,甚至明显落后于印度。因此,在我国制剂产业外贸竞争力取得长足进步之前,加入GPA难以改变目前我国单方面开放医药市场的现状,对我国制药产业很可能＂弊大于利＂。我国医药产业应借推行新版GMP和落实自主创新方略等政策的机会,加快企业＂走出去＂的步伐,争取在加入GPA之前成为真正的制药强国。     

加强政府采购管理,推广基本医疗卫生服务

本文先介绍规范的政府采购活动应遵循的基本原则，以及贯彻这些原则对推广基本医疗卫生服务的必要性，再明确政府采购的目之一在于的是提供基本医疗卫生服务，并说明了服务的范围。最后结合实践效果和理论说明，加强政府采购管理，能够达到推广我国基本医疗卫生服务的公平公开公正高效发展的结果。     

影响苯作业工人GPA基因突变频率的相关因素

目的应用血型糖蛋白A（GPA）基因突变频率等指标探寻影响苯作业工人GPA基因突变频率的相关因素，探讨该指标用于预测苯中毒风险的可行性。方法采用固定群体随机抽样的方法，选取慢性苯中毒工人40例及其对照82例，分离、固定外周血红细胞，与荧光素标记的单抗结合后，采用流式细胞术进行GPA突变分析；应用统计学方法对影响GPA基因突变频率的相关因素进行分析。结果慢性苯中毒组GPA基因突变频率明显高于对照组GPA基因突变频率，差异有统计学意义（P〈0．05）。年龄、工龄、苯接触累积评分与苯作业工人GPA基因突变频率呈正相关关系（P〈0．01），3-氨基苯甲酰胺（3AB）指数与GPA基因突变频率之间呈负相关（GPANO：rs=-0．589，P〈0．01；GPANN：rs=-0．615，P〈0．01）。多因素回归分析，苯接触和个体易感性因素进入模型，决定系数R^2=0．819。结论苯接触和个体易感性因素是影响GPA基因突变频率的重要因素。苯接触水平越高，GPA基因突变频率越高；个体的易感性越强，GPA基因突变频率越高。     

医疗卫生服务市场探析

医疗卫生服务市场探析河南省卫生厅（４５０００３）袁东河，常同钦河南省人民医院常燕玲我国社会主义市场经济体制的确立，使医疗卫生改革面临一个突出的问题，就是医疗卫生服务如何适应社会主义市场经济的体制。下面就此谈几点粗浅意见，供参考。一、医疗市场客观存在＂...     

加入WTO对我国医药卫生行业的影响和对策分析研究

世界贸易组织（WTO）对推动全球经济发挥着极其重要的作用,我国加入WTO已是指日可待,根据WTO《服务贸易总协定》的条款,“入世”后,我国医药卫生行业将全面向国际市场开放。本文就目前我国医药卫生行业的现状,加入WTO对我国医疗卫生行业、制药行业和医疗保险业的影响进行了分析,并研究了应采取的对策和建议。     

引进JCI标准提高医院药学服务质量

随着我国加入世界贸易组织，医疗卫生体制改革不断深化，医疗服务市场将逐渐开放。医院面对发达国家同行业占绝对优势所带来的压力，面对医疗卫生体制改革的冲击，机遇和挑战同时摆在面前。如何把握机遇、迎接挑战、与国际医院接轨是目前我国医院管理面临的重要课题。     

应用血型糖蛋白A基因突变分析技术探讨发生慢性苯中毒危险的相关因素

目的应用血型糖蛋白A（glycophrin A,GPA）基因突变分析技术探讨苯作业工人发生慢性苯中毒危险的相关因素,为苯危害的评价和慢性苯中毒的防治提供理论依据。方法分离、固定122例苯作业工人外周血红细胞,与荧光素标记的单抗结合后,采用流式细胞术进行GPA变异分析,应用统计学方法分析个体易感性与慢性苯中毒的关系。结果GPA基因突变频率与作为反映个体易感性的3-氨基苯甲酰胺（3AB）指数之间的相关性分析显示,慢性苯中毒组的GPA基因突变频率与3AB指数之间无显著的相关性（P〉0.05）,而对照组的GPA基因突变频率与3AB指数之间有非常显著的负相关关系（P〈0.01）。结论在苯接触相近的情况下,慢性苯中毒组的GPA NΦ和GPA NN基因突变频率均高于对照组（P值分别为0.032和0.035）,证实了苯接触不是影响GPA基因突变频率、导致苯作业工人发生慢性苯中毒的惟一因素。慢性苯中毒组由于其DNA损伤修复能力较低,个体易感性较强,个体DNA损伤修复能力低下使其接触苯时发生慢性苯中毒的危险性增加。     

浅谈医疗器械管理

浅谈医疗器械管理河南省肿瘤医院（４５０００３）刘国中，褚守祥随着我国社会主义市场经济的逐步建立，医疗市场也进一步健全。那么，医疗卫生单位的物化劳动与治疗手段同样也需要更新与完善。作为“救死扶伤，治病救人”的医疗卫生单位要完成社会主义市场经济条件下的医...     

中国非政府卫生机构研究

民营医院作为医疗卫生改革的新生事物，在我国医疗卫生服务体系中有着特殊的地位，但由于多种因素并不能形成期望的竞争局面。要在我国医疗市场打破公立非营利性医院的垄断地位，发展多样化、多种形式的办医模式，形成公平、有序的竞争，可谓任重道远。但我们也看到，中国加入WTO后，办民营非政府医疗机构的潜在市场很大，亟待开发。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.