以科学发展观为指导 把握好四大体系建设之间的关系——摘自卫生部部长陈竺在2010年全国卫生工作会议上的工作报告

——科学统筹公共卫生服务与医疗服务两大体系。坚持正确的改革方向。公共卫生和医疗服务两大体系必须加强功能融合，相互支持，更好地将防治任务落到实处。从工作角度来讲，目前促进两大体系结合的环节主要在城乡基层医疗卫生机构、处置突发公共卫生事件以及人才培养上。城乡基层医疗卫生机构承担着公共卫生和医疗服务的多重任务，接受专业公共卫生机构和二、三级医院的业务指导。     

政府投入方式对社区卫生服务工作的影响分析

公共卫生功能是政府职能的体现。政府有责任对公共卫生进行投资，社区卫生服务机构是公共卫生体系的网底，大量的基本公共卫生功能靠社区卫生服务中心来完成，因此政府应该对社区卫生服务的基本公共卫生进行补偿。     

6所社区卫生服务机构经济运行现状研究

目的：描述和分析6所社区卫生服务机构经济运行现状，发现制约其生存和发展的关键因素。方法：在收集现有资料的基础上，通过定量、定性和现场追踪观察等方法，了解并描述各机构经济运行现状。结果社区卫生服务机构提供公共卫生服务和准公共卫生服务越多，亏损也越大。结论：补偿机制不健全已成为制约云南省城市社区卫生服务机构持续发展的关键因素。     

浙江省基本公共卫生服务均等化财政保障体制机制研究

浙江省基本公共卫生服务均等化存在的主要问题是：公共卫生资源配置和公共卫生机构服务能力存在城乡、地区差别,特殊人群享受公共卫生服务均等化程度较低,某些财政保障政策不合理。对此,需要通过制定规划、缩小投入差距、提高筹资层次、创新支付方式、增加薄弱环节投入、增强公共卫生机构服务能力、建立绩效评价体系等措施,提高浙江省基本公共卫生服务均等化水平。     

广州市某区2007年社区预防保健服务评价探索与实践

目的通过对社区卫生服务机构提供的社区预防保健等公共卫生服务项目进行评价,核拨社区预防保健等公共卫生服务补助经费,引导社区卫生服务机构健康发展。方法组织专家成立社区公共卫生服务评价小组,对9家社区卫生中心(站)进行了社区预防保健等公共卫生服务评价。结果各社区卫生服务机构社区预防保健等公共卫生服务评价分数相差悬殊(32.5～84.5分),其中社区卫生服务中心评价分数(56分)比社区卫生服务站(48分)高。结论本评价体系较适用于现阶段城市社区公共卫生服务的评价,有助于保证政府"购买服务"政策的实施。     

浦口区基本公共卫生服务功能现状及对策研究

目的分析浦口区公共卫生服务功能现状和存在的问题，提出实现浦口区公共卫生服务功能的措施。方法通过对浦口区疾病预防控制中心、区妇幼保健所、社区卫生服务中心等机构进行现场访谈和问卷调查，了解机构实施公共卫生服务功能现状。结果浦VI区公共卫生服务功能实施中主要存在人力资源配置缺乏，工作人员素质低，未能彻底履行工作职能等。结论浦口区应采取优化公共卫生服务资源配置、提高工作人员整体素质、加大宣传力度等措施，实现浦口区公共卫生服务功能的普及。     

中国公共卫生服务绩效评价研究

通过文献综述,对公共卫生服务绩效评价的现状进行了分析,对构建绩效评价指标与框架进行了探索.指出可以通过评价体系“指挥棒”对公共卫生服务机构进行导向和激励.我国公共卫生服务绩效考核规范和标准欠缺,应建立国家层面的评价框架,从而提高公共卫生服务体系的绩效.     

建立城市疾病预防控制机构和社区一体化服务的实践

<正>我国疾病预防控制机构和社区卫生服务中心是城市公共卫生服务预防保健体系的重要组成,但由于长期以来的体制、机制问题,导致二者之间关系不顺、功能定位不准、职责权限不清,影响了城市预防保健政策的落实,制约二者各自公共卫生功能的发挥,阻碍城市公共卫生工作的深入开展。     

完善社区卫生服务准入制度

目前很多城市都缺乏对社区卫生服务实行的较为完善的准入制度。良好的准入制度，是促进机构运行且最大限度地满足目标的基本保证。本文调查了影响社区卫生服务公共功能完善的部分因素，认为有必要通过完善一整套的准入制度来完善社区卫生服务机构的公共卫生服务功能，充分发挥社区卫生服务机构公共卫生服务网底的功能和作用。     

试论安徽省公共卫生人力资源现状及发展对策

探讨各级疾控机构和基层医疗卫生机构公共卫生人才队伍建设的发展策略和措施。通过对安徽省各级疾病预防控制人才队伍现状和公共卫生人力资源需求的调查统计分析,结合当前医疗卫生体制改革日益繁重的公共卫生服务任务,分析安徽省疾控人才队伍发展需求,为全省各级政府和卫生行政部门制定当地的公共卫生人才队伍建设规划和措施,提出一些参考建议,认为安徽各级各类疾病预防控制机构和基层乡镇、社区应加强和优化公共卫生服务人才队伍建设,以提高服务能力和水平。     

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.     

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.     

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.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.