云南省宣威市、宾川县、勐海县新型农村合作医疗试点调查研究

[目的]了解新型农村合作医疗试点工作情况,分析不同模式新型农村合作医疗的实行对农村居民看病就医行为的影响,以进一步完善和发展新型农村合作医疗.[方法]利用卫生部统计信息中心编制的<新型农村合作医疗家庭健康询问调查表>调查问卷,采用随机整群抽样的方法,抽取宾川、勐海、宣威三个新型农村合作医疗试点县每县随机抽取600户共计1800户、7658名农村居民为调查对象进行入户面对面调查.[结论]①试点工作开展顺利,参合率高于2004年全国平均水平,但低收入组参合率明显低于高收入组;②宾川和勐海分娩受益率逐年上升,三个试点县门诊受益率均达到54%以上,实际补偿比例基本接近各县制定的补偿比例,住院受益面相对较小,实际补偿比例高于门诊补偿比例,但均低于各县制定的补偿比例.[建议]①加强农村卫生服务体系建设;②完善筹资工作制度化机制;③统一补偿模式,提高补偿标准,建立健全二次补偿机制,完善农村贫困医疗救助制度,确保新农合公平性、公益性的完全实现.④规范完善新农合资金使用的账务和财务管理制度,尽快建立全省统一的新农合信息管理系统,保证资金运作的安全、高效.     

浙江省2003-2010年新型农村合作医疗运行情况分析

目的:总结浙江省2003-2010年新型农村合作医疗运行情况,为进一步做好新农合工作提出建议。方法:对浙江省2003-2010年新农合相关运行数据进行统计分析。结果:浙江省新农合农民参合率较高;基金筹资水平不断提高,且使用率较高;住院补偿和门诊补偿的结报率和补偿率持续增高。结论:参合农民的受益程度较高,但需调整政策,优化筹资来源,提高筹资水平,增加农民参合积极性。     

龙海市新型农村合作医疗基金筹集方式改进探讨

[目的]探讨降低新型农村合作医疗(新农合)基金筹集成本的方法及长效机制。[方法]对龙海市新农合基金的筹资方式、成本进行评价,并与其他地区对比分析。[结果]龙海市新农合基金的筹资方式、成本等与其他地区一样存在不合理,有待改进。[结论]应加强立法并尝试多种筹资方式,确立基金筹集的长效机制,降低成本,保障新农合制度的可持续发展。     

关于新型农村合作医疗缴费机制相关问题的思考

农民筹资先行到位是新型农村合作医疗（以下简称新农合）运作的前提和关键，传统的筹资方式是属于典型的被动式收费，筹资难度大，筹资成本高，收费任务重，成为制约新农合有效运作和可持续发展的一大瓶颈。按照中央、四川省2008年度新农合工作会议“增加补助，全面铺开．巩固完善”的指导思想。建立稳定高效的基金筹集机制已成为目前推进新农合工作向纵深发展的最为迫切的课题。文章结合泸州市新农合工作的实际情况，针对我国新农合现行农民筹资方式进行总结、比较和分析，对新农舍缴费机制中存在的问题进行思考并提出相应的对策。     

邹城市新型农村合作医疗运行现状与发展思考

介绍了邹城市新型农村合作医疗的运行现状和运行成效,分析了新型农村合作医疗存在的主要问题。从利于新农合管理的角度,确定新农合主管部门;规范医疗服务行为,维护好新衣合平台;加强医药费用控制,减少基金过度使用;合理确定新农合报销补偿比例,充分发挥补偿效益;探索规范合理的新农合筹资机制;加快新农合立法建设,促进新农合规范长效发展六个方面,对促进新型农村合作医疗制度持续发展进行了思考。     

山西省阳城县新型农村合作医疗基金使用状况分析

[目的]分析山西省阳城县新型农村合作医疗基金的使用状况,探讨完善新型农村合作医疗基金管理的方法和途径. [方法]应用山西省阳城县新型农村合作医疗统计信患报表,对县(乡)定点医疗机构新型农村合作医疗管理人员进行问卷调查,应用Excel软件进行数据录入及处理分析. [结果]在新农合制度实施的初期,基金使用率较低.随着新农合工作的开展,基金使用率大幅提高,存在透支的风险.住院补偿基金流向以县级和乡镇级医疗机构为主,门诊家庭账户基金流向以村级医疗机构为主.[结论]应定期进行基金运行分析,建立基金透支和结余风险预警机制;转变门诊家庭账户模式,实施门诊统筹.     

新型农村合作医疗农民个人筹资机制研究

新型农村合作医疗（以下称新农合）的主要目标是抵御因大病造成的农民疾病经济风险，而该制度的抗风险能力主要取决于基金规模。目前，新农合实行个人缴费、集体扶持和政府资助相结合的筹资机制，中西部农村地区的新农合基金80％来源于政府。从各个筹资渠道看，地方政府持续增加对参合农民的补助存在一定困难，集体经济对新农合支持非常有限，而个人筹资明显不足。[第一段]     

宁波市新型农村合作医疗制度运行状况分析

文章通过对宁波市新型农村合作医疗制度运行状况分析认为,本地区新型农村医疗合作制度运行整体平稳,其筹资结构、筹资水平和补偿模式体现了沿海经济发达地区新农合工作的特点。针对农民对新型农村合作医疗制度知晓率不高、基金结余率偏高等问题,提出加强组织引导和基金管理,进一步提高基金运行效率等建议。     

加强新农合医疗费用控制的措施

我国现阶段的新型农村合作医疗制度还是一种低水平筹资的互助共济制度,医疗费用的不合理增长不仅会降低新农合补偿水平,也会降低合作医疗基金使用效率,增加农民经济负担,进而影响到新农合制度的可持续性发展.本文结合重庆市新型农村合作医疗工作中费用控制的一些做法,对如何加强新农合资金的管理和完善支付方式进行了一些思考与探索.     

新农合筹资标准调整后的补偿方案设计思考

新型农村合作医疗制度自2003年试点推行以来,取得了令人瞩目的成绩。伴随着新农合筹资标准的逐步提高,制度的受益人次、基金使用效率和实际补偿比也明显提高。2010年,新型农村合作医疗的筹资最低达到人均每年150元的标准,对制度的补偿提出了新的要求,因而必须通过科学调整补偿模式、合理分配基金的使用比例、加大对重大疾病的补助等来提升新型农村合作医疗制度的实际效果。     

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 occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.