条件价值法在医院院誉价值评估中的应用——研究背景、原理与设计

对医院院誉价值的评估目前仍然是医院管理学界的一个难题。运用条件价值法从需求方的角度对医院院誉的价值进行评估，是对传统无形资产评估方法的突破。对条件价值法在医院院誉价值评估中应用的背景、基本原理进行介绍，并按以下技术路径设计了本研究过程：从总体中选取样本，确定调查对象；设计调查问卷，调查其支付意愿或受偿意愿；运用统计方法确定总体的支付意愿或受偿意愿，推断医院院誉价值：进行敏感性分析和可靠性检验。     

条件价值法在医院院誉价值评估中的应用——最大意愿支付额影响因素分析

对最大支付意愿的数额进行分析是应用条件价值法评估医院院誉价值的重要内容。在对Tobit模型进行简要介绍的基础上，通过模型回归对影响最大支付意愿额的因素进行分析发现，年龄、年龄的二次方、是否更愿意来该医院、对风险的态度、受教育程度、家庭大小和家庭总收入水平对最大支付意愿额有显著影响，同时对各因素的影响强度进行了探讨，并对模型的相关问题进行了简单讨论。     

条件价值法在医院院誉价值评估中的应用——意愿支付概率影响因素分析

为分析应答者意愿支付概率的各种影响因素．从而研究人们对有关健康的支付意愿的内在决定机制，通过对调查数据的x^2检验，发现人们对有关健康的支付意愿，受到不同医院知名度的“诱导”和不同层次社会经济状况的“分化”双重因素的影响。通过Logit模型回归分析，讨论了年龄、对医院水平的认识、是否更愿意来该医院就诊、受教育程度、对风险的认识等因素对人们意愿支付概率的方向和强度的影响，并对模型进行了简单讨论。     

山东省公立医院护理人员离职意愿调查

目的了解公立医院护理人员离职意愿情况,给医院管理者提供参考性建议来稳定护理队伍。方法采用方便抽样的方法选择山东省内的公立医院12家,用自行设计的问卷对在班护理人员进行留置问卷调查,共发放问卷400份,回收380份,整理有效问卷346份。对调查数据进行了独立样本检验、交叉列表分析、描述性统计等统计分析。结果从护理人员这一团体来说,有离职意愿者比例较高,总体来说,随着年龄的升高、职称的晋升、收入的增长,其离职意愿有降低的趋势,但其中也有特殊的人群,如主管护师组中有离职意愿者所占的比例要高于护师组;月收入在2001～3000元者中,有离职意愿者的比例要高于月收入1001～2000元者。同时,聘用制护士中的有离职意愿者所占比例要高于正式护士,而不同学历、不同级别医院的护理人员中,其有离职意愿者比例没有显著差异。结论医院可以通过提高护理人员收入、弱化职称与收入的关系、探索新的薪酬制度、改革人事制度等降低其离职意愿,稳定护理队伍。     

徐州市城市居民慢性病就医意愿及其影响因素分析

目的了解江苏省徐州市城市居民慢性病就医意愿及其影响因素,为合理配置卫生资源、方便居民就医提供参考依据。方法于2016年7—8月采用分层随机抽样方法在徐州市抽取710名年龄≥18岁城市居民进行问卷调查。结果徐州市710名城市居民中,慢性病就医意愿选择基层医疗卫生机构者300人(42.3%),选择区级医院者172人(24.2%),选择市级医院者238人(33.5%);多因素非条件logistic回归分析结果显示,去年月均收入≥3000元的徐州市城市居民慢性病更愿意选择区级和市级医院就医,而年龄≥50岁、有基层就医经历、知晓分级诊疗制度和支持分级诊疗制度态度的徐州市城市居民慢性病更愿意选择基层医疗卫生机构就医。结论徐州市城市居民慢性病有基层就医意愿者比例较低;年龄、去年月均收入、基层就医经历、是否知晓分级诊疗制度和对分级诊疗制度的态度是该地区城市居民慢性病就医意愿的主要影响因素。     

医务人员工作满意度与离职意愿的相关性研究

目的了解医务人员的离职意愿情况,分析工作满意度对离职意愿的影响。方法采用问卷调查法,对江西省某三级甲等综合性医院的528名医务人员进行调查。结果不同特征的医务人员离职意愿不同。工作满意度与离职意愿呈负相关（P=0．000）,报酬与福利、工作本身和工作条件3个因素对离职意愿总变异的解释能力为43．1％,其中报酬与福利对离职意愿的影响最大。结论医院管理者应重视医务人员的工作满意度,从而避免离职意愿的产生。     

医院转型升级期间基于转型冲击理论的护士留职意愿现状及影响因素研究

目的：调查苏州市某医院由一级升级为二级医院一年以来，医院护士的转型冲击和留职意愿现状，探讨其影响因素。方法：应用微信问卷星，由该医院护士填写新护士转型冲击量表（the Transition Shock of Newly Graduated Nurses Scale,TSNGNS）和护士留职意愿量表，利用SPSS26统计学软件进行数据处理，P <0.05有统计学意义。结果：调查60名该医院护士，护士转型冲击总体得分为（86.567±19.340）分，各因子均分为（3.206±0.716）分；护士的留职意愿总分为（20.920±4.412）分，因子均分为（3.486±0.735）分；人口学因素对转型冲击和留职意愿均无影响（P> 0.05）。转型冲击与留职意愿互为负相关。结论：医院由一级（社区卫生服务中心）向二级转型升级，给护士群体带来了较高水平的转型冲击，尤其是身体和知识技能方面的冲击。护士的留职意愿较高，降低医院转型升级给护士带来的身体、心理和社会文化与发展方面冲击水平可以提高护士的留职意愿。     

军医大学附属医院低年资聘用制护士的留职意愿调查

目的：了解低年资聘用制护士留职意愿现状,并探讨其影响因素。方法采用一般资料问卷、留职意愿调查问卷,对驻沪某医院703名低年资聘用制护士进行问卷调查,对相关数据进行单因素分析及多元线性回归分析。结果低年资聘用制护士留职意愿平均得分为（3．17±0．67）分,不同年收入满意度、工作压力、周工作时数及对单位职称晋升支持、提供继续教育机会、积极办理居住证在意度不同的聘用制护士,留职意愿差异有统计学意义;其中年收入满意度、对继续教育在意度、工作压力是留职意愿的主要预测因素。结论低年资聘用制护士留职意愿处于中等水平,医院管理部门应根据影响因素,制订针对性措施,提高低年资聘用制护士的留职意愿,稳定护理队伍。     

聘用制护士组织承诺与留职意愿的相关性研究

目的：了解军医大学聘用制护士组织承诺与留职意愿的现状及两者相关性。方法采用一般资料问卷、组织承诺量表、留职意愿调查问卷,对驻沪某军医大学附属医院1392名聘用制护士进行问卷调查。结果聘用制护士留职意愿和组织承诺的平均得分分别为（3．14±0．69）分、（2．96±0．58）分;感情承诺、经济承诺、理想承诺、机会承诺、年收入满意度、工作压力、职称（P ＜0．05）是留职意愿的主要预测因素。结论军医大学附属医院人力资源管理部门应采取综合措施提高聘用制护士的组织承诺水平,以提高其留职意愿,稳定护理队伍。     

医疗保险对农村成人乙肝疫苗接种意愿的影响分析

目的：探讨农民医疗保险对其乙肝疫苗接种意愿的影响.方法问卷调查河北省12个村的4020名成人,重点分析其中未接种过乙肝疫苗的2315名调查对象的接种意愿,以医疗保险为关键变量拟合 Logistic 回归模型.结果2315名调查对象中,有接种意愿者923人(39．9％).不同医保分组人群的乙肝疫苗接种意愿差异具有统计学意义(χ2＝7．795,P ＝0．020).Logistic 回归分析结果显示,在控制性别、年龄、婚姻状况、受教育程度、收入、知识得分、距离接种机构的路程时间和自评健康条件下,医疗保险会影响乙肝疫苗接种意愿,具体来说,城镇职工医疗保险及城镇居民医疗保险参保者和在新农合基础上又购买了商业健康保险者,在将来选择接种乙肝疫苗的概率是无医保者的2．577倍(1/0．388),是新农合参保者的2．278倍(1/0．439).同时,具有统计学意义的影响因素还有年龄、受教育程度和知识得分3个变量.结论将乙肝疫苗费用纳入医疗保险支付有利于防控乙肝,并符合医疗保险发展趋势.     

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.     

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.     

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.     

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.     

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.