公立医院践行社会责任的探索

概括了公立医院社会责任的概念和公立医院社会责任的分级模型,并在此基础之上,介绍了天津市人民医院履行社会责任的实践:积极完成上级部门交派的医疗、公共卫生任务,履行基本社会责任;积极开展对口帮扶,承担中级社会责任;开展大肠癌筛查工作,实现高级社会责任。对公立医院践行社会责任提出建议:深化思想认识,主动承担社会责任;结合自身优势,探寻符合自身特点的公益项目;加大政府投入,完善公立医院补偿机制。     

公立医院领导干部经济责任审计评价指标体系研究——以甘肃省某三甲医院为例

根据近年来公立医院领导干部在履行经济责任中出现的问题,梳理国内外研究成果,运用层次分析法,从遵守法律责任、财务管理责任、绩效管理责任、社会责任四个层面构建了一套完备的公立医院领导干部经济责任审计评价指标体系,并结合案例分析提出相应的建议,对今后评价公立医院领导干部经济责任履行情况具有一定的借鉴作用。     

浅析公立医院社会责任的实践

公立医院要始终把社会责任放在第一位,公立医院未来的竞争将是履行社会责任的竞争,社会责任是医院服务的竞争资本,是医院获得核心竞争力的关键。质量管理、成本管理、综合满意、文化建设是公立医院履行社会责任的有效路径,社会效益和经济效益的双赢是公立医院履行社会责任的最佳体现。     

新时期大型公立医院社会责任价值取向与实现路径

分析了大型公立医院公益性、绩效管理和社会责任等不同价值取向的区别及矛盾冲突,认为社会责任不是对公益性和绩效管理的扬弃,而是兼容并蓄。根据大型公立医院的功能定位及事业单位分类改革等环境的变化,认为大型公立医院与县级及以下公立医疗卫生机构价值取向应该有所区别,应选择社会责任价值取向,并基于社会责任理论提出大型公立医院社会责任的内涵、社会责任的履行和评价机制,实现大型公立医院的社会责任价值。     

公立医院社会公益职能弱化的原因及其治理对策

我国公立医院提供了大量具有社会功能性质的任务,但在运行中也出现一些问题,如应有的功能和责任履行不到位,布局、规模和结构不尽合理,职工收入与经济效益挂钩等.政府为公立医院提供良好的政治、经济、政策环境,是促使公立医院体现公益性、履行社会责任的重要保证.公立医院要加强行业自律,提高运营绩效.     

公立医院社会责任与法律保障关系探讨

随着公立医院改革试点的指导意见确立,公立医院发展面临前所未有的挑战。围绕公立医院社会责任以及运用法律保障公立医院更好地履行社会责任等方面进行分析,具有探讨性地提出一些观点。同时对如何保障公立医院的合法权益,如何为公立医院、医务人员提供良性的执业环境等方面从法律角度,结合我国目前新医改方案出台、公立医院面临新一轮改革的形势,提出一些建议与意见。深化医药卫生体制改革是确保公立医院履行社会责任的有效途径之一,目的是建立中国特色的基本医疗卫生制度,保证城乡居民公平,享有安全、有效、方便、价廉的基本医疗卫生服务。这不仅是解决当前医患矛盾也是确保公立医院履行职责的治本之策、久安之道。     

公立医院与社会责任

公立医院作为政府投资设立的非营利组织，应该承担一定的社会责任，但是，如何理解公立医院的社会责任是需要研究的问题。本文通过分析公立医院承担社会责任的现状，探讨公立医院承担社会责任的方式，旨在增强医院的社会责任意识，构建和谐医患关系。     

我国政府举办公立医院的理论依据和职责研究

根据人权理论、价值观、福利经济学、人力资本、公共产品等基本理论,公平提供基本医疗卫生服务、保障人群健康是政府不可推卸的责任,而举办公立医院,是政府履行保障人群健康职责的有效途径之一。根据社会组织学、公共选择、社会主义优越性等理论,我国公立医院具有公益属性,应当承担社会功能和责任。政府为公立医院提供良好的政治、经济、政策环境,是促使公立医院体现公益性、履行社会责任的重要保证,也是政府履行职责的表现形式。然而,目前我国各级政府及其相关部门在履行举办公立医院的职责方面存在许多问题,主要有：各级政府之间的职责没有完全理清;政府相关部门没有理顺关系,存在多头管理问题;卫生、财政、人事、物价等政府主要相关部门对公立医院的监管、经费投入、编制核定、医疗服务价格制定等职责落实不到位。     

广东省不同等级公立医院社会责任现状分析

目的探讨广东省不同等级公立医院在履行社会责任方面存在的差异,为提升社会责任履行水平提出建议。方法 2016年下半年对广东省公立医院进行问卷调查,采用SPSS 22.0进行数据处理分析,对数据变量进行重新编码、分组、计算等。在数据处理中,采用卡方检验或FISHER确切概率检验分析不同等级医院在六个维度的社会责任行为上是否存在差异。结果通过比较不同等级公立医院社会责任现状发现,在组织结构及社会责任行为层面、员工层面、患者层面、政府层面不同等级医院存在差异。结论一二级医院应重视社会责任的履行,进一步将社会责任纳入医院的发展战略规划,从医院管理层面加强社会责任工作的开展,进一步规范医院管理;加强重视临床业务运转和患者满意度,加强完成政府指令性任务,要在支援帮扶方面投入更多的力量和资源,在兼顾自身运营效率的同时,从事产生更多社会效益的活动。政府应加大对医院的财政补助投入力度,进一步推进分级诊疗制度建设,缩小不同等级公立医院间履行社会责任水平的差距。     

基于社会责任的公立医院可持续发展研究

在社会主义市场经济环境下,社会责任管理是任何一个公立医院在谋求可持续发展过程中都不容忽视的一个重要问题.公立医院应该把社会责任管理作为可持续发展的战略选择,并努力构建有效的社会责任管理体系.     

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.     

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.     

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.     

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.