流动人口妇幼保健服务利用及服务提供模式的定性研究

采用专题小组讨论和个人深入访谈的方法,了解了现行的医疗保健服务系统为流动人口提供妇幼卫生服务以及流动人口妇女儿童对这些服务的利用情况,同时了解了服务提供者对如何提高流动人口妇幼保健服务利用的有关意见和建议。研究发现,对于流动人口这一特殊群体,大多数医疗保健机构仍然只是坐堂行医,没有树立上门服务的思想。医疗保健机构人员配置和经费供给不足等因素影响其为流动人口提供妇幼保健服务。大多数流动人口妇女在大城市艰苦的生活状况和自身的文化素质决定了她们寻求医疗保健服务的态度以及接受医疗保健服务的能力,有相当部分的人就医选择的是私人诊所和非法行医者。建议在目前现有的条件下,充分利用现有资源,调动各方面的力量,建立以社区为依托,多部门合作的流动人口妇幼保健服务模式。同时,政府在重点地区相关机构人员的配备和经费的投入上应该考虑流动人口,适当增加人员和经费。     

城市流动人口妇幼保健服务模式探索与研究

目的:通过项目的开展探索完善适合城市流动人口妇幼保健服务模式。方法:在对流动人口孕产妇和儿童保健状况基线调查分析的基础上,研究制定杭州市下城区流动人口妇幼保健管理模式,5年后对相应问题问卷调查并进行对比分析。结果:孕产妇对危险征兆的自我识别和防护明显提高,儿童家长的保健意识明显增强,流动人口孕产妇及儿童的保健服务指标明显提升。结论:杭州市下城区流动人口妇幼保健服务模式取得了较好效果,为政府制定相关政策提供了实践依据。     

省市县三级妇幼保健机构2004～2006年度服务提供及发展能力分析

目的:对省市县三级妇幼保健机构的服务和发展能力进行分析,为妇幼保健机构规范化建设提供政策依据。方法:通过网络直报的形式,开展对全国妇幼保健机构资源与运营情况的年度监测,采用对比分析的方法对2004～2006年度妇幼保健机构的服务和发展能力进行评估。结果:三级妇幼保健机构年门诊人次、年出院人次,资产、业务收入逐年增加,大部分指标增长率也逐年提高。结论:总体上各级妇幼保健机构的服务和发展能力逐年增强,县级妇幼保健机构服务和发展状况有所改善。     

北京流动人口妇幼保健现况研究

目的 了解北京流动人口妇女儿童对医疗保健服务的利用，以及流八城市的相关部门对流动人口的管理和提供服务的现状．方法 采用定性和定量方法收集资料，应用SPSS统计软件对数据进行描述性统计和统计推断。结果 被调查的539名育龄妇女．平均年龄29．6岁，90．9％已婚，其孕期早检率为43．7％、5次及以上产前检查率为37．6％，选择回户籍地分娩的妇女住院分娩率（67．5％）高于留在北京分娩的妇女的住院分娩率（37．6％）。初中及以上文化水平妇女的住院分娩率（63．8％）高于初中以下者的住院分娩率（46．4％）。定性调查发现。流八地医疗保健机构、公安、街道等部门的人员和经费是按户籍人口进行配置的．因此这些部门在对流动人口进行管理和服务时，面临人员和经费严重不足的问题。提供妇幼保健的医疗单位的现有服务模式、收费标准等影响流动人口妇女孕期保健服务的利用。结论流动人口妇女孕产期医疗保健服务利用率低下。建议政府在为医疗保健部门人员经费配置时考虑流动人口数量；另外，提供妇幼保健服务的医疗保健机构需加强多部门合作，改变现有服务模式、提供适宜流动人口的医疗保健服务。     

社区外来流动人口的妇幼保健工作管理模式研究

调查了社区外来流动人口妇女与幼儿对卫生保健的需求，并考察了此项服务管理工作的现状。结果发现：社区外来流动人口中的妇幼保健服务需求很高，有关的主管与服务机构都关心和支持这项卫生服务的管理工作。根据调查结果，并根据有关卫生改革与发展的政策和法律，研制了一个管理模式，以理顺关系，明确各方职责，系统地整合各项分工管理工作，满足社区外来流动人口中妇幼保健服务的需求。     

妇幼保健机构个体保健服务人力测算方法探讨

目的探讨妇幼保健机构保健人力测算方法,对各级妇幼保健机构所需保健人力进行测算,为制定妇幼保健机构保健人员设置标准提供参考。方法通过查阅相关文献及专家咨询,确定各级妇幼保健机构保健服务项目、社会对妇幼保健服务的需要、妇幼保健机构提供保健服务所占市场份额,以及每项服务每人次所需工时,对各级妇幼保健机构所需人力进行测算。结果确定妇幼保健机构提供的保健服务项目17大项,详细描述每项服务内容,分别对每项保健服务所需人力进行测算,根据提供服务项目的种类和数量测算不同级别机构所需保健人力。结论通过开展妇幼保健服务人力测算,为妇幼保健机构人员合理设置及争取政策支持提供依据。     

“十五”期间北京市妇幼保健工作回顾与思考

"十五"期间,北京市广大妇幼保健工作者,坚持妇幼保健工作方针和全心全意为妇女儿童服务的宗旨,在强化政府对妇幼保健工作的领导、探索新的服务模式、完善妇幼保健机构和网络、满足广大妇女儿童健康需求等方面取得了长足进展.     

北京市朝阳区《卫生部/WH0/UNICEF城市流动人口妇幼保健服务项目》基线调查报告

目的:了解北京市朝阳区流动孕产妇和儿童的健康、营养、保健服务利用情况,以及医疗保健服务机构的管理水平和服务质量情况.方法:采用社区及医疗保健机构调查、个人问卷调查、访谈和座谈的方法,调查朝阳区的经济、社会、人口等基本情况;对1100名5岁以下流动儿童监护人及孕产妇进行问卷调查;对卫生部门和流动人口管理部门工作人员进行访谈,与街道、社区工作人员座谈.结果:在京流动儿童<母子健康档案>或定期体检卡的建卡率为59.1%,监护人的文化程度和家庭经济收入影响儿童建卡率(P<0.001);流动孕产妇文化程度和经济收入水平低是影响孕妇建册率的主要因素(P<0.05);流动妇女儿童的保健服务已纳入本地管理,但保健机构的人员、房屋及设备配比不足,对流动人口信息掌握不够准确.结论:流动人口孕产妇和儿童监护人文化程度低,相对贫困,缺乏卫生保健的知识,保健意识淡薄,影响保健服务质量,应加强健康教育,提高保健意识,实现资源共享,准确掌握流动人口信息.同时还需加大医疗保健设备及人员的投入,以满足流动人口妇幼保健服务的需求.     

武汉市流动人口中已婚妇女生殖保健需求及服务对策的研究

目的:了解武汉市流动人口中已婚妇女生殖保健需求及服务现况,探索出一条适合我国国情的流动人口生殖保健需求及服务的管理方法和措施。方法:采取随机整群抽样的方法,对武汉市江岸、江汉、桥口、汉阳、武昌、青山6个区2205名流动人口已婚妇女进行问卷式调查。结果:流动人口已婚妇女的文化程度普遍偏低;从事的职业以个体经营小商贩为主,在汉生活、居住的条件都非常简陋;他们对生殖保健知识方面的了解率非常低,自我保护意识普遍较差,对妇女生殖保健服务的需求也不够强烈;流动人口已婚妇女生育调节的可得性较差;现居住地的生殖保健服务可得性也较差。结论:应该大力开展生殖保健的宣传教育,调整健康服务取向,以促进传统的妇幼保健、计划生育模式向以提供优质服务为中心的生殖健康模式转变,对提高流动人口的生殖健康十分必要。     

广州市社区卫生服务机构妇幼保健工作现状及资源配置公平性研究

目的 探讨广州市社区卫生服务机构妇幼保健工作开展现状、资源配置情况及其公平性.方法 2010年12月至2011年2月,广州市妇幼保健院采用自行设计的<社区卫生服务机构及镇医院妇幼保健工作基本情况调查表>对广州市提供社区卫生服务机构进行普查,并运用Lorenz 曲线和Gini系数分析法,进行社区妇幼保健服务人力资源配置及其公平性进行评价.结果 广州市10个区及2个县级市,共计195家社区卫生服务机构接受调查,从业妇幼保健的人员共计735位.按照服务人口测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.107,0.114;按照辖域面积测算,社区卫生妇幼机构及妇幼保健人力资源配置的Gini系数分别为0.509,0.598.按照辖域面积测算的Gini系数处于公平性配置警戒区域.结论 广州市社区卫生服务机构总体布局基本合理,达到国家覆盖人口设置标准,但公平性尚待改善,社区卫生服务人员结构仍尚待改善.     

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.     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.