宁夏盐池县构建互联网+基本公共卫生服务体系的探索与实践

目的以问题和需求为导向,构建盐池县互联网+基本公共卫生服务体系,实现覆盖县、乡、村一体化的多业务应用与服务。方法运用"互联网+"、系统集成等技术,提出盐池县互联网+基本公共卫生服务体系的总体框架、业务体系和服务范围,通过对上级、同级和外部信息系统的数据交换接口,整合县域内不同层次、不同类型的医疗机构信息资源。结果通过搭建互联网+基本公共卫生服务平台,实现各级各类医疗卫生机构的业务协同和信息共享,在健康管理、家庭医生签约、医卫融合、疾病预防、妇幼保健、健康教育、工作监管等业务领域发挥了较好作用。结论互联网+基本公共卫生服务体系可有效提高基本公共卫生服务的质量与效率,提升管理水平,降低服务成本。     

大数据时代的流行病学研究：机遇、挑战与展望

近年来，高通量组学技术迅速发展，人群队列与样本资源逐渐累积，互联网和信息技术飞速进步，大数据开发工具不断涌现，健康医疗大数据为流行病学研究提供了丰富的数据资源和广阔的科研平台。本文将分析大数据时代流行病学研究的机遇和挑战，展望未来学科的发展方向。流行病学应抓住机遇，开辟新方向、发展新方法，推动医学基础研究成果向公共卫生和临床实践的转化应用，实现"健康中国"的美好愿景。     

基于互联网信息的公共卫生监测进展

互联网数据因其更新快和数据量丰富的特点被引入公共卫生监测领域。通过挖掘分析互联网中丰富的健康相关信息,研究者建立基于互联网的公共卫生监测系统,以快速估计人群中健康相关事件的分布。基于互联网的公共卫生监测系统根据信息来源不同可分为主动式监测系统和被动式监测系统。相较于传统监测系统,基于互联网的监测系统具有及时性佳和成本低的优点,还可在健康相关行为监测和卫生政策评价等传统监测力所不逮的领域发挥作用。但由于假阳性消息的存在,基于互联网的监测系统存在准确性不佳的缺点。本文介绍基于互联网的公共卫生监测进展及其在疾病预警中的应用,为我国开展相关工作提供参考。     

宜昌市“互联网+健康管理”新模式

目的 将“互联网+”应用到健康管理服务中去,为探索全人群、全生命周期的健康管理新模式提供参考.方法 研究首次利用宜昌市大数据技术整合宜昌市各类诊疗服务、健康体检、公共卫生和智能健康监测、疾病预防控制、食品安全、环境卫生等人口健康信息以及跨行业部门信息的多样化等信息;采用ETL(Extract-Transform-Load)进行数据预处理后进入健康大数据资源池,再同步至健康大数据仓库.结果 利用数据挖掘工具进行主题数据分析,建立多维度数据模型与健康评估模型,发现城市健康问题,形成健康白皮书.根据城市健康现状,制定健康干预与促进措施,开展健康干预并评估干预效果.结论 借助互联网技术实现为全人群(健康人群、亚健康人群和疾病人群)、全生命周期的健康管理服务,即“互联网+”健康管理模式服务.     

公共卫生监测主要技术和方法

公共卫生监测的技术和方法在近几十年发展中得到不断的扩充与创新,本文主要对公共卫生监测数据的采集、分析及监测评估方法做一综述,并尝试探讨公共卫生监测今后的发展趋势.公共卫生监测数据采集方法除了传统的半信息化数据采集和信息化数据采集平台,还有新兴的互联网检索、基于互联网的疾病信息交流平台和基于热线电话和电子监控档案的监测方法等.监测信息分析技术和方法主要涉及实验室检测分析技术、信息筛选分类技术、风险评估方法和流行病学与卫生统计学分析方法.公共卫生监测评估起源于上世纪80年代后期,目前主要有美国CDC和WHO的公共卫生监测系统评价指南.前者着重于单病监测系统的完善,后者着重于强化和提高国家整体的监测能力.公共卫生监测今后的发展趋势倾向于建立一个网络实验室和流行病学监测系统相整合的监测信息大平台,达到信息共享、有效分析并及时反馈,同时有成熟的评估体系对其进行评价.     

应用互联网健康信息监测流行病的数字流行病学

数字流行病学(digital epidemiology)是在数字化时代背景下催生的一个新兴研究领域,其提供了应用互联网健康信息监测流行病的方法,较传统流行病监测方式能够更早地发现疫情和实现预警,有望加快流行病暴发的监测速度,提高其监测效率。世界卫生组织(World Health Organization,WHO)及其组建并负责的全球疫情警报与反应网络(global outbreak alert and response network, GOARN)已整合数字流行病学报告,并用于辅助全球卫生安全监测工作。欧美发达国家数字流行病学发展已较为成熟,且积累了大量的实践经验。本文详细概述了应用互联网健康信息监测流行病的数字流行病学数据处理流程、应用脉络及潜在困境,以为我国数字流行病学的相关研究及应用提供参考和借鉴。     

基于区域卫生信息平台的健康档案管理与数据共享的探讨

电子健康档案能够通过标准化的数字信息录入,实现医疗数据信息的数据共享。通过建立区域卫生信息平台,实现各业务信息系统在平台上的数据整合,动态形成个人健康档案,实现健康档案信息的共享。本文的目的是基于健康档案拓展各业务数据收集与管理,有力支撑医改,同时加快公共卫生事业的信息化发展。     

机器学习在公共卫生领域的应用现状

公共卫生问题与人们的健康状况和生命质量密切相关。近年来随着人工智能的发展,机器学习在公共卫生领域得到了更为广泛的应用,机器学习技术可以处理大量的数据,并从中发现模式和趋势,从而帮助公共卫生部门更好地了解公共卫生问题。本文综述了近年来机器学习在公共卫生领域的应用,包括在流行病学研究、公共卫生监测、健康信息处理、公共卫生决策、心理健康等方面中的应用。     

基因组时代的公共卫生

人类医学进入基因组时代,海量的生物医学信息在疾病防治领域的应用带给公共卫生前所未有的机遇和挑战.基因组时代的公共卫生将实现广泛的国际合作,并通过跨学科跨专业的信息整合与共享,使生物医学信息在描述疾病分布、探讨病因、疾病三级预防和弥合临床医学与公共卫生的裂痕等方面得到充分应用,并最终实现促进人类健康的宏伟目标.     

互联网+公共卫生服务信息系统的技术架构研究

为解决基于互联网的公共卫生服务业务碎片化严重、个人信息保护难以有效控制等问题,引入"中台"理念,构建互联网+公共卫生服务信息系统的技术架构。从系统的数据交互模式、业务协同应用的服务模式、移动互联网用户的认证与注册、公民个人信息的保护策略4个方面,对互联网+公共卫生服务信息系统的技术架构进行阐述。该技术架构基本实现责任边界清晰、信息保护策略可靠,以及业务系统与公众需求的紧密对接与实时响应,为后续各类公众服务提供技术支撑,也为推进公共卫生信息服务提供借鉴。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

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.