广西乡镇卫生院免疫规划工作机构设置及人员配备现状调查

目的了解乡镇卫生院免疫规划工作机构设置及人员配备现状,为制定政策提供依据。方法采用现况调查方法收集分析相关数据。结果100．0％的卫生院设置有免疫规划工作机构（防保组）。防保人员配备为1．22人／万人,平均每个乡镇有防保人员4．73人。与2008年相比,11．5％乡镇卫生院防保人员减少,32．0％维持在原来水平,56．5％乡镇卫生院防保人员增加。中专及以下学历占47．8％,31．7％的防保人员无职称,初级职称占49-3％。结论广西乡镇卫生院免疫规划工作机构设置完整,但防保人员不足,学历学位均较低,需要不断增加补充乡级防保人员,进一步提高他们的工作技能。     

广东省乡镇卫生院医生人力资源现状分析及政策建议

目的：了解广东省乡镇卫生院医生人力资源的现状．探索发展对策。方法：采用现场问卷调查的方法，对全省随机抽样的18家乡镇卫生院的486名医生年龄、性别、文化程度、科室和职称情况等进行调查。结果：广东省乡镇卫生院医生学历以大专和中专为主，职称以初级为主．占62．0％，珠江三角洲地区医生学历层次和职称水平明显高于东西两翼和粤北山区；临床医生的学历和职称水平明显高于防保人员。结论：广东省乡镇卫生院医生总体素质偏低，同区域医生发展不平衡．综合素质差别很大．临床医生的素质高于防保医生。建议加强乡镇卫生院医生的继续教育．提高素质，改善结构．采取有力措施缩小区域差距，适当增加防保人员数量，采取对策提高防保人员的质量。     

佛山市疾病预防控制体系人力资源现状分析

目的：了解佛山地区市、区、镇三级从事疾病预防控制工作人力资源现状，为疾病控制机构人力资源的舍理配置提建设性意见。方法：收集2005年佛山市及五区疫病预防控制中心、37个镇（街道）59问医院防保中心的工作人员基本信息以及辖区面积、人口等指标，应用EXCEL和SPSS12．0对数据进行统计分析。结果：全市疾控人员在学历方面，中专及以下学历占46．2％；在职称方面，以初、中级为主，其中初级占64％，中级占28．7％；在专业方面，市区级人员专业构成以预防医学和检验为主，镇（街道）人员所学专业以临床和护理为主。结论：佛山市、区、镇（街道）痰控机构人员总量不足，重医轻防现象相当严重。提出疾控机构人员配置比例至少为2．5人／万的建议，为促进乡镇、村级基层公共卫生网底建设可在村委会（社区居委会）聘用卫生协管员。     

某市疾控机构环境相关疾病预防与控制的人力资源配置现况

[目的]了解环境相关疾病预防与控制人力资源配置状况,为制定市、县（区）级疾病预防控制中心环境相关疾病防制的人力资源配置标准提供依据。[方法]采用回顾性研究和现况研究方法调查某地市疾病预防控制中心环境相关疾病防制的人力资源配置状况,分析其公共卫生职能执行情况。[结果]某市各级疾病预防控制中心从事．环境相关疾病防制的专业人员共118人（其中31．36％为兼职人员）,年龄（37．95±9．01）岁。全市人口中环境相关疾病预防与控制专业人员拥有率为1．92人／10万。专业人员学历以本科为主,占50．85％,研究生及以上学历占9．32％;研究生、本科、大专、中专人数的比例约为1：6：2：2。中级职称以上占61．02％;高级、中级、初级职称的比例为2：5：4。另外,过去5年有15．71％本科以上学历和（或）中级以上职称的专业人员调离了本岗位。该地区公共卫生职能落实程度为40％～60％。[结论]该地区从事环境相关疾病预防与控制的专职人员明显偏少,相应的公共卫生职能有所削弱。建议各级疾病预防控制中心要合理配置环境相关疾病防制的人力资源。     

经济欠发达地区乡村卫生人力资源现状分析

受城乡二元经济的影响,经济欠发达地区乡村卫生人力资源严重缺乏,人员数量每千人仅为0．88人,人力结构大龄化（45岁以上卫生人员占46．71％）、学历结构低（中专学历占81．04％）、专业结构不合理（缺乏预防、医技和护理人才）、职称结构不协调（初级职称占38．13％）,卫生体制不健全和培训机制不完善是导致经济欠发达地区乡村卫生人力资源严重缺乏的直接原因。     

四省基层医疗卫生机构传染病监测人力资源现状调查

目的了解基层医疗卫生机构传染病监测岗位人力资源现状,为相关部门制定卫生规划提供依据。方法对4个省基层医疗卫生机构采用分层抽样的方法抽取调查单位,对抽取的单位所有传染病监测人员全部自填问卷进行调查。结果4个省基层医疗卫生机构传染病预防控制和防保人员746人,传染病诊疗医生285人,检验人员166人。县级疾控机构、县级医院和乡镇卫生院／社区卫生服务机构的传染病监测人员中有专业学历者分别占94．6％、97．8％、89．5％;县级疾控机构传染病预防控制人员中,公共卫生专业的人员占42．7％,县级医院和乡镇卫生院／卒土区卫生服务机构传染病诊疗医生中,临床医学或中医学／中西医结合专业的人员分别占88．8％和79．3％,检验人员中医学检验（或临床检验）和卫生检验专业分别占30．7％和30．1％,无专业学历人员占13．3％（22／166）;职称以初级为主,占48．5％;其次为中级职称占39．9％;各类传染病监测人员具备执业证书者占81．2％,13．3％的人员无任何执业证书。结论4省基层医疗卫生机构传染病监测人员中,学历、职称、专业构成不合理,部分人员没有学历、不具备执业医师（助理医师）或执业护士资格。     

福州市2007年不同经济水平地区接种门诊信息化管理现状

目的了解福州市目前免疫规划信息化管理的基本情况，为运行预防接种信息化管理系统提供依据。方法按照各地经济水平对该市13个区、县（市）182个接种点进行调查，资料使用SPSS13．0进行统计分析。结果该市拟参加信息管理人员482人，Ⅰ、Ⅱ、Ⅲ类地区每个接种门诊拟参加信息管理的平均人员数为3．80、2．46和2．12人，方差分析显示3类地区差异有统计学意义（F=23．822，P〈0．01）；该市计划免疫信息化人员电脑水平，以低级电脑水平人员占较大比例，达50．4％；全市共有132个乡镇接种门诊配备了电脑，其中能够通过宽带或拨号上网的有124个接种门诊，Ⅰ类地区有电脑及能上网比例均高于Ⅱ、Ⅲ类地区。结论福州市已初步具备开展儿童预防接种信息化管理的条件，但各地预防接种信息化管理工作发展不平衡，应逐步建立适合我市各种经济水平地区的信息化管理模式。     

宁夏各市县疾控机构艾滋病防制人力资源现状及公平性研究

目的了解疾控机构艾滋病防制人力资源现状及人口和地理分布配置的公平性。方法于2012年采用问卷调查宁夏5个市级、19个县级疾控机构艾滋病防制人员的年龄、职称、学历及11项艾滋病工作项目开展情况等信息,并采用基尼系数测算公平性。结果共调查艾滋病防制人员82人,以女性为主占67．1％（55／82）,平均年龄（38．61±8．31）岁,学历以本科为主51．2％（42／82）,艾滋病防制人员正高、副高、中级、初级职称的比例为1：2．8：6．2：6．4。11项艾滋病防制工作7项均已开展（机构开展率均为100．0％）,其他艾滋病综合示范区、母婴阻断、哨点监测及疫情报告和处理4项内容,机构开展率分别为25．0％（6／24）、37．5％（9／24）、54．2％（13／24）和91．7％（22／24）。人口分布的公平性基尼系数为0．1375,地理面积分布的公平性基尼系数为0．3251,艾滋病疫情中防制人员分布的公平性基尼系数为0．3166。结论艾滋病防制人力资源数量从地理、人口及疫情分布的配置公平性较好,但人力资源的职称、学历等构成及分布仍需优化调整。     

北京某郊区县卫生防疫系统现况调查

目的了解基层卫生防疫系统的现状，为完善卫生防疫体系以应对今后可能的突发公共卫生事件提供依据。方法采用机构考察、个人访谈、问卷调查等定性与定量研究相结合的方法，于2003年5—6月，对北京市某郊区县疾病控制中心(CDC)及17所乡级卫生院的卫生防疫系统现状进行调查。结果防保科承担本辖区内的儿童保健、计划免疫、精神卫生、传染病防治、流行病学调查、卫生宣教等日常工作；防保人员70％左右的工资需单位自筹。防保人员占总业务人员比例5％及以下的占41．2％；各乡卫生院防保人员占服务人口的比例为平原乡平均1．7人／万人，少或半山乡1．6人／万人，山区乡2．6人／万人；平原乡防保人员年纪轻、学历高、多受过相关专业训练．山区乡防保人员年龄偏大、均为中专学历，57．1％为非预防医学专业毕业、42．9％为非医学专业毕业人员经培训后从事防保工作。结论该地需要进一步明确区、乡两级预防保健系统的职能，工作中急需得到政府部门的理解与配合；区、乡两级预防保健系统资金及防保人员不足、专业人才匮乏问题有待解决。     

安徽省乡镇卫生院卫技人员专业结构与质量的研究报告

该研究抽样调查了安徽省５７８所乡镇卫生院。卫技人员占职工总数８９．０％：中西师（士）占３７．８％、检验占４．７％、放射占３．６％，均基本达到一级医院基本标准。但医护之比＝１∶０．４，严重失调、卫技人员质量低下，无专业学历者占３９．７％，其中３５岁以下占４８．７％，医生中具有大专及以上学历仅占１１．７％，无专业学历占３１．９％；师级以上技术职务中不具备大专及以上学历占８４．２％，在士级不具备中专学历的占２６．３％。预测将有６０．３％的卫技人员需要接受正规化、系统化教育。防保人员每院２．８人，但分布不均，仅有４８．５％乡镇卫生院拥有专职防疫人员，无专业学历占４４．８％，明显低于其他类别卫技人员。该研究认为，要把医学教育重点放到乡镇卫生院在岗人员的培训上，采用“学历教育与专业证书教育”并重策略；调整医护比例，调整专业结构；发展合作医疗制度，理顺卫生体制与运行机制，使农村卫生人力开发与卫生系统之间协调发展。     

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.     

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.     

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.     

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.     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.