552名门诊患者的调查分析

目的：分析患者选择就诊医院的影响因素和门诊患者的候诊需求，探讨医院如何适应新形势，在医疗市场中保持竞争优势。方法：随机抽取门诊患者552名进行问卷调查，分析影响患者就诊的因素和候诊需求。结果：影响患者选择就诊医院的主要因素有医疗水平，对医生的信任度高。患者希望就诊医院改进的问题主要有降低收费，简化手续、提高医疗质量和改善服务态度等。患者希望得到的候诊服务有健康知识宣传、随时能就诊进展、专家医师的介绍等；希望改进的候诊服务是耐心解答问题、服务热情、增设看病流程提示标识等。结论：提高医疗水平和医务人员整体素质、强化服务意识、加强成本核算、规范医疗行为等是医院在医疗市场竞争中取胜的关键。     

社区门诊患者就医需求调查分析

目的通过调查了解社区门诊患者的健康状况及就医需求情况,更好地体现"以病人为中心",提高服务满意度。方法选择2011年1月20—23日上海市嘉定区江桥社区就诊的门诊患者200例进行健康现状及就医需求调查。结果社区门诊患者中,疾病谱排列前5名依次为高血压、脑梗死后遗症、冠心病、糖尿病、上呼吸道感染。影响患者就诊医院的相关因素有医疗技术、对医务人员的满意度、医疗费用、健康指导等。患者希望得到和改进的诊疗服务有健康指导、便捷的就诊方式、诊疗信息、专家信息及其特色、医德医风等。结论社区门诊患者有较高的就医需求,提高医疗水平,强化医务人员服务意识、规范医务人员医疗行为等,均是医院做好以病人为中心、提高服务满意度的重要措施。     

医改前后患者对就诊机构的评价变化及影响不满意的因素

目的：了解医改前后就诊患者对就诊机构评价的变化,为提高患者满意度,促进医患和谐提供参考。方法利用2008年第4次国家卫生服务调查的数据以及2011年医改阶段性评价调查的数据,采用单因素分析和logistic回归分析,了解就诊患者对就诊机构的评价以及影响病人不满意的因素。结果医改实施两年后,门诊患者对就诊机构各方面的满意度均有升高。费用高、设备差、药品少仍然是就诊患者最不满意的3个方面。收入、医疗费用支付方式、就医过程中候诊时间、就诊环境及对医生的信任程度等因素会影响患者满意度。结论提高患者满意度需要进一步提高医疗人员的技术水平,加强医疗安全、缩短候诊时间、改善就医环境。营造医患和谐环境,需要医患双方共同努力。     

根据患者需求改进门诊服务

随着卫生体制改革的不断深入，患者对医院的选择权力越来越大，医院面临的将是开放的竞争激烈的医疗服务市场。如何在改革中保持竞争优势，吸引更多的患者前来就诊，关系到医院的生存与发展。笔者通过调查门诊患者选择就诊医院时所关注的重点，了解患者需求，并据此改进门诊服务，提高医疗服务水平。     

某医院儿童门诊候诊时间影响因素分析

目的分析儿童门诊候诊时间的影响因素,提出应对措施,缩短门诊患者候诊时间,为医院合理配置门诊医疗资源提供借鉴。方法运用SQL Server 2008 R~2提取2015年门诊患者的就诊信息,并对数据进行处理,运用SAS9.2软件进行单因素方差分析和多元逐步回归分析。结果年龄、病人来源、就诊类型、季节、星期、时段、科室、职称9个因素分类间平均候诊时间均不相同,差异均有统计学意义(P0.0001)。挂号科室、医师职称、初诊科室是平均候诊时间最主要的影响因素。结论针对影响候诊时间的因素提出弹性排班、分时段诊疗、缩小就诊差异等措施,从而有效缩短候诊时间。     

658例保健儿童的调查分析

目的 为了了解保健儿童家长的需求,更好地为儿童家长指导儿童的养育知识,提高服务满意度.方法 随机抽取门诊658名进行保健儿童的家长,发送选择保健医院的影响因素和候诊需求等问卷调查.结果 影响选择保健医院的主要因素有医疗技术水平、对医生的信任度,环境舒适度等.家长希望得到和改进的候诊服务有随时通报体检进展、育儿知识宣传等.结论 提高医疗水平和医务人员整体素质、强化服务意识等是保健门诊搞好医疗保健工作的重要举措.     

武汉市门诊病人选择就诊医院的影响因素分析

目的 研究影响武汉市门诊病人选择就诊医院的原因，为卫生资源的合理配置提供科学依据。方法 随机选择不同级别的多所医院，对各科门诊病人进行问卷调查，结果 利用Foxpro建立数据库，采用SAS软件进行统计分析。结果 医院吸引病人就诊的原因为就近、医疗水平高、对口单位、医疗设备好、有专家门诊等，不同级别的医院略有差异。结论 服务质量及医疗服务的可及性是影响病人选择就诊医院的主要原因。     

综合门诊患者满意度调查及影响因素分析

[目的]对医院门诊患者就诊满意度进行调查,探讨门诊患者满意度的影响因素。[方法]采用自制问卷进行调查,问卷内容包括患者的一般人口学资料、已候诊时间、自我健康评价、疾病认知、对本次就诊的满意度、情绪因子等。[结果]患者的性别、年龄、婚姻、职业、学历对患者满意度的影响没有统计学意义(P>0.05);候诊时间、负性情绪、自我健康评价对患者满意度的影响有统计学意义(P<0.05)。[结论]缩短候诊时间,减少患者负性情绪的发生,加强疾病相关知识的宣教,对自我健康评价不同的患者给予个性化的就诊服务指导可以提高门诊患者就诊满意度。     

欠发达地区门诊患者就诊机构选择及影响因素——基于我国西部地区县级医院及乡镇卫生院的实证研究

目的:调查西部农村地区医疗机构门诊患者治疗常见病的就诊机构选择,并分析其影响因素。方法:研究收集我国西部11省的县级医院和乡镇卫生院门诊患者常见病就诊机构选择情况,采用非条件无序多分类logistic回归和卡方检验分析就诊选择的影响因素。结果:共纳入4 233名样本,其中45.5%选择乡镇卫生院。样本来源机构、省份和受访者性别、教育程度、职业、月收入、医保类型等自身因素对患者的选择意愿有显著影响。就诊机构的"距离"、"收费的合理性"、"医务人员服务态度"及"医务人员技术水平"是就诊选择的主要外部原因。结论:男性、务农务工群体、教育程度较低、收入较低的患者,倾向于在级别较低的医疗机构就诊;农村居民对村卫生室的医疗需求多为方便、及时,对较高级别的医疗机构(如县级及以上医院)的需求则定位于更好的服务态度和技术水平,因此村卫生室、乡镇卫生院应更注重提高基本医疗服务的可及性,而县级及以上医疗机构应着眼于提升医疗服务水平、改善患者的可负担性及满足患者较高层次的卫生服务需求。     

广东省某医院门诊病人满意度调查

目的了解门诊病人就诊的满意度情况,找出门诊的缺陷,了解病人对医院的服务需求,分析原因,寻找对策,提高门诊服务质量,提高病人满意度。方法采用自制的门诊服务调查表,利用两周时间,随机分发给候诊病人,说明注意事项后,由候诊病人自行填写。结果共449名患者接受了调查,绝大多数病人对该院的门诊服务质量是满意的,但对等候时间的满意度低于服务态度。结论总结影响服务满意度的因素,探讨对策,进行针对性的优化和整改,提高医疗服务质量。     

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.