激励-保健因素对村医工作满意度的预测作用

[目的]了解村医工作满意度水平,分析激励、保健因素对村医工作满意度的预测作用。[方法]2010年1月对贵州省黔西南布依族苗族自治州普安县7个培训地点149名村医进行工作满意度调查,釆用多元线性逐步回归分析方法。[结果]村医工作满意度得分(3.44±0.62)分;福利与收入、工作条件、工作本身得分分别为(2.76±0.76)、(2.92±0.80)、(3.32±0.70)分,低于工作满意度得分;领导考虑村医工作意见、领导肯定村医工作、在岗培训机会、每周工作时间、村医技术素质、村医社会福利能预测工作满意度,标准偏回归系数分別为0.24,0.22,0.19,0.18,0.16,0.13;复相关系数为0.74;回归方程的决定系数为0.54。[结论]村医工作满意度水平较低;激励因素在岗培训机会,保健因素领导考虑村医工作意见、领导肯定村医工作、村医技术素质、村医社会福利对村医工作满意度有正向预测作用。     

普安县村医收入状况及满意度调查

目的 了解贵州省黔西南布依族苗族自治州普安县村医医疗卫生服务收入状况及收入与福利满意度水平,分析相关因素.方法 2010年1月选取普安县149名村医,通过调查问卷进行面对面访谈.结果 81.9％的村医具有乡村医生执业资格,18.1％为执业助理医师;86.9％的村医2009年参加过在岗培训,13.1％的村医未参加;所有村医无养老保险;村医每人医疗卫生服务月均收入60～2 600元,平均1258元;其中,医疗服务收入1000元,占79.5％,公共卫生服务补助258元,占20.5％;执业助理医师较乡村医生、参加在岗培训的村医较未参加培训的村医月均收入高(P＜0.01);村医收入与福利满意度总得分为(2.83±0.90)分,低于理论中性值3.0分;村医工作报酬、医疗服务劳务补偿标准、公卫服务补贴标准、村医医疗保险、村医养老保险单项满意度得分分别为(2.83±1.03)、(2.73±1.05)、(2.67±0.99)、(3.20±0.93)、(2.72±0.91)分;月均收入≥1 258元的村医收入与福利满意度总得分较高(P＜0.01).结论 普安县村医医疗卫生服务月均收入及满意度水平较低;相关因素为执业(助理)医师比例、在岗培训、医疗服务及公卫服务补贴标准、养老待遇.     

普安县村医收入状况及影响因素分析

目的 了解贵州省普安县村医医疗卫生服务收入状况并分析影响因素.方法 2010年1月对贵州省黔西南布依族苗族自治州普安县149名村医进行医疗卫生服务收入状况调查,采用多元Logistic逐步回归方法分析影响因素.结果 执业资格以乡村医生为主,占81.9%,执业助理医师占18.1%;村医每周工作时间以＞48 h为主,占87.2%,≤48 h占12.8%;2009年参加在岗培训者为主,占86.8%,未参加者占13.2%;村医每人月均收入1 258元;其中,医疗服务收入1000元,占79.5%,公共卫生服务补助258元,占20.5%,月均收入≤1000元占55.0%,＞1000元占45.0%;新农合实施后收入增加者为主,占59.1%,未增加者占40.9%;在岗培训、每周工作时间和执业资格对村医医疗卫生服务收入有正向预测作用,OR值分别为8.96,3.94,3.12;卡克斯-史奈尔决定系数为0.17;模型x2检验值为27.22(P＜0.01).结论 村医医疗卫生服务收入较少,在岗培训、每周工作时间和执业资格对村医收入有影响.     

甘肃省部分地区乡村医生现状及培训状况调查

目的对参加甘肃中医药大学2017年乡村医生进修培训的乡村医生进行调查,了解甘肃省乡村医生的基本情况、在岗培训情况和对本次培训的满意度及建议,提出相关的对策和建议。方法从参加甘肃中医药大学2017年乡村医生进修培训的乡村医生中随机抽取629人进行问卷调查,回收有效问卷574份。调查内容包括乡村医生队伍的基本情况、在岗培训情况、本次培训在学时安排和授课等方面的满意度及建议等。调查结果采用SPSS 19.0软件进行统计分析。结果我省乡村医生队伍老龄化现象已有所改善,35～55岁占79.96%;学历结构偏低,本科及以上学历仅占0.17%;执业化程度较低,执业(助理)医师仅占9.93%,低于全国平均水平;工作量较大,日工作时间8 h及以上占57.14%,78.92%的村医既从事乡村医生工作又务农;收入较低,85.89%的村医月收入在2 000元以下,76.31%的村医无养老保险;在岗培训情况不理想,55.23%的人员未参加过培训;本次培训调查学员对培训的时间、地点和师资均比较满意,理论培训课程学时安排满意度平均得分(4.08±0.06)分,教师授课满意度平均得分(4.14±0.13)分。结论乡村医生队伍依然是我省医疗卫生服务体系的薄弱环节,应继续加强乡村医生队伍的建设;保障乡村医生的收入,完善乡村医生的养老制度;根据乡村医生的实际工作需求加强乡村医生在岗培训。     

贵州省少数民族贫困县村医队伍现状调查

目的 了解少数民族贫困县村医队伍现状.方法 2010年1月选取贵州省黔西南布依族苗族自治州普安县14个乡镇77个村卫生室所有在岗村医172人进行面对面访谈.结果 村医年龄22～68岁,平均年龄39岁;98.8%的村医无专业技术职称;执业资格以乡村医生资格证书为主,占81.4%,执业助理医师占18.6%;医学学历以中专或相当于中专水平(贵州省卫生厅授证)为主,占86.7%,大专及以上占1.2%,无任何医学学历占12.1%;平均每千农业人口乡村医生和卫生员0.48人,明显低于全国、西部地区及贵州省的平均水平(P＜0.01);村医每人月均收入1250元,低于当地民办小学教师收入水平;所有村医无养老保险,自费参加新农合;各乡镇村医农业人口分布的洛伦兹曲线紧靠绝对公平线.结论 普安县村医年龄结构偏老化,技术素质较低;村医短缺;收入水平较低,未享受政府补助的社会保障;乡镇间村医分布公平性好.     

贵州省民族地区村医队伍现状及对策分析

民族地区村医队伍的状况关系到解决少数民族村民“看病难、看病贵”的问题.为了解村医队伍现状,为制定民族地区村医相关政策提供科学依据,2010年在贵州省民族地区普安县、三穗县及凯里市进行实地调研,分析村医队伍人员数量、结构、分布及收入与社会福利状况,并提出加强贵州省民族地区村医队伍建设的对策及建议.     

十堰市城区养老机构医养结合模式满意度调查

目的由于老龄化问题不断加剧,养老服务业的发展成为社会的关注点。本研究探讨入住老年人对十堰市城区医养结合模式养老机构的满意度状况。方法 2018年7月在十堰市城区选取4所医养结合的养老机构养老人员为调查对象。模式一为医疗机构与养老机构共同提供医疗与养老服务,模式二为完全由养老机构提供医疗与养老服务,每种模式各两所。最终纳入41名养老人员作为调查对象。调查内容包括基本情况和满意度,具体包括性别、收入水平、年龄、生活自理等级、日常生活、居住环境、医疗服务和人文关怀。结果月收入≥2 000元老年人满意度评分为(2.51±0.53)分,高于月收入<2 000元老年人的(2.01±0.70)分,t=-2.466,P=0.021。模式一缴费合理性满意度得分为(3.00±0.00)分,高于模式二的(1.90±1.02)分,t=4.819,P<0.001;模式一的人文关怀满意度得分为(2.71±0.46)分,高于模式二的(2.30±0.66)分,t=2.343,P=0.024;模式一的伙食满意度得分为(2.71±0.46)分,高于模式二的(2.30±0.66)分,t=2.343,P=0.024;模式一的硬件设施满意度得分为(2.71±0.56)分,高于模式二的(1.70±0.92)分,t=4.226,P<0.001;模式一的医护人员配备满意度得分为(2.10±0.94)分,高于模式二的(1.30±0.73)分,t=3.022,P=0.005;模式一的医疗技术满意度得分为(2.86±0.48)分,高于模式二的(1.80±0.89)分,t=4.686,P<0.001;模式一的医疗设备满意度得分为(2.90±0.44)分,高于模式二的(2.00±1.03)分,t=3.642,P=0.001。结论医疗机构与养老机构共同提供医疗与养老服务模式满意度更高,经济收入是影响满意度的重要因素。     

乡镇卫生院卫生技术人员组织承诺及影响因素分析

目的了解乡镇卫生院卫生技术人员组织承诺现状及其与工作相关的影响因素,为提高基层卫生人才队伍的稳定性提供科学依据和政策建议。方法对山东、安徽和陕西45家乡镇卫生院的803名卫生技术人员进行现场问卷调查。结果乡镇卫生院卫生技术人员组织承诺各维度得分从高到低依次为:规范承诺(14.92±2.71)分,感情承诺(14.08±2.92)分,理想承诺(12.87±3.03)分,经济承诺(12.13±2.96)分,机会承诺(11.17±2.93)分;16项激励因素中,医患关系、同事关系、领导能力和作风满意度最高,分别为67.5%、56.4%和44.4%;收入、福利、培训机会、职业发展满意度最低,分别为10.3%、12.9%、18.0%和19.0%;多因素分析结果显示,组织承诺各维度分别有1~5项影响因素(P<0.05);经济承诺=0.365×收入,感情承诺=0.247×收入+0.508×生活环境+0.501×医患关系+0.284×工作量+0.588×领导能力和作风,理想承诺=0.408×福利+0.417×生活环境+0.358×培训机会+0.415×管理制度+0.461×施展能力空间,机会承诺=0.448×收入+0.373×培训机会-0.382×同事关系,规范承诺=0.392×工作条件+0.309×医患关系+0.426×领导能力和作风。结论乡镇卫生院卫生技术人员对组织的态度较积极;在改善经济激励的同时应注重非经济激励手段进一步提高卫生技术人员的组织承诺。     

幼儿教师工作满意度与工作绩效的关系:心理资本的中介作用

目的探讨幼儿教师群体工作绩效、工作满意度及心理资本三者之间的关系。方法采用工作满意度问卷、心理资本问卷与工作绩效问卷对贵州省16所幼儿园的312名幼儿教师进行调查研究,并通过依次检验程序和基于潜变量建模的Bootstrap方法探讨心理资本在幼儿教师工作满意度与工作绩效之间的中介作用。结果幼儿教师心理资本问卷及其自我效能、韧性、希望及乐观各维度得分分别为(3.97±0.43)分、(3.95±0.47)分、(3.93±0.56)分、(3.92±0.48)分及(4.06±0.50)分,其工作满意度和工作绩效得分分别为(3.98±0.70)分、(3.70±0.58)分。相关分析结果显示:心理资本及其各维度与工作绩效呈正相关(P0.01),心理资本及其各维度还与工作满意度呈正相关(P0.01),且工作绩效与工作满意度同样呈正相关(P0.01)。多元逐步回归分析结果显示:心理资本及工作满意度对工作绩效具有显著的预测作用(P0.05)。中介作用检验结果显示:心理资本在工作满意度与工作绩效之间起到部分中介作用,中介效应占总效应值的57.38%。结论工作满意度既可直接影响幼儿教师的工作绩效,又可通过心理资本对其产生间接作用。     

中国儿科医生工作满意度及影响因素分析

目的分析中国儿科医生工作满意度现状及影响因素,探讨儿科医生短缺原因并提出对策。方法 2018年8—12月,在全国范围内进行多阶段分层随机抽样,共抽取4 906名儿科医生进行工作满意度调查,并运用单因素方差分析与多因素logistic回归分析进行统计分析。结果有效调查4 198人,儿科医生总体工作满意度平均得分为(3.06±0.613)分,工作本身与社会支持平均得分为(3.37±0.650)分,工作内容与回报平均得分为(2.32±0.733)分,领导与人际关系平均得分为(3.06±0.771)分。单因素分析结果显示,年龄、性别、地区、医疗机构等级、专业职称等级、任职年限、管床数(工作量)、周休息天数、月收入分组工作满意度得分差异均有统计学意义(P 0.05)。多因素logistic回归分析显示,任职年限≥1年是儿科医生工作满意度的危险因素,女性、周休息天数1～2 d、月收入≥10 000元是儿科医生工作满意度的保护因素。结论中国儿科医生的工作满意度较低,月收入、周休息天数、性别、工作年限等是影响其工作满意度的主要因素。     

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.