北京市农村社区卫生服务中心基本公共卫生服务人力和成本现状调查

目的：了解北京市农村地区社区卫生服务中心的基本公共卫生服务人力资源和服务成本情况,为推进基本公共卫生服务均等化提供政策依据。方法：自行设计调查问卷和调查表,选择北京市昌平区、通州区、怀柔区和密云县作为调查地区。根据经济发展水平高、中、低,以整群抽样法抽取12个社区卫生服务中心、108位基本公共卫生服务人员进行调查。结果：在基本公共卫生服务人员中,年轻女性、防保人员和低职称人员占的比例较大;农村地区为预防接种和健康教育等项目分配的人员较多,为妇女保健和生殖健康等项目分配的人员较少;设置健康教育专栏、现场疫点处理等项目的单位成本较高;近郊地区为每个项目分配的工作人员数大多高于远郊地区,而每个项目的单位成本则大多低于远郊地区。结论：北京市农村地区基本公共卫生服务队伍的人力资源建设有待加强;各项基本公共卫生服务所需的成本差异较大,应结合实际需求情况和资源现状进行政策和财政上的调整。     

北京市公共卫生信息化建设中存在问题探讨

目的对北京市公共卫生信息建设发展中存在的主要问题进行分析,探讨北京市公共卫生信息化建设的策略,为加强首都公共卫生体系建设提供参考依据。方法 2017年9月19日-10月18日,通过文献调研和半结构访谈问卷对北京市卫生行政部门和公共卫生专业机构的管理人员及部分公共卫生专家进行深度访谈和焦点组访谈,了解北京市公共卫生信息化建设现状、存在的主要问题并提出发展策略建议等。结果北京市现有公共卫生信息系统多是围绕特定领域和范围建设的,属于相对封闭的系统,信息化建设资源统筹与整合利用、业务协同和数据共享、公共资金投入和信息公开惠民服务建设不足;信息化建设人才缺乏,复合型卫生信息化人才明显缺乏,信息安全建设也面临问题和挑战。结论北京市现有公共卫生信息缺少能满足互联互通、信息共享的信息平台,不能满足全生命周期健康管理服务需求,需要实施符合首都发展特色以及功能定位的公共卫生健康信息管理策略。     

邯郸市社区公共卫生人力资源现状

目的调查邯郸市社区公共卫生人力资源现状,为基层公共卫生人力资源管理提供理论依据。方法调查邯郸市4个区20个社区卫生服务中心、44个社区卫生服务站,对单位领导人采用个人访谈法。结果邯郸市社区公共卫生技术人员配备不足,特别是防保人员数量低于所需比例要求,人员学历水平偏低,职称结构不平衡。结论应加快邯郸市社区公共卫生人才的引进或培养,促进邯郸市公共卫生事业的发展。     

北京市公共卫生医师规范化培训体系设计与启动试行

目的为适应公共卫生人才培养需要,将医学院校预防医学专业毕业生培养成疾病预防控制工作的实用型人才,探索构建北京市公共卫生医师规范化培训体系模式。方法采用研讨论证和座谈会的方式,组织相关专家和疾病预防控制机构相关人员对培训的必要性和培训的专业设置、培训内容、基地标准等进行研讨和论证,组织专家编写规范化培训体系文件,由北京市卫生局发布并启动试行。结果 2006—2011年,初步完成了北京市公共卫生医师规范化培训体系模式框架设计,设置了7个公共卫生亚专业和3个临床亚专业,制定了各亚专业的培训细则,编写了各亚专业的登记手册和考核手册及考核管理规定,制定了公共卫生各亚专业基地标准以及评估指标,完成了基地评审和认证,在市区两级疾病预防控制中心开展北京市公共卫生医师规范化培训试行工作。结论 2011年招收了首批由市、区两级疾病预防控制中心选送的新入职的预防医学专业本科毕业生14人进入基地培训,现正在逐步健全和完善。     

河南省疾病预防控制系统公共卫生人力资源调查

目的对河南省疾病预防控制系统公共卫生人力资源配置进行调查分析。方法制定统一调查问卷,从公共卫生人员的数量、性别、职称、学历、专业等方面,对省和省辖市公共卫生人员进行了的调查。结果河南省和省辖市级疾控中心公共卫生人员配置不足,人员老龄化,职称学历较低,非专业人员比例偏大。结论需解决我省公共卫生人才的需求,促进我省公共卫生事业的健康发展,并应积极开展公共卫生人员的继续学历教育和专业培训。     

湖南省公共卫生人才队伍建设现状与建议

 

在抗击新型冠状病毒肺炎（简称新冠肺炎）疫情的斗争中,湖南省率先启动重大突发公共卫生事件一级响应,采取一系列前所未有的防控和救治举措,确诊病例的总体治愈率在全国名列前茅。但此次新冠肺炎的暴发也暴露出了湖南省公共卫生人才数量不足、结构不合理、人员经费投入不足、人员考核和激励机制不够完善等突出问题。本文从以下四个方面提出建设意见：深化公共卫生与预防医学人才培养改革,为公共卫生事业提供人才支撑;完善公共卫生人才准入原则与使用办法;加大公共卫生的政府投入,提高人员待遇保障;完善公共卫生人员考核评价和激励机制,增强人员工作效率和发展高质量公共卫生服务等。

     

加快人才梯队建设，增强应对突发公共卫生事件的能力

人才梯队建设是应对突发公共卫生事件的重要保障。本文分析了目前公共卫生人员的小足之处：人手不足、水平不高、队伍不稳定、传统教育等。为进一步加强公共卫生人才梯队建设，提高他们应对突发公共卫生事件的能力，我们采取了一系列措施，使本中心公共卫生专业人员的学历、职称结构显著改善，人才建设成效显著。     

农村基本公共卫生服务开展利用情况研究

目的:了解农村基本公共卫生服务的开展、利用情况,为继续推进基本公共卫生服务提供对策和建议。方法:采用随机抽样的方法,对北京市郊区的三个区县共32个乡镇进行函调以及问卷调查。结果:(1)调查地区基本公共卫生服务均已得到不同程度开展,不同区县间、开展的服务项目间均存在显著差异;(2)不同区县在服务利用情况上存在明显差异,并且卫生室/站是农村居民的首诊机构;(3)农村居民对基本公共卫生服务的认知情况较好,认识程度和是否愿意接受基本公共卫生服务之间呈显著相关。建议:(1)采用多元化的手段落实基本公共卫生服务项目的开展;(2)加强对基本公共卫生服务项目的宣传;(3)从群众实际需求出发提供切实可行的基本公共卫生服务;(4)健全农村卫生服务体系,提高公共卫生服务能力。     

江苏省公共卫生队伍调查及思考

随着社会经济的发展、人民生活水平的提高以及近几年突发公共卫生事件不断发生,使得人们对公共卫生越来越重视,同时对其要求也越来越高,所以培养一支高素质的公共卫生队伍是当前公共卫生事业迫切需要解决的问题。目前我国的公共卫生人员素质虽然在逐步提高,但队伍还不够完善,人员还存在许多问题[1]。本文对江苏省各市、区、县级疾病预防控制中心和卫生监督所等的公共卫生人员的组成和结构状况以及各公共卫生机构工作内容和职责进行了调查和分析,旨为我国公共卫生人才培养提供依据,更为各卫生机构更好的建设人才梯队提供一些建议。1材料与方…     

综合医院临床护士化疗防护知识的调查

目的了解北京市郊区综合医院临床护士对化疗药物使用中的防护知识掌握情况,为采取有针对性的防护措施提供依据。方法采用调查问卷对北京市郊区4家二级综合医院232名接触化疗药物的护士进行调查。结果北京市郊区综合医院护士对化疗防护知识的掌握程度不高,总答对率为76.3%。肿瘤科与非肿瘤科护士化疗知识水平存在差异(t=2.80,P0.05);接受过岗前培训的答对得分高于未经过培训人员的得分,差异有统计学意义(t=2.59,P0.05);不同学历、职称的护士化疗防护知识得分情况比较,差异无统计学意义(P0.05)。结论重视岗前培训,加强化疗防护临床管理有助于提高护士的化疗防护水平。     

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.     

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.     

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.     

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.