上海市徐汇区医院发热门诊工作人员传染性非典型肺炎知识调查

目的 了解徐汇区发热门诊工作人员对传染性非典型肺炎防护知识的掌握情况。方法 采用个别问卷调查法，对徐汇区13家医院发热门诊的155名工作人员进行调查。结果 96．6％的工作人员参加过传染性非典型肺炎防护知识的系统培训。大约80％的人员知道诊断标准及如何处理，多于95％的人员知道如何对处于隔离治疗的病人进行心理干预。大约3／4的人员知道如何对医疗用品进行消毒。有不到一半的人员担心自己被感染。总之，医护人员对传染性非典型肺炎的知识率明显高于医技人员和清洁人员。结论 发热门诊的工作人员有一定的传染性非典型肺炎防护知识及处理能力。     

Alternative medicine,worker health,and absenteeism in the United States

Health related absenteeism costs an estimated $153 billion annually in the United States (Witters and Agrawal, 2011).¹ Chronic conditions (major contributors to absenteeism) are often successfully managed by Complementary and Alternative Medicine (CAM). As CAM becomes an increasingly visible component of healthcare, firms may wish to consider whether CAM therapies can help reduce illness-related absenteeism. This paper aims to extend the literature on healthcare utilization and absenteeism by exploring whether CAM treatment is associated with fewer workdays missed due to illness.MethodsUsing the 2007 National Health Interview Survey (NHIS) and propensity score matching (PSM), this study estimates the relationship between visits to CAM practitioners, health, and illness-related absenteeism.ResultsIn a sample of 8820 workers, the average annual number of workdays lost due to illness is 3.69. Visiting an acupuncturist correlates with lower absenteeism among men (1.182 fewer workdays missed, p < 0.05), whereas visiting a naturopathic doctor correlates with 2.359 and 2.521 fewer workdays missed for women and men, respectively (both p < 0.001). Active mind-body practices, massage, chiropractic and acupuncture treatments are all significantly associated with improved health.ConclusionsEstimates suggest that some CAM modalities correlate with lower absenteeism, and many correlate with improved health. Two limitations of this study are worth noting. First, a small proportion of the sample uses CAM, limiting the generalizability of results. Second, if health conscious individuals are more likely to use CAM, then health attitudes may be contributing to lower absenteeism among the treated. Further research is needed to identify a causal relationship between CAM treatment, health, and absenteeism.     

Emergency department image interpretation accuracy: The influence of immediate reporting by radiology

IntroductionThe misinterpretation of radiographs is recognised as a key source of emergency department (ED) errors, regardless of clinician profession. This article compares ENP and medical staff accuracy in the interpretation of musculoskeletal trauma X-rays between immediate and delayed radiology reporting pathways.MethodThe data for this study was drawn from a larger pragmatic randomized controlled trial of immediate reporting. Patients were recruited and randomly assigned to immediate or delayed reporting arms and treated according to group assignment. Image interpretive accuracy between ED staff groups and arms was undertaken together with an assessment of the influence of immediate reporting on patient pathways and journey times.ResultsSix hundred and seventy-four radiographic examinations were performed (598 patients). There was a significant reduction in the interpretive errors in the immediate reporting arm for all ED clinicians (proportional difference = 4.2%; 95% CI [0.017, 0.068]; p = 0.001), but no significant difference in proportion of interpretive errors was evident between ENPs and medical staff. Patient journey times, discharge and referral rates were not significantly different between study arms, although admission rates varied for medical staff collectively.ConclusionENP X-ray interpretation accuracy is comparable with that of medical staff, but immediate reporting was seen to reduce errors without increasing patient journey times.     

上海市徐汇区艾滋病防治人员艾滋病歧视状况调查

[目的]了解徐汇区艾滋病防治医务人员对艾滋病毒感染者/患者(PLWHA)的歧视状况,分析影响医务人员歧视态度和行为意愿的因素。[方法]自行设计调查问卷,对徐汇区31家医疗机构133名艾滋病防治医务人员开展问卷调查。[结果]在对待PLWHA态度方面,歧视得分最高项和最低项分别为"艾滋病感染者应该到传染病医院就诊"、"应该尊重艾滋病感染者的隐私",分值分别为1.59分、0.03分;在对待PLWHA行为意愿方面,歧视得分最高项和最低项分别为"不会去艾滋病感染者处买东西"、"愿意继续和感染了艾滋病的熟人交往",分值分别为1.05分、0.48分。歧视得分女性>男性,临床岗位>检验岗位>防保岗位。[结论]性别、从事岗位类别为影响歧视得分的主要因素;对待PLWHA存在态度与行为意愿不一致的现象。应切实贯彻实施《艾滋病防治条例》、加强医务人员职业道德培训、强化职业防护政策保障和培训,减少对PLWHA的歧视。     

无机三氧化物聚合物根尖段根管充填与倒充填治疗慢性根尖周炎的疗效比较

目的:比较应用无机三氧化物聚合物(mineral trioxide aggregate,MTA)在显微镜下进行根尖段根管充填与倒充填治疗慢性根尖周炎的疗效。方法:对慢性根尖周炎患者107例共130颗患牙进行治疗,根据MTA在根尖段充填方式的不同将其分为2组:根尖段根管充填MTA组(n=58)和根尖倒充填MTA组(n=72)。随访2年,通过临床症状和X线片检查评价疗效。结果:根尖段根管充填MTA组成功率为82.76%,根尖倒充填MTA组成功率为90.28%,2组成功率无显著差异(P>0.05)。结论:采用MTA根尖段根管充填与倒充填的方法治疗慢性根尖周炎均能获得较好的疗效。     

上海市肺结核病防治示范区I—PPM模式的实施现状与效果研究

目的：了解上海市肺结核病防治示范区I-PPM模式的实施情况,总结上海大城市结核病防治的效果、经验与挑战,提出进一步完善的建议。方法：以上海市7个结核病防治示范区为研究现场,采用现有资料收集、补充问卷的定量调查方法和深入访谈、小组讨论的定性调查方法。结果：各示范区运用结防PPM模式于病例发现、转诊追踪、确诊治疗、督导化疗和健康教育等各个过程。2009年示范区新涂阳肺结核患者的治愈率达到88．3％,自付费用占家庭年收入的比例约为5％。患者总体满意超过90％,结防人员满意度3．55分。结论：该模式有效整合资源,加强了疾病预防控制中心（CDC）的监督管理职能,实现了患者在医疗机构的“非中心化”发现、提高了地区结核病诊疗水平,充分发挥了社区督导管理的便利可及性。但在提高人力可持续性和控制医疗费用方面仍需研究有效的机制来提高I-PPM的效果。     

上海市徐汇区1995-2004年20岁以下人群白血病死亡率Poisson回归分析

[目的] 了解1995～2004年上海市徐汇区20岁以下人群白血病死亡率的时间变化趋势及其与性别、年龄的关系。 [方法]拟合Poisson回归模型,分析死亡人数与影响因素之间的关系。 [结果] 徐汇区10年间20岁以下人群白血病死亡率无随时间变化的趋势(z=0．38,P>0．5),女性死亡率低于男性(IRR=0．4706,P<0．1),0-4岁及5 ～9岁的死亡率均低于10～19岁者(IRR1=0．2308,IRR2=0．1538,P<0．05),每年因白血病死亡的20岁以下者平均2．5 人。 [结论] 徐汇区近10年20岁以下人群白血病死亡率稳定,但在性别和年龄上有差异;Poisson回归模型适用于类似资料的统计分析。     

社区实施慢性病自我管理项目的研究

[目的]在社区实施慢性病自我管理项目，并评估其对慢性病患者综合干预效果，进而在多个社区进行推广。[方法]在徐汇区长桥社区，开展慢性病自我管理项目社区动员6个月，对636名志愿参加慢性病自我管理项目的居民，随机分为干预组326人，对照组278人，采用统一问卷进行基线调查后，对干预组实施慢性病自我管理项目综合干预，对照组不做干预，6个月后再次进行问卷调查。[结果]干预组每周平均耐力锻炼时间增加，明显高于对照组（F=6．09，P：0．01），认知症状管理方法实践评分亦高于对照组，两者差异有统计学意义（F=121．95，P=0．00）；干预组在健康状况的6个方面（整体健康自评、健康担忧、气短、疼痛、失能、情绪低落）明显好于对照组，两组之间差异有统计学意义（P〈0．05）。[结论]在社区开展慢性病自我管理项目综合干预,取得了良好效果。     

上海市徐汇区胃癌高危患者定期胃镜检查依从性分析

目的 对上海市徐汇区胃癌高危患者进行定期胃镜检查依从性评价及高危人群对肿瘤防治的知识、态度和行为（KAP）调查。方法对206名胃癌高危患者定期胃镜检查依从性及KAP问卷调查。结果206名患者中完全依从者54人，不完全依从69人，不依从83人；胃癌高危人群的依从件分布，性别上具有统计学意义，女性的依从性好于男性；文化程度分布无统计学意义；就业状况、家庭收入状况具有统计学意义。结论本区胃癌高危患者定期胃镜检查依从性及肿瘤防治知识的知晓率均不高，需要在今后的工作中加强。