A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community

Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.     

新型冠状病毒肺炎社区防控人员的结构、知识、态度和工作特征研究

背景　新型冠状病毒肺炎（新冠肺炎）是一种防控难度极大的新发传染病,社区防控是遏制疫情扩散的重要途径。社区防控人员承担出入登记、环境治理和防疫知识宣传等任务,是防控队伍的主体。但目前对社区防控人员新冠肺炎知识的掌握及工作内容的研究仍不明确。基于此,本研究就社区防控人员的结构、知识、态度和工作特征开展调查,为健全社区常态化疫情防控机制提供信息参考。目的　了解新冠肺炎社区防控人员的结构、知识、态度和工作特征,为优化社区防疫人力资源配置和培训普及新冠肺炎防控知识提供科学依据。方法　采用自行设计的问卷,于2020-03-12至2020-03-21在深圳市宝安区5个街道进行便利抽样问卷调查,问卷内容包括社区防控工作人员基本情况和工作特征、新冠肺炎相关认知情况和新冠肺炎态度情况。结果　共发放调查问卷756份,回收有效问卷753份,问卷有效回收率为99.6%。753例社区防控人员中,男552例（73.3%）,女201例（26.7%）;年龄18~35岁占比最多〔61.1%（460/753）〕,文化程度高中或中专占比最多〔31.2%（235/753）〕。新冠肺炎防控知识知晓率排在前3位的是患者出院后继续自我健康状况监测天数〔73.3%（552/753）〕、潜伏期〔44.6%（336/753）〕和解除隔离的标准〔39.0%（294/753）〕。男性社区防控人员主要症状知晓率高于女性,传染病类别、灭活新型冠状病毒消毒液种类、随访与复诊时间及患者健康状况监测天数知晓率低于女性（P<0.05）;年龄越低,对传染病类别和潜伏期的知晓率越低,对主要症状的知晓率越高（P<0.05）;除传播途径不随文化程度变化外,其余各条目知晓率均随文化程度升高而升高或降低（P<0.05）;不同职业社区防控人员传染病类别和患者健康状况监测天数知晓率比较,差异有统计学意义（P<0.05）;家庭人均年收入越高,对患者健康状况监测天数的知晓率越高（P<0.05）;自评健康越差,对潜伏期的知晓率越低,对患者健康状况监测天数的知晓率越高（P<0.05）。防控人员对新冠态度得分为（46.07±5.77）分。社区防控人员平均工作（42.77±14.87）d,每日工作时长8~12 h的人数最多〔51.5%（388/753）〕。498例（66.1%）参与社区“三位一体”排查,240例（31.9%）参与3项及以上防控工作。结论　当前社区防控人员结构不合理,新冠肺炎防控知晓率较低,对新冠肺炎的影响呈消极态度。人口学特征对新冠肺炎各项知识知晓率的影响不尽相同。防控工作呈现长期性、艰巨性、复杂性的特征。应立足社区防控工作常态化特点,优化人员配置,调整工作内容,加强防控知识培训。     

北京市丰台区公务员健康状况自评与工作状况研究

摘要：目的　了解北京市丰台区公务员自评健康状况和工作状况以及两者之间的关系。方法　采取随机整
群抽样的方法,选取了北京市丰台区６家公务员单位,并对抽中单位中１８～６０岁的所有在职工作人员开展
问卷调查。采用单因素方差分析和多元线性回归进行分析,犘＜０．０５为差异有统计学意义。结果　本研究
共调查公务人员６４６人,其中男性４００人,占６１．９２％,女性２４６人,占３７．０８％。健康状况自评得分男性
为（７４．３２±１１．８７）分,女性为（７４．７５±１１．６９）分;就工作状况而言,５２．０２％的调查对象认为工作强度
较小;４７．６８％的调查对象非常喜欢／喜欢当前的工作;４５．６７％的调查对象认为自己的工作有很大／有成就
感;５４．４９％的调查对象认为自己的工作能力能得到很好发挥。多元线性回归分析发现,随着工作强度的增
大（β＝－３．７３１）、工作兴趣的减少（β＝－３．０３２）、工作成就感的降低（β＝－２．６９３）、工作能力发挥程度
减少（β＝－２．１２６）,健康状况自评量表的得分越低（犘＜０．０５）。结论　公务员群体健康自评得分较高,
健康自评得分与工作强度、工作兴趣、工作是否有成就感、在工作中能力是否得到发挥明显关联。
关键词：公务员;健康自评;工作状况
中图分类号：Ｒ１９　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０４ ０３３２ ０４     

关于加强医学生诚信廉洁教育的几点思考

从实践出发,阐述了会计工作中遇到的常见问题,并在此基础上提出了加强在校医学生诚信廉洁教育的几点思考,主要有：加强基础性课程和应用型课程的学习;培养诚信意识,加强诚信教育;开展廉洁教育,培养廉洁意识。     

论培养社区卫生工作需要的全科医生

分析社区卫生工作的特点及对全科医生的要求.并在此基础上,研究规范化培养全科医生需要注意的一些关键问题,主要表现在：全科医生培养的体系设置要结合社区卫生工作的实际需要;高度重视选拔和培养全科医生的师资;建设全科医生培养训练基地,狠抓社区在职医生转型教育工作;加强对农村贫困地区社区全科医生的“定向培养”,以此来培养符合社区卫生工作需要的全科医生.     

哈尔滨市社区卫生服务人员工作压力现况调查

目的:了解社区卫生服务人员工作压力的现况及其对工作满意度的影响,为管理者采取措施,缓解工作人员压力,提高工作满意度提供数据支持和理论依据.方法:对哈尔滨市6个社区卫生服务中心的全科医生、公卫医师和护士进行现场问卷调查,用logistic回归分析社会人口学变量及工作压力对工作满意度的影响.结果:目前社区卫生服务人员工作需求的压力最大,同事支持的压力最小,对工作满意者的压力小于不满意者的压力;工作年限、学历等人口学变量以及工作需求、技术自由度和领导支持压力,对工作满意度有显著影响.结论:管理者应注意合理分配社区卫生服务人员的工作任务、增强工作多样性、为员工提供深造机会,以降低其工作压力,提高工作满意度.     

People with multiple disabilities learn to engage in occupation and work activities with the support of technology-aided programs

These two studies were aimed at assessing technology-aided programs to help persons with multiple disabilities engage in basic occupation or work activities. Specifically, Study I focused on teaching two participants (an adolescent and an adult) with low vision or total blindness, severe/profound intellectual disabilities, and minimal object interaction to engage in constructive object-manipulation responses. The technology monitored their responses and followed them with brief stimulation periods automatically. Study II focused on teaching three adults with deafness, severe visual impairment, and profound intellectual disabilities to perform a complex activity, that is, to assemble a five-component water pipe. The technology regulated (a) light cues to guide the participants through the workstations containing single pipe components and the carton for completed pipes and (b) stimulation events. The results of both studies were positive. The participants of Study I showed consistent and independent engagement in object-manipulation responses. The participants of Study II showed consistent and independent pipe assembling performance. General implications of the two programs and the related technology packages for intervention with persons with multiple disabilities are discussed.     

Predicting work-related disability and medical cost outcomes: A comparison of injury severity scoring methods

Introduction

Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes.

Methods

Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers’ compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression.

Results

The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa = 0.73), and between WTR scores and those estimated by ICDPIC (kappa = 0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability.

Conclusions

Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research.     

Investigation on the association between diabetes distress and productivity among patients with uncontrolled type 2 diabetes mellitus in the primary healthcare institutions

AimsTo investigate associations between diabetes distress and productivity, and to identify the potential risk factors that could affect these particular associations.MethodsThis cross-sectional study was conducted in three outpatient healthcare institutions. Patients aged ≥21 years with uncontrolled T2DM and polypharmacy were included. The Problem Areas in Diabetes (PAID) measuring diabetes distress and Work Productivity and Activity Impairment General Health (WPAI-GH) measuring productivity were administered by trained interviewers.ResultsA total of 259 patients were analysed. Point prevalence of clinically severe diabetes distress, work productivity loss and life productivity loss were 7.7%, 45.0% and 35.1% respectively. Diabetes distress was positively associated with work productivity loss (p = 0.001) and life productivity loss (p < 0.001). Multiple linear regression analysis demonstrated that diabetes distress (p = 0.003), the total number of chronic medications (p = 0.012), insulin therapy (p = 0.027) and the presence of chronic kidney disease (p = 0.038) were significantly associated with work impairment. Diabetes distress (p = 0.001) and the presences of osteoarthritis (p = 0.039) were significantly associated with activity impairment.ConclusionHealthcare professionals should screen patients for diabetes distress to prevent productivity losses, especially in patients with polypharmacy and/or on insulin and with coexisting osteoarthritis or chronic kidney disease.     

Effects of occupational regulations on the cost of dental services: Evidence from dental insurance claims

In the United States, occupational regulations influence the work tasks that may legally be performed by dentists and dental hygienists. Only a dentist may legally perform most dental procedures; however, a smaller list of basic procedures may be provided by either a dentist or a dental hygienist. Since dentists and hygienists possess different levels of training and skill and receive very different wages, it is plausible that these regulations could distort the optimal allocation of skills to work tasks. We present simple theoretical framework that shows different ways that such regulations might affect the way that dentists and dental hygienists are used in the production of dental services. We then use a large database of dental insurance claims to study the effects of the regulations on the prevailing prices of a set of basic dental services. Our empirical analysis exploits variation across states and over time in the list of services that may be provided by either type of worker. Our main results suggest that the task-specific occupational regulations increase prices by about 12%. We also examine the effects of related occupational regulations on the utilization of basic dental services. We find that allowing insurers to directly reimburse hygienists for their work increases one year utilization rates by 3–4 percentage points.