济南市生活垃圾袋装化收运模式改进

分析了济南市生活垃圾袋装化收运模式存在的问题,并提出相应的改进方案.     

Shift work,work time control,and informal caregiving as risk factors for sleep disturbances in an ageing municipal workforce

Objectives:This study aimed to examine the contribution of shift work, work time control (WTC) and informal caregiving, separately and in combination, to sleep disturbances in ageing employees.Methods:Survey data were obtained from two prospective cohort studies with repeated measurements of working conditions, informal caregiving, and sleep disturbances. We used fixed-effect conditional logistic regression analysis to examine whether within-individual changes in shift work, WTC and informal caregiving were associated with changes in sleep. Secondary analyses included between-individuals comparison using standard logistic regression models. Results from the two cohorts were pooled using meta-analysis.Results:Low WTC and informal caregiving were associated with sleep disturbances in within-individual analyses [odds ratios (OR) ranging between 1.13 (95% confidence interval 1.01–1.27) and 1.48 (95% CI 1.29–1.68)] and in between-individuals analyses [OR 1.14 (95% CI 1.03–1.26) to 1.33 (1.19–1.49)]. Shift work alone was not associated with sleep disturbances, but accumulated exposure to shift work, low WTC and informal caregiving was associated with higher risk of sleep disturbances (OR range 1.21–1.76). For some of the sleep outcomes, informal caregiving was related to a higher risk of sleep disturbances when WTC was low and a lower risk when WTC was high.Conclusions:Informal caregiving and low WTC are associated with risk of sleep disturbances among ageing employees. The findings also suggest that low WTC in combination with informal caregiving may increase the risk of sleep disturbances whereas high WTC may alleviate the adverse impact of informal caregiving on sleep.     

Reflection in night nursing: a phenomenographic study of municipal night duty registered nurses’ conceptions of reflection

Aim. The aim of the study was to describe nurses’ conception of reflection in their working situation. Background. To be a municipal night duty registered nurse in Sweden means to shoulder nursing care responsibility for numerous units with older people in need of care. Two night nurses share nursing care responsibility for up to 1300 people. In nursing research, reflection is an often‐mentioned phenomenon discussed with advantages and benefits within the ‘traditional fields’ of nursing (hospital context). A question to ask is, how do night nurses having an untraditional amount of nursing care responsibility conceptualise and experience reflection in their working situation? Design. A phenomenographic methodology was used. Methods. Data were collected by interviewing all nurses (n = 7) in a medium‐sized municipality bordering a metropolitan area of Sweden. Results. The nurses’ conceptions of reflection are categorised as ‘Field of applications’ (an instrument for interpreting, a strategy for handling the working situation and an approach to learning) and ‘Field of prerequisites’ (presence facilitates reflection; flexibility implies reflection; courage in thought and activity increases reflection). Conclusion. The findings reveal that reflection in the nurses’ working situation is more than an instrument for learning, understanding and encouragement for change and improvement. Reflection is conceptualised as an instrument for interpreting nursing care situations, which requires courage and is facilitated by presence and flexibility. Reflection is also conceptualised as an approach to handling, managing and coping with a sometimes impossible working situation that includes nursing responsibility for hundreds of older people and can sometimes entail difficulties and stress. Relevance to clinical practice. The findings showed that reflection has a broader use than had earlier been described. Deliberate use of reflection could mean improved nursing practice. This guides nursing managers to pay attention to the phenomenon as an instrument for nursing care improvement.     

市级医院后勤安全风险与管理

分析了医院日常运行中存在的安全风险,阐述了后勤安全管理的定义、特点与实施要点以及新形势下后勤安全管理的探索与实践。     

城市固体废弃物处理方式的生命周期评价——以北京市为例

针对北京城市固体废弃物量大、成分复杂的特点,对固体废弃物的卫生填埋、堆肥、焚烧以及综合处理方式进行生命周期评价,定量评价这4种处理方式对环境的影响,同时进行经济成本、资源消耗的对比分析。结果表明：焚烧处理方式在环境影响、经济成本以及资源消耗方面都影响最显著,所以应实现分类回收的普及,同时加强对废气的无害化处理：卫生填埋的经济成本低但环境影响显著,实现填埋气和渗沥液的资源化尤为重要;此外,针对目前北京市固体废弃物处理方式结构组成,应降低填埋和焚烧的比重,提高堆肥和综合处理的比重,以期实现人口、资源与环境的可持续发展。     

Recycling of Pre-Washed Municipal Solid Waste Incinerator Fly Ash in the Manufacturing of Low Temperature Setting Geopolymer Materials

In this work, three samples of municipal solid waste incinerators fly ash (MSWI-FA) have been stabilized in systems containing coal fly ash to create geopolymers through a polycondensation reaction. Monolithic products have been obtained with both MSWI fly ash as received and after the partial removal of chloride and sulfate by water washing. The polycondensation products have been characterized qualitatively by means of Fourier transform infrared spectroscopy, X-ray diffraction and scanning electron microscopy and quantitatively, through the determination of the volume of reacted water and silicate. Furthermore, the heavy metals and chloride releases together with the physico-mechanical properties have been evaluated on the hardened products. In conclusion, considering the technological and environmental performances of the obtained geopolymers, they could be suitable for many non-structural applications, such as backfilling of abandoned quarries, decorative materials or brick fireplaces, hearths, patios, etc.     

Healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care

The aim was to investigate healthcare consumption in men and women aged 65 and above in the two years preceding decision about long‐term municipal care at home or in special accommodation and to investigate determinants for healthcare consumption. The study comprised 362 people (aged 65 or over), all subject to a decision about municipal care and/or services during 2002–2003, drawn from the Swedish National Study on Aging and Care (SNAC). Data were collected from three existing registers, the SNAC data covered age, gender, marital status, functional ability, informal care and living conditions and were merged with the Skåne County Council's patient administration system PASiS and PrivaStat covering healthcare consumption from the year 2000 and forward. About 50% of the acute hospital stays (n = 392) occurred within 5 months prior to municipal care. The men (n = 115, mean age 80.8) had significantly longer stays in hospital (P = 0.025), more diagnoses (P = 0.004) and contacts with other staff groups beside physicians in outpatient care (P < 0.001) compared to the women (n = 247, mean age 83.8). The regression analysis showed heart conditions, cancer, musculoskeletal problems, genitourinary diseases, injuries and unspecified symptoms to be significantly associated with various kinds of healthcare consumption. The findings indicated a breakpoint in terms of hospital admissions about 5 months prior to municipal care and service and a share of 15% having several admissions to hospital. Early detection and preventive interventions to these people in a transitional stage of becoming increasingly dependent on continuous care and services seems urgent to prevent escalating acute healthcare consumption.     

苏州市社区卫生服务机构与市级公立医院互动现状分析与探讨

为进一步缓解人民群众看病就医问题,根据国务院《关于发展城市社区卫生服务的指导意见》和《苏州市社区卫生服务发展规划》,苏州社区卫生服务机构与市级公立医院开展积极互动,通过互动,建立起具有较大覆盖面,分工明确的医疗体系,方便了人们的健康服务,实现医疗资源的优化配置与利用;提高了社区人才队伍数量和质量,但在实际操作中也存在一些问题。作者就苏州市社区卫生服务机构与市级公立医院互动现状在市民、社区卫生服务机构和市级公立医院进行了调研,希望能揭示互动中存在的问题,为政府决策提供参考,进一步改进互动模式。     

重庆市城市生活垃圾现状及综合处理探讨

在分析重庆市生活垃圾的产生量、组成、处理方式和存在问题的基础上,提出了重庆市生活垃圾的综合处理对策.