吉林省农村人群碘营养水平及甲状腺功能调查

2009年4月从吉林省磐石市宝山、明城、烟筒山3个乡抽取8～10岁儿童100名,并从其家庭巾抽取18 ～45岁成人100名.另外,抽取孕妇、哺乳妇女及其0～2岁婴幼儿各50名.调查显示,居民户盐碘中位数为30.2 mg/kg,水碘为2.8 μg/L;依据世界卫生组织对人群尿碘巾位数的评价标准,学龄儿童( 196.5 μg/L)、孕妇(198.5 μg/L)、哺乳妇女(224.9 μg/L)以及婴幼儿(209.0 μg/L)的尿碘巾位数均处于适宜水平,仅成人(269.0 μg/L)达到了“超需要量”水平;B超测量学龄儿童甲状腺肿大率为1.8％.各类人群甲状腺功能异常率均较低,以亚临床甲状腺功能亢进(2.1％)、亚临床甲状腺功能减退(1.5％)、甲状腺功能亢进(1.2％)为主.亚临床甲状腺功能减退主要在成人(2.7％)、孕妇(1.7％)、哺乳妇女(1.8％)中流行,亚临床甲状腺功能亢进主要发生在学龄儿童(4.5％)及哺乳妇女(3.6％)人群中.提示当前吉林省农村地区居民碘营养水平对其甲状腺功能没有产生明显不良影响.     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.     

Ultrasound as visual feedback in speech habilitation: Exploring consultative use in rural British Columbia,Canada

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech‐language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school‐aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target // after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi‐experimental clinic‐based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy.     

Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools

Background

Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program’s fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars.

灾难性卫生支出的城乡差异及分配敏感性研究

目的:分析实现全民医保后我国灾难性卫生支出的发展趋势、城乡差异及分配敏感性状况。方法:利用中国家庭动态跟踪调查2012年与2014年数据,采用世界卫生组织关于灾难性卫生支出及分配敏感性计算的方法。结果:2012—2014年,灾难性卫生支出总体发生率和发生强度均有明显下降。总体而言,灾难性卫生支出的收入分配状况相对均等。但是,发生率绝对值较高,且城乡有别,农村受到的灾难性卫生支出冲击更大;穷富有别,灾难性卫生支出更多发生在穷人身上。2012年城市发生率比农村更不均等,2014年正好相反。2012—2014年,所有家庭平均差距的集中指数由负变正。结论:全民医保对于降低灾难性卫生支出发生率与发生强度有一定作用;有限的保障内容、水平可能导致医保无法改善甚至加剧灾难性卫生支出的强度;收入水平与医疗保险差异导致农村、穷人遭受更大的灾难性卫生支出发生风险。     

农村地区培养卫生人才的国际经验与启示

目的:描述国外为农村地区培养卫生人才的政策和项目,分析增加农村地区卫生人力的做法和措施,为我国订单定向免费医学生培养政策提供参考和依据。方法:采用文献综述方法,搜索国内外为农村地区培养卫生人才相关文献48篇,对上述文献进行逻辑分析归纳,系统回顾分析国内外相关策略和做法,总结经验启示。结果:为农村地区培养卫生人才的常见措施包括:招收农村背景学生、导师制医学培养、农村卫生机构实习、经济激励措施、毕业后强制农村服务。对我国的启示包括:充足的财政资金是保证项目顺利实施的先决条件;做好项目管理和评价工作可以提高项目实施效果;选择合适的做法组合实施此类项目可以提高其效果。结论:订单定向免费医学生培养政策适合当前我国国情,同时不少国外经验值得我们借鉴:加大资金投入,加强管理和评价,加强部门合作,进一步完善订单定向医学生培养。     

四川省定向免费医学生政策的实践与探索

目的:从卫生政策研究和改进政策的角度出发,总结四川省农村订单定向免费医学生政策在推行中遇到的实际问题,为优化农村订单定向免费医学生政策在四川省的实施提供参考。方法:采用半结构式访谈对四川省、县市级卫生行政部门和基层医疗机构的定向培养政策主要负责人进行个人访谈,并采用焦点小组访谈了解定向生的思想动态。结果:定向生了解政策的渠道有限,对基层医生工作的理解不深,诚信档案未能切实发挥留住人才的作用;定向生考研意愿较高,但报考研究生与留任基层之间存在矛盾;对定向生的培养过程管理缺乏合理高效的模式。结论:应更注重培养定向生的荣誉感和责任意识,改进培养项目中的奖惩机制,优化管理考核模式,在促进各个政策参与部门之间工作衔接更加和谐有序的同时,更好地将定向生引入基层,从而优化基层卫生人力资源建设。     

Two-stage vertical flow multi-soil-layering (MSL) technology for efficient removal of coliforms and human pathogens from domestic wastewater in rural areas under arid climate

This paper investigates the removal efficiency of organic matter, nitrogen, phosphorus, coliforms and pathogens from rural domestic wastewater in a two-stage vertical flow multi-soil-layering (MSL) system. The effects of wastewater quality, season and arid climate conditions on pollutants removal efficiency by the system were examined for one year. The experimental setup included two similar MSL systems composed of two layers: soil-mixture-layers (SML) and gravel permeable layers (PL) that are arranged in a brick like pattern. The applied hydraulic loading rate was 1000 L m^?2 day^?1. Results showed that most of the physicochemical contaminants elimination occurred while the wastewater percolated through the first MSL stage. The second stage demonstrated an improvement in the reduction of all pollutants, especially fecal bacteria indicators and pathogens. The mean overall removal rates performed by the two-stage MSL system were 97% for TSS, 96% for BOD₅, 91% for COD, 96% for TN and 95% for TP. For bacterial indicators, the combination of two-stage MSL system achieved high log removals between 2.21 and 3.15 log units. Contaminants reduction processes in MSL technology are more dependent on internal than external environmental factors. The effectiveness of the two-stage MSL system to treat domestic wastewater was strongly influenced by wastewater quality. Significant relationships between influent contaminants level and their removal efficiency were found. The efficiency of MSL technology to reduce contaminants is not sensitive to season and air temperature fluctuations. This is due to the capacity of MSL system materials to withstand the air temperature variation, which highlights one of the advantages of MSL’s technology. Wastewater quality is the most important factor affecting the removal of contaminants in the MSL, which could be a critical parameter to considered when designing MSL system. Two-stage MSL system achieved a high treated wastewater quality amenable for treated wastewater reuse in agriculture recommended by Moroccan code of practice. Therefore, the combination of two-stage vertical flow MSL system could be considered an efficient and promising domestic wastewater treatment solution in arid countries to promote environmental protection and wastewater reuse.