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1.
BackgroundStressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.ObjectivesTo investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.DesignCross-sectional correlation studySettingsUniversityParticipantsThe sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.MethodsThe following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.ResultsThe clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.ConclusionsThere is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.  相似文献   
2.
深化家庭医生签约服务是深化医药卫生体制改革、强化基层医疗卫生服务、实现"健康中国"战略目标的重要选择,也是当前更好维护人民群众健康的重要途径。为有效推进签约服务工作,国家陆续推出各项政策,全国各地也在积极进行实践探索,成效明显。但是,签约服务仍面临诸多问题,其中"执行难"是签约服务深度推进的一大困境。通过史密斯政策执行过程模型,结合签约服务政策执行过程,发现签约服务仍存在法治性不足、政策执行人员水平不高、激励不足、政策环境影响等诸多制约因素。因此,需要从法律和制度方面进行顶层设计、提升执行人员素质和职业认同、建立医患互信、优化政策执行环境等角度进行政策创新,探索家庭医生签约服务可持续发展的路径。  相似文献   
3.
We examined the associations between parks/sports facilities in local communities and the onset of functional disability among Japanese older adults. We further investigated the spatial spillover effects of parks/sports facilities in 1st-, 2nd-, and 3rd-degree neighboring communities. Data on the onset of functional disability, including date of onset, sex, age, and address (school district) of all older adults aged 65 years and older living in Kobe City were obtained from the public long-term care insurance database (163,348 men [190,831 person-year] and 200,443 women [230,464 person-year]). Multilevel proportional hazard regression analyses showed that the number of parks and sports facilities were negatively associated with the onset of functional disability among men. In particular, these associations were stronger for the adjacent district than for individuals’ living districts. Our results imply that involving multiple neighboring communities as the intervention unit is effective when utilizing community built environments for long-term care prevention in men.  相似文献   
4.
目的 调查徐州市直属小学学生近视现状,分析教室光环境及学龄对儿童视力的影响。方法 采用整群抽样方法,运用标准对数视力表对直属小学学生进行视力检测;随机抽取4所学校,使用TES-1332A照度计测定教室光环境;计量资料采用t检验或方差分析;计数资料采用χ2检验,等级资料采用秩和检验分析其统计学差异。结果 2018年徐州市小学生近视检出率总体为49.84%(男生45.81%,女生53.88%),女生高于男生(χ2=52.001,P<0.05),且重度近视检出率更高(Z=7.795,P<0.05)。市直属小学生近视检出率54.18%,县区直属小学46.45%,市区高于县区(χ2=47.247,P<0.05)。不同年级近视发生情况不同,二~六年级近视检出率分别为36.03%,40.5%,48.45%,58.77%,65.4%,高年级近视发生率高于低年级(χ2趋势=384.766,P<0.05),且重度近视高于低年级(χ2=742.673,P<0.05)。各检测小学不同楼层间教室黑板以及桌面照度不同 (F=3.894,P<0.05) ,但均符合国家标准。结论 徐州市直属小学学生近视检出率较高,并随学龄延长而加重,女生更严重;监测学校教室光环境符合要求。改善和保护学生视力除了保障教室光环境合格和定期监测外,应进一步探讨影响学生视力的其他因素,共同促进学生视力健康。  相似文献   
5.
陈露  马芳  马蕊  马国芳 《现代预防医学》2022,(21):3944-3950
目的 评估我国疾病预防控制体系建设相关政策文件效力和实施效果,为我国疾病预防控制体系政策制定建言献策。方法 通过国家卫生健康委员会官网、“北大法宝”检索系统以“疾病预防控制”、“疾控体系”、“疾控”为主要检索词检索2003—2022年中央、国家及各部委发布的政策文件,经筛选后最终纳入52项疾病预防控制相关政策。将政策效力划分为政策力度、政策措施、政策目标3个维度,用疾病预防控制支出表示政策效果,通过构建多元线性回归模型对环境型、供给型、需求型三种不同政策工具疾病预防控制体系建设政策实施效果进行回归分析。结果 2003—2022年,我国疾控体系建设相关政策数量与总体效力值呈现平稳波动,且具有明显的正相关关系,政策平均效力值呈M型稳定变化趋势,整体水平偏低; 政策措施得分最高,政策目标次之,政策力度得分最低。相较于其他两种政策工具,环境型政策工具使用频率最高,需求型政策工具使用频率最低; 环境型(Coef.=0.732,P=0.015)、供给型(Coef.=0.64,P=0.010)、需求型(Coef.=0.523,P=0.035)三种政策工具对政策实施效果均具有促进作用,滞后期保持在1~2年; 上一年度的疾控支出对下一年度的政策效果具有促进作用(Coef.=0.74,P=0.032)。结论 我国疾病预防控制政策效力不断提高主要源于政策颁布数量的累计效应; 不同政策工具使用过程中存在不平衡、不充分问题; 三类政策工具均对我国疾病预防控制体系政策实施效果起到一定影响,且环境型政策工具最优; 疾病预防控制相关支出会强化政策实施效果,推动疾控体系建设快速发展。  相似文献   
6.
目的:了解实习护生情绪智力、临床实习环境与病人安全感知能力现状并探讨三者关系。方法:采用情绪智力量表、临床实习环境量表和卫生职业教育病人安全感知量表对492名实习护生进行调查。结果:实习护生情绪智力总分为(123.81±18.69)分,临床实习环境总分为(119.48±22.16)分,病人安全感知能力总分为(67.16±12.06)分,情绪智力、临床实习环境与病人安全感知能力呈正相关(r值分别为0.723和0.720,P<0.01);情绪智力在临床实习环境和病人安全感知能力间起部分中介效应,中介效应估计值为0.286(28.6%)。结论:学校要举办人文课程活动以培养情绪智力;医院应制订计划增加学习机会,选拔给予护生充分支持的带教老师,改善临床实习环境。  相似文献   
7.
目的 全面了解肇庆市端州区中小学校教学环境的卫生状况,为相关部门采取有效措施提供科学依据。方法 以端州区所有中小学校为监测对象,于2015—2019年对学校教室进行教学环境监测,并对监测结果进行评价。结果 共监测学校58所,小学42所,中学16所,监测教室384间,课桌椅3 480套,教室采光系数、窗地比、灯桌间距、黑板尺寸合格率分别为100%、96.55%、95.40%、84.20%;黑板反射比、黑板下缘与讲台地面垂直距离、人均面积、课桌面照度合格率分别为67.82%、48.85%、35.34%、30.75%;课桌椅分配符合率和黑板面照度合格率非常低,分别为0.86%和2.59%。小学与中学的教室人均面积(χ2=36.47,P<0.001)、黑板尺寸(χ2=10.44,P=0.001)、黑板反射比(χ2=40.85,P<0.001)合格率差异有统计学意义。结论 端州区中小学校教室采光、教师黑板卫生状况较好,但教室人均面积(特别是小学)、课桌椅分配符合率、教室照明合格率低,亟须进一步整改。  相似文献   
8.

Objective

The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms.

Data Sources and Study Setting

AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity.

Study Design

The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants.

Data Collection/Extraction Methods

This paper did not require novel data collection; the authors collected the data from the existing evidence base.

Principal Findings

The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools.

Conclusions

Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.  相似文献   
9.
To assess the effects of exposure to extremely low-frequency magnetic fields (ELF-MFs) on MDCK cell lines, experiments were performed in a chamber under controlled conditions (temperature, humidity and CO2). Therefore, the measured physicochemical and electrical changes in the cells are due solely to the magnetic field exposure and not to external factors. A developed sinusoidal magnetic field generator produced the ELF-MFs with a uniform magnetic field and adjustable intensity and frequency. Three experimental indicators were used: (i) transepithelial electrical impedance (TEEI); (ii) cell migration and proliferation; and (iii) expression of the proteins of the tight junctions, and changes in the area and shape of the cell nuclei. No significant effects on TEEI values were observed when 10 and 50 G 60 Hz magnetic fields were applied to confluent cell monolayers. There were no significant differences in migration and proliferation of the cell monolayer exposed to 60 Hz magnetic fields10 and 50 G , but a contact inhibition factor was observed. The expression of the CLDN-1 protein decreased by 90% compared with the control, while ZO-1 protein expression increased by 120%. No significant effects were observed in the area and shape of the cell nuclei. Experimentation in a controlled environment, under physiological conditions, ensures that the observed effects were strictly due to exposure to magnetic fields. Different exposure conditions are necessary to determine the impact on TEEI and cell migration–proliferation indicators.  相似文献   
10.
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