Dependency, social factors, and the smoking cessation process: the doctors helping smokers study

We analyzed data obtained from a representative sample of the smoking patients (n = 1,338) of 66 family physicians to determine predictors of attempts to stop smoking, desire to quit smoking, and successful smoking cessation. Compared to subjects who made no attempt to quit smoking, subjects who tried to quit smoking tended to be younger, had tried to quit smoking in the year prior to the study, waited longer before smoking their first cigarette of the day, had more desire to quit smoking, and had more social support for quitting. Education and cigarettes smoked per day were not independently related to the subject making a quit attempt. Desire to quit smoking was associated with an attempt to quit in the year prior to the study and social support for smoking cessation (support of spouse, second most important social contact, and physician). Desire to quit smoking was not independently related to age, education, or dependency on cigarettes (measured by the number of cigarettes smoked per day and the length of time a subject waited before smoking the first cigarette of the day). Compared to subjects who tried to quit and failed, subjects who succeeded were older, smoked fewer cigarettes per day, and waited longer to smoke their first cigarette of the day. Spouse support, support of the second most important social contact, and advice of a doctor to quit smoking were not independently related to whether or not a cessation attempt would be successful. These data suggest that successful smoking cessation requires two components: social support to make an attempt to quit and the ability to overcome dependency on cigarettes to make the attempt successful.     

加强医院药学管理 创新医院药学服务

随着科学技术的进步,医院药学发展的总趋势是进行医院药事管理,药学技术工作和药学服务要向临床靠拢。这就要求医院药学部门应掌握国内外药学发展动态,根据实际情况不断引进、吸收和应用现代药学新知识、新技术和新方法,创新医院药学管理。文章对此进行了分析,并就创新医院药学管理提出了建议。     

推进国防卫生动员准备

坚持战时卫勤保障需求为中心,在当前国防动员力量建设的基础上,健全法律法规体系,扎实做好国防卫生动员准备,提高卫生动员保障能力。坚持军地一体为框架,构建卫生动员联动格局,必须加强统筹力度;坚持建用一致目标,做好卫生动员无缝链接,优化机构运行环境,促进卫生动员工作落到实处。坚持以实战需求为牵引,构建卫勤保障信息化平台,扎实抓好实战化研训,做到平时准备与战时保障的无缝链接。     

Cultivating a worldly repose: the contribution of Sally Gadow's work to interpretive inquiry

This paper discusses the contribution that the work of Sally Gadow makes to understandings of interpretive inquiry and it's potential to inform and influence nursing practice, research, and education. The discussion draws on several of Gadow's published works that make explicit her understandings of what it means to be interpretive, to be open to multiple truths, to hear multiple voices, to have a history, to be experienced, and to recognize agency in language. Situating this discussion of Gadow's contribution in opposition to a metaphysics of genius is intended to move our understanding of particular work past the subjectivity that produced it, past the subjectivized responses to the work, past the reporting on myself – my thoughts, my perspectives, my experiences – to explore, to see the worthwhileness or even the possibilities of exploring the work itself and the worlds it evokes. This paper is a deliberate attempt to disrupt the call to the author to save us from the task of interpreting the questions that the work itself places us under. Gadow's work itself points us away from a valorization of the voice of the author of the work, a single voice, and towards a cultivation of a worldly repose where each interpretive account points us to some longstanding whole to which the work belongs and from which it gains its sense and significance.     

充分发挥绍兴市社区卫生服务机构功能的几点构想

据调查,绍兴地区各个大中型医院＂看病难、看病贵＂问题较为突出,而且许多高层次专科医生在诊疗一些常见小病,既浪费医疗资源,也不利于高层专科人才的提高。这与目前社区卫生服务机构不完善,社区卫生服务队伍不健全,人员素质不高,双向转诊制度不落实,绝大部分患者涌向大中型医院有关。如要从根本上来解决这一问题,就必须大力发展社区卫生服务,培养以全科医师为骨干的社区卫生服务队伍,提高社区卫生服务能力,同时做好政府优惠政策的宣传工作及适宜技术的推广工作,完善双向转诊制度等措施,让社区来承担预防、保健、健康教育、计划生育、医疗和康复等六位一体的职能。逐步做到＂大病进医院,小病在社区＂,这样对于方便群众就医,减轻费用负担,建立和谐的医患关系,具有重要意义。     

2007～2008年江苏省淡色库蚊和家蝇的抗性研究

目的了解江苏省蚊蝇对常用杀虫剂的抗药性情况,指导蚊蝇防治的科学用药。方法蚊虫抗药性检测采用幼虫浸渍法,家蝇采用点滴法。结果南京市家蝇对敌敌畏、溴氰菊酯、高效氯氰菊酯和残杀威的抗药性均相对较高,而淮安市均为最低;4种杀虫剂中,残杀威抗性均为最高,其次为敌敌畏,溴氰菊酯抗性均为最低。淡色库蚊对高效氯氰菊酯、溴氰菊酯和仲丁威的抗性在淮安市均为最高,对双硫磷抗性在苏州市为最高;4种杀虫剂中,仲丁威抗性均为最高,溴氰菊酯除在淮安高于双硫磷外,抗性均为最低。结论在蚊蝇防治时应避免使用抗性较高的残杀威、仲丁威和敌敌畏,优先考虑使用溴氰菊酯等拟除虫菊酯类杀虫剂。     

Ethical behavior of nurses in university hospitals

The aims of this study were to analyse the conception of ethics in the nurse's speech and practice, to verify its influence on nurses formation, and to investigate the nurses views regarding to the contribution of ethics to the comprehension of the moral reality and to the critical analysis of the nursing practice. The methodology focused on the qualitative analyses of data collected through the techniques of: document collection and analysis, group interviews, and observations of the nurses ethical behaviour during their practice. According to he results, the nurses conception of ethics relates in satisfaction to their work, to professional discrimination, and to corporate issues of health team. No reference was made to citizenship concerns. There is also a setting away from ethics understanding while moral behaviour and a critical view of the profession and of health care.     

市场经济体制下的医院经营之道

医院面对其置身医疗市场的现实,应慎重决策,认真管理;以病人需求为导向,注意经营效益;抓大不放小,实行低成本扩张战略;采取开展高新和适应技术,改善环境,加强成本核算,提高服务质量,拓宽医疗市场途径,争取医疗市场份额;抓好急危重症抢救、介入治疗、微创手术、器官移植四在技术,提高技术水平和医疗质量。同时,医院还要重视抓好机构改革、干部管理、人才管理,处理好发展与稳定的关系。     

A 4-year study of Pseudomonas aeruginosa susceptibility to antibiotics (1998-2001) in northern Lebanon

Four hundred and sixty-four Pseudomonas aeruginosa strains were isolated in northern Lebanon at the Islami Hospital Microbiology department, in Tripoli. The purpose of this study was to evaluate the susceptibility of these strains to antibiotics, to compare this susceptibility according to the nature of the sample and the year of sampling. The results show that urinary samples were the most frequent (39.3%), followed by wound samples (21.2%), and ear samples (16.5%). The average rate of susceptible strains was 39.8% to ticarcillin, 56.9% to piperacillin, 58.2% to piperacillin + tazobactam, 74.1% to imipenem, 63.3% to ceftazidime, 60.4% to cefepime, 62.1% to aztreonam, 60.3% to netilmicin, 57.5% to gentamicin, 62.2% to tobramycin, 69% to amikacin, 100% to colistin, 45.4% to pefloxacin and ofloxacin, 57.7% to ciprofloxacin and 1.3% to rifampicin. The study showed that the strains isolated from pulmonary secretions were the most resistant to antibiotics.     

Principles for planning the teaching of health promotion in an MPH course

The Ottawa Charter on Health Promotion defined the term Health Promotion as "the process of enabling people to increase control over, and to improve, their health". It also specifies that "to reach a state of complete physical mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment". Three main strategies for promoting health were stated: advocacy, enabling, and mediating. A great emphasis was put on policy. The Jakarta Declaration at the 4th International Conference on Health Promotion in 1997 reconfirmed the Ottawa Charter and added to it that "Health Promotion is carried out by and with people, not on or to people". The learning objectives of health promotion should refer to the values and strategies of 'Health 21', to the strategies and areas of action in health promotion as specified in the Ottawa Charter, and it should be relevant to the needs of the society that the participants are going to serve. The main goal of a training program in health promotion should be to develop competence in health promotion. "Competence" refers to the combination of three domains: attitudes, knowledge, and skills. Each school of public health or planners of an MPH course should decide upon the right mix of these three domains, according to their institute's mission and goals.     

Radiological threat assessment and the Federal Response Plan--a gap analysis

The ability of the federal government to effectively and efficiently respond to nuclear or radiological terrorist attacks has been the subject of intense discussion and analysis for many years. Because of recent terrorist activities and intelligence information, there is strong sentiment that it is not a question of if, but when, a radiological or nuclear terrorist attack will occur. As a result, there is considerable concern that the federal government may not be adequately prepared to respond to an attack involving a radiological dispersal device or improvised nuclear device. In response to these concerns, federal departments and agencies have initiated actions to develop a better understanding of the magnitude of the radiological/nuclear terrorist threat, assess the ability of the federal government to support state and local responses to such attacks, and improve the Nation's ability to prepare for, respond to, and recover from these types of attacks. In an era of limited fiscal growth and competing priorities, the federal government will have to enhance its collaboration with state and local governments, the private sector, and academia to ensure that the Nation is capable of responding to a terrorist attack involving radioactive or nuclear material.     

社区产后访视健康教育对母乳喂养的影响

目的:通过社区产后访视健康教育知识宣传让产妇和家属了解和接受母乳喂养知识和技能,提高母乳喂养率.方法:社区产后访视人员在产妇及新生儿出院后3天、28天各进行上门访视一次,先了解产妇及新生儿健康状况、母乳喂养知识了解程度和喂养技能掌握情况,再根据当前存在的问题给予纠正.对可能发生的问题给予预防措施指导.利用健康教育宣传母乳喂养知识,使产妇及家属了解和接受母乳喂养知识.结果:社区产后访视健康教育宣传指导使产妇及家属接受和正确实施母乳喂养,从而提高了母乳喂养率.结论:社区产后访视利用健康教育宣传和指导母乳喂养知识和技能对提高母乳喂养率有很大的促进作用.     

加强妇幼卫生信息管理 提高妇幼保健工作质量

为全面提高珠海市妇幼保健工作质量,通过采取提高认识,摸清现状,明确管理模式;加强妇幼卫生信息网络建设,建立健全信息管理制度和常规;以提高人员素质为突破口,提高妇幼卫生信息质量;规范妇幼卫生信息收集的标准工具;狠抓妇幼卫生信息的质量控制;及时准确地向管理决策部门提供科学、有效的信息等强化妇幼卫生信息管理措施,使珠海市１９９０～１９９８ 年婴儿死亡率由２２４９‰降至１０７３‰,５ 岁以下儿童死亡率由２６５８‰降至１２９６‰,孕产妇死亡率由４５６８／１０ 万降至１２８０／１０ 万,３ 岁以下儿童保健系统管理率由 ３８９７％ 提高到８１１４％ ,孕产妇保健系统管理率由４９２５％ 提高到６６７９％ ,住院分娩率由７６２３％ 提高到９９７１％ 。     

Perceived health: age and sex comparisons in a community.

The need to find accurate and reliable indicators on which to base the planning, provision, and evaluation of health services gave impetus to the attempt to develop reliable and valid measures of the perceived health status of the consumers of health care. Subjective measures can provide an important complement to traditional statistics by giving direct access to the personal feelings of discomfort or distress that influence the use of health services. Such measures also give meaningful criteria for the evaluation of the efficacy of such services. Self assessments of health obtained from surveys and interviews have consistently found age and sex differences in the tendency to report symptoms, ill-health, disability, visits to doctors, and sickness absence. Many of these data, however, may have been misleading in using instruments of unknown or uncertain validity and reliability. Nevertheless, subjective assessments of health have been shown to have value and to add a dimension to objective measurements of health. They have been considered to be one of the better predictors of mortality and of adjustment to major episodes of illness.     

谈我院实施军字一号工程建设

加强医院的网络化建设是加速医院适应现代化建设的需要，必须切实抓好。但在医院网络化建设中应把握：①工作一次到位，实现网络三全三通。其中设施是基础，网络硬件是关键，故应把好资格关、价格关、监控关。保证三全，即软件系统上得全、站点分布全、人员培训全。实现三通，即医疗信息通，经济信息通，物质信息通。②医院领导要着力抓，保证经费落实，责任到人。③抓好全员技术培训。④要有有效的管理手段作保障，如进行动态讲评，及时监控，解决数据不准和瓶颈工程等，防止夹生饭，减少浪费。     

Balancing relevance and excellence: organizational responses to link research with decision making.

Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.     

Ten years of anti-smoking programs in Italy: a review

A diverse anti-smoking program for the prevention of cancer and cardiovascular diseases has been ongoing in Italy since 1981, coordinated by the National Cancer Institute of Genoa and the Italian League Against Cancer of Genoa. The program includes several initiatives addressed to different target groups; schoolchildren and teachers, military personnel, doctors and nurses, and women. A preliminary inquiry on the attitudes and habits towards smoking was implemented by the distribution of questionnaires to the various groups involved in the program. An annual school-based anti-smoking program involves about 10,000 students aged four to 18 and their teachers. Meetings are delivered by experts to groups of 20 to 40 students with the aid of specific audiovisual material, which are periodically updated. Additional informative material, leaflets, and posters are distributed to both schoolchildren and teachers. Another educational program on primary prevention of smoking-related health hazards is addressed to military recruits, career soldiers, and medical officers. It consists of several initiatives: training of military doctors and nurses, lectures to military recruits, and distribution of informative material in the barracks. An annual meeting is organized to discuss program implementation and results. Surveys are carried out by distributing an anonymous questionnaire to health professionals in several Italian hospitals to assess the smoking habits of doctors and their attitudes and practices towards counseling patients against smoking. The results show marked differences in smoking habits in the cities under study. Annually since 1983, an updated course is organized and addressed to teachers of primary and secondary schools in Genoa. The aim of the course is to train school personnel and to help them to implement prevention programs in the schools, with the aid of experts in the field of prevention. A series of initiatives are addressed to women at different ages to sensitize them not only to the more common tobacco risks but also those regarding pregnancy, oral contraception, and so on. The survey was conducted on a representative sample of 12- to 65-year-old female population groups. It is the first of this kind in Italy to ascertain trends in smoking behavior among Italian women in relation to age, educational achievement, and occupation.     

A facilitated early return to work program at a large urban medical center

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.     

医疗质量考评体系改革的方法和策略

介绍了在医院等级评审全面展开的背景下,参照医院评审标准要义,进行医院医疗质量考评体系改革,即以建立健全2个体系、全面加强2项管理、持续改进4项质量、保障患者安全为目标,设置关键指标考评模块,构建医疗质量考评三级网络,设置关键指标考评模块,突出质量,兼顾效率,向服务倾斜,注重消费和成本控制,成立医疗质量与安全管理基金,实行奖惩两条线等.