我国国境卫生检疫如何应对《国际卫生条例》修订

<国际卫生条例>是一个关于国际卫生检疫领域的公约.<国际卫生条例>的修订将对我国的国境卫生检疫工作提出新的挑战.新修订的<国际卫生条例>主要有5个方面的特点通报、透明、主动、扩展、关联.根据其新特点,提出5项应对措施科学卫生检疫;积累信息、利用信息;采用国际标准或发达国家先进标准;培养精通国际法规则的人才;调整卫生检疫工作内容.     

《国际卫生条例》的修改与中国国境卫生检疫

世界卫生组织于1995年开始修订<国际卫生条例>,旨在使该条例继续保持调整人类应对公共卫生危害的国际法律规范的地位.新修订的<国际卫生条例>适应了人类公共卫生危害的变化,其主要变化表现在文本结构进行了调整,增加了新的概念和内容;具有新特点与新要求.中国国境卫生检疫要全面适应新修订的<国际卫生条例>的变化,显然面临着一些变数,主要概括为①机构定位问题;②法律修订问题;③机构基础业务建设问题;④业务管理方式转变问题.     

研究新"条例"应对新挑战

<国际卫生条例>既是我国国境卫生检疫法律体系的重要组成部分,同时也是我国国境卫生检疫立法的重要渊源之一.<国际卫生条例>的修订,不容置疑地将对我国国境卫生检疫的立法、发展等诸多方面产生重大影响.为此,从事国境卫生检疫工作的专业人员及相关人员要以强烈的事业心及责任感对<国际卫生条例>的修订、实施给予高度的重视,做好各方面的充分准备,采取新措施,应对新挑战.     

从新修订的《国际卫生条例》基本框架看卫生检疫应对

新修订的<国际卫生条例>规定国家应当承担"监测、通报、信息、核实和应对"的义务.作为承担我国国境卫生检疫职责的检验检疫机构,其承担的主要义务是"信息"和"应对".因此应具有如下的能力①确定国际关注突发公共卫生事件的能力;②具有强大的信息获取的分析能力;③设有高效的全国口岸应对协调机制;④具备完善的口岸检疫基础设施;⑤具有一支高素质的卫生检疫专业队伍.新修订的<国际卫生条例>提出的挑战和要求是多方面的,中国卫生检疫的应对也应当是全面的.     

浅谈卫生检疫在《国际卫生条例》修订后的国际义务

[目的] 研究卫生检疫在<国际卫生条例>修订后的国际义务.[方法] 从<国际卫生条例>修订前后规则的改变,分析有关口岸卫生检疫国际义务的变化[结果] 修订后的<国际卫生条例>强化了一些义务,包括充分通报义务;适当的预防与控制义务;对国际交通施加最小干扰的义务;双向义务.[结论] 卫生检疫必须明确和及时、高效地履行新修订的<国际卫生条例>下的国际义务,才能防止传染病的国际传播,保障人民的健康.     

国境卫生检疫模式转变与《国际卫生条例》

[目的] 提高对国境卫生检疫转变的认识,更好地适应新的国境卫生检疫模式,采取有效的应对措施,确保国境卫生检疫工作的有效实施.[方法] 探讨国境卫生检疫模式转变与<世界卫生条例>变革的历程和关系.[结果] 国境卫生检疫模式从以被动隔离留验为主的口岸卫生检疫到以主动检疫查验为主的口岸卫生检疫,转变为积极应对公共卫生事件的国际卫生检疫的模式.[结论] 国境卫生检疫模式应适应<国际卫生条例>的变革,卫生检疫模式转变为积极的公共卫生事件应对模式,这对合理正确地实施卫生检疫措施提供了国际法律支持和保障.     

研究新修订的《国际卫生条例》加快卫生检疫的应对准备

<国际卫生条例>是国际卫生检疫领域的国际公约.该条例自1969年颁实施以来未进行过重大修改.随着新兴传染病的不断爆发和已灭绝的传染病的死灰复燃,特别是经历了SARS和禽流感事件后,世界卫生组织深感现行的<国际卫生条例>已不能适应新兴传染病防治和最大限度地维护公民健康权益的要求.为此历经10年的努力,对<国际卫生条例>进行了重新修订.新修订的<国际卫生条例>突破了传统的传染病管理模式,将原有的3种国际检疫传染病修改为生物、化学、核和辐射所引起的3种国际关泣的公共卫生事件.为应对新修订<国际卫生条例>的实施,卫生检疫部门应从10个方面作好准备.     

新修订的《国际卫生条例》与《中华人民共和国国境检疫法》的异同

[目的] 将新修订的<国际卫生条例>与现行的<中华人民共和国国境卫生检疫法>进行比较,以使我国的卫生检疫工作在法律法规的制定与修改上与国际公约接轨.[方法] 对2部法律从目的、内容和管理模式上进行比较研究.[结果] 新修订的<国际卫生条例>的目的已将疾病控制从传染病向严重危害公众的疾病(含生物、化学、放射源引起的疾病)转变,而<中华人民共和国国境卫生检疫法>仅限于对传染病的控制.从内容上看,2部法律文件在"留验"、"检验查验"、"特殊物品"、"感染控制"、"尸体骸骨管理"、"军队"等方面存在着一定的差异.[结论] 应尽快组织人员对2部法律文件进行深入的研究,以制定出与新修订的<国际卫生条例>相适应法律、法规和规范性文件,以适应实施新修订的<国际卫生条例>的需要.     

新修订的《国际卫生条例》与突发公共卫生事件应急管理对策

近年来,国内外重大公共卫生事件时有发生,特别是"非典"疫情的爆发,暴露出检验检疫工作在突发公共卫生事件应急处理、管理中存在的一些问题,新修订的<国际卫生条例>增强检验检疫人员的认识,并在某种程度上为出入境检验检疫机关加强、改进突发公共卫生事件的应急管理工作提供了新的思路.为此,简要阐述了新修订的<国际卫生条例>颁布的重要性,从加强国内外突发公共卫生事件应急管理的组织机构建设、信息收集、人员培训、物资储备、口岸卫生检验设施建设、加快<国境卫生检疫法>的修订等方面提出了做好国内外突发公共卫生事件应急管理工作的对策.     

新修订《国际卫生条例》的特点与卫生检疫应对措施

世界卫生组织对现行的<国际卫生条例>进行重大修改,旨在提高该条例的实用性和有效性,适应目前国际上的交通和贸易往来,并能较好地应对传染病在目前和未来提出的挑战.新修订的<国际卫生条例>具有如下的特点①编写结构更加条理明晰,实用方便,易于调整更新;②最大限度地扩大其适用范围;③注重传染病爆发预警和应对能力的建设和要求;④增强了<国际卫生条例>的约束力和强制力;⑤明确了国家不同级别和口岸的监测和应对的基本能力要求.新修订的<国际卫生条例>的即将颁布和实施对我国的卫生检疫事业将发生重大影响,它将成对我国卫生检疫的工作内容、工作、理论研究,卫生法规制定和卫生检疫监管模式提出严峻的挑战,同时也为卫生检疫事业的发展提供难得的机遇.     

Health Promotion and the Preventative Health Taskforce

The release in October of the Preventative Health Taskforce's discussion paper, ‘Australia: the healthiest country by 2020’ offers health promotion practitioners their greatest opportunity to participate in national policy development for many years. The Taskforce, which was established by the Federal Health Minister Nicola Roxon in March, has been asked to develop a National Preventative Health Strategy for the Government by mid‐2009, focusing initially on obesity, smoking and alcohol. The Taskforce has proposed the following targets to be achieved by 2020:

• halt and reverse the rise in overweight and obesity;
• reduce the prevalence of daily smoking to 9% or less;
• reduce the prevalence of harmful drinking for all Australians by 30%; and
• contribute to the ‘Close the Gap’ target for Indigenous people, reducing the 17‐year life expectancy gap between Indigenous and non‐Indigenous Australians.

     

陕西省山区县农村居民口腔保健健康教育效果分析

目的了解健康教育与健康促进对农村居民口腔保健知识提高率和健康行为形成率的影响,总结农村居民口腔保健的有效方法。方法在充分查阅资料的基础上,抽取口腔疾病高发的2个山区农村县,干预前后分别将2个县按经济好、中、差分类,每类随机抽取1个乡,每个乡按照相同的方法随机抽取1个村,每村随机调查10岁以上常住居民240人,2个县共调查1440人。结果健康教育与健康促进策略的综合运用使农村居民口腔保健认知水平和口腔保健行为形成率显著提高（P〈0.001）。结论提出农村开展健康教育与健康促进工作的有效方法与策略。     

Health Care Coverage and the Health Care Industry

Objectives. We examined rates of uninsurance among workers in the US health care workforce by health care industry subtype and workforce category.Methods. We used 2004 to 2006 National Health Interview Survey data to assess health insurance coverage rates. Multivariate logistic regression analyses were conducted to estimate the odds of uninsurance among health care workers by industry subtype.Results. Overall, 11% of the US health care workforce is uninsured. Ambulatory care workers were 3.1 times as likely as hospital workers (95% confidence interval [CI] = 2.3, 4.3) to be uninsured, and residential care workers were 4.3 times as likely to be uninsured (95% CI = 3.0, 6.1). Health service workers had 50% greater odds of being uninsured relative to workers in health diagnosing and treating occupations (odds ratio [OR] = 1.5; 95% CI = 1.0, 2.4).Conclusions. Because uninsurance leads to delays in seeking care, fewer prevention visits, and poorer health status, the fact that nearly 1 in 8 health care workers lacks insurance coverage is cause for concern.For complex socioeconomic reasons, private health insurance, typically provided by an employer, is “the dominant mechanism for paying for health services” in the United States.^1(p79) According to the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute, analyses of data from the Current Population Survey (CPS) show that, in 2006, 54% of the US civilian, noninstitutionalized population had employer-sponsored health insurance; 5% had private, nongroup health insurance; and 26% had public health insurance coverage. Approximately 46 million US residents (16% of the population) are currently uninsured.² Numerous studies have shown that, relative to people with health insurance, uninsured people receive less preventive care, are diagnosed at more advanced disease stages, and, once diagnosed, tend to receive less therapeutic care and have higher mortality rates.^3–8Although national uninsurance trends are well-documented, the rate of uninsurance within the health care workforce has received scant attention. Given that health care employment rates are increasing at a more rapid pace than overall employment rates, this lack of attention is especially worrisome. According to the Bureau of Labor Statistics, nearly half of the 30 occupations in which employment opportunities are growing fastest are health care occupations. For example, whereas the Bureau of Labor Statistics projects that overall employment will increase about 10% from 2006 to 2016, employment opportunities for personal and home care aides are projected to increase nearly 51%, and opportunities for physical therapist assistants are expected to increase by a third. The Bureau of Labor Statistics also projects that, by 2016, new job opportunities for registered nurses will increase by approximately 24% (approximately 587 000 new jobs).⁹Although the overall employment outlook for health care workers is promising, what is less clear is to what degree employment in health care is associated with health insurance coverage. A 2001 General Accounting Office report suggested that one fourth of nursing home aides and one third of home health care aides were uninsured.¹⁰ The Kaiser Family Foundation reported that the uninsured rate among workers in the health and social services industry was 23% in 2007.¹¹ On the basis of a review of the literature in the health and human services occupations, Ebenstein concluded that the health insurance plans offered to direct care workers in the developmental disabilities field are “inferior … with less coverage and more out-of-pocket expenses” and that fewer direct care workers “are able to afford health coverage even if they are eligible.”^12(p132)Taking a more comprehensive look at the US health care workforce, Himmelstein and Woolhandler¹³ used 1991 CPS data to estimate uninsurance rates among physicians and other health care personnel. They reported that, overall, 9% of health care workers were uninsured, along with more than 20% of nursing home workers. Examining CPS data from 1988 to 1998, Case et al. found that uninsurance rates among all health care workers rose from 8% to 12%, that rates increased more for health care workers than for workers in other industries, and that rates differed according to occupation and place of employment.¹⁴ For example, occupation-specific uninsurance rates were 23.8% among health aides, 14.5% among licensed practical nurses, and 5% among registered nurses, whereas place-specific rates were 20% among nursing home workers, 8.7% among medical office workers, and 8.2% among hospital workers.¹⁵In their studies, Himmelstein and Woolhandler¹³ and Case et al.¹⁴ used national-level data to estimate uninsurance trends among health care workers. However, these trends were not adjusted for health care workers'' social, demographic, or economic characteristics, which would have helped explain variation across categories or over time. Moreover, with the growth of the health care workforce, estimates from these older studies probably do not reflect the current situation. As a result, the picture of uninsurance as it pertains to the health care workforce lacks the precision and currentness necessary for sound policy decisions. In an effort to expand knowledge in this area, produce more up-to-date estimates, and provide support for possible policy decisions, we used data from the National Health Interview Survey (NHIS) to examine uninsurance among workers in the health care industry.