Statistical process control for referrals by general practitioner at Health Insurance Organization clinics in Alexandria

Quality control is the application of statistical techniques to a process in an effort to identify and minimize both random and non-random sources of variation. The present study aimed at the application of Statistical Process Control (SPC) to analyze the referrals by General Practitioners (GP) at Health Insurance Organization (HIO) clinics in Alexandria. Retrospective analysis of records and cross sectional interview to 180 GPs were done. Using the control charts (p chart), the present study confirmed the presence of substantial variation in referral rates from GPs to specialists; more than 60% of variation was of the special cause, which revealed that the process of referral in Alexandria (HIO) was completely out of statistical control. Control charts for referrals by GPs classified by different GP characteristics or organizational factors revealed much variation, which suggested that the variation was at the level of individual GPs. Furthermore, the p chart for each GP separately; which yielded a fewer number of points out of control (outliers), with an average of 4 points. For 26 GPs, there was no points out of control, those GPs were slightly older than those having points out of control. Otherwise, there was no significant difference between them.The revised p chart for those 26 GPs together yielded a centerline of 9.7%, upper control limit of 12.0% and lower control limit of 7.4%. Those limits were in good agreement with the limits specified by HIO; they can be suggested to be the new specification limits after some training programs.     

上海市闵行区不同性质企业职业危害因素及职工健康状况

目的了解上海市闵行区各类企业工作场所职业危害现状,健全区内企业档案,为各级政府和卫生部门制定职业卫生服务政策提供科学依据。方法对闵行区具有职业危害因素1 127家企业开展调查,使用Excel录入并整理数据库,采用SPSS 17.0统计软件进行统计分析。结果 1 127家企业中小型企业920家,中型企业182家,大型企业25家。企业中有职业危害因素的作业场所每家平均(2.64±3.35)个。工作场所主要职业危害因素分别为粉尘、苯系物(苯、甲苯、二甲苯等)、氨气氨水、铜锡铅镍锌汞等。职业病危害因素点数(指存在或产生职业危害因素作业场所或工作地点存在的职业病危害因素点数的总量)每家平均为(6.80±15.24)个,最小0个,最大227个。上岗前、在岗期间和离岗时职业健康检查率分别为87.03%、100.00%和86.94%。结论闵行区企业存在的职业危害因素主要以粉尘为主,应继续加强监测和监督,规范开展工作环境职业卫生管理和劳动者健康监护。     

Work-family conflict and mental disorders in the United States: cross-sectional findings from The National Comorbidity Survey

BACKGROUND: Work-family conflict (WFC) may have negative effects on workers' health and productivity. The objective of this analysis was to assess the association between WFC and mental disorders that occurred in the past month. METHODS: Data from the U.S. National Comorbidity Survey were used. The 1-month prevalence of mental disorders was estimated by levels of WFC and by gender. RESULTS: Compared to participants who reported low WFC, those who reported high WFC had a significantly higher prevalence of mental and/or substance use related disorders in the past month. Working hours and domestic roles did not have significant impacts on the association between WFC and mental disorders, irrespective of gender. CONCLUSIONS: Work and family roles and the balance between the two are important for workers' mental health. The influence of WFC on mental health should be investigated in conjunction with important work environment characteristics in longitudinal studies.     

2007年四川省死因监测点居民死因分析

目的了解四川省死因监测点居民主要生命统计指标水平,为慢性病综合防治及其他公共卫生决策提供科学依据。方法收集2007年四川省死因监测点死因监测资料,分析监测居民主要死亡原因及其死亡水平。结果死因监测点居民平均期望寿命76．02岁,男性平均期望寿命73．42岁,女性平均期望寿命为79．16岁。粗死亡率为569．99／10万,标化死亡率为412．2／10万,男性死亡率为672．23／10万,女性死亡率为463．11／10万,城市死亡率是519．14／10万,农村死亡率是610．94／10万。死因排在前5位的依次是肿瘤、呼吸系统疾病、循环系统疾病、损伤和中毒、消化系统疾病;从死亡的单病种看,居于前5位的是慢性下呼吸道疾病、脑血管病、心脏病、肺癌和肝癌。结论当前危害四川省居民健康的主要死因是慢性非传染病。城乡之间、男女之间的首位死因各不相同,应根据不同性别和地域人群的特点,开展常见疾病的健康教育,防治结合,提高居民整体健康水平的目的。     

Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index

OBJECTIVE: From Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. METHODS: Data on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person: mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. RESULTS: In all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. CONCLUSIONS: The distribution of general practitioners in Australia is skewed. Nonmetropolitan areas are relatively underserved. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.     

Socioeconomic inequalities in self-rated health: role of work-to-family conflict in married Korean working women

Little evidence exists on the role of work-to-family conflict (WFC) in explaining socioeconomic inequality in self-rated health (SRH). We examined the association between socioeconomic status (SES) and SRH and tested the mediating effect of WFC in the association between SES and SRH among married Korean working women. A cross-sectional study was conducted using data from the 2014 Korean Longitudinal Survey of Women and Family. Participants were 3,226 women. Three SES indicators were used: income as measured by income-to-needs ratio; education categorized into college vs. noncollege education levels; and occupation classified by white vs. pink/blue-collar occupations. Lower levels of all the SES indicators were significantly associated with poor SRH and higher levels of WFC. The higher levels of WFC were also significantly associated with poor SRH. In the relation between SES and SRH, WFC showed a partial mediating effect for income (z = ?4.13, p < .001) and full mediating effects for education (z = ?3.79, p < .001) and occupation (z = ?4.59, p < .001). WFC played a mediating role in explaining socioeconomic health inequality among married Korean working women. Workplace strategies focused on alleviating the WFC levels of socioeconomically disadvantaged married women may be crucial for improving their health status.     

Evaluating the effectiveness of health promotion policy: changes in the law on drinking and driving in California

The purpose of the study was to determine the utility of general population health surveillance data for evaluating broad policy changes that relate to health promotion. Data were drawn from the United States (US) Behavioral Risk Factor Surveillance System (BRFSS) for one US state, California. Because these data are collected frequently and continually, a quasi-experimental approach to the evaluation was possible using a type of interrupted time series analysis or longitudinal impact analysis. A statistically significant decrease in the number of declared episodes of drinking and driving was found after enactment of new state policy. These findings were compared and found consistent with another study in California that examined the effect of changes in the law on alcohol-related traffic accidents. Our findings suggest that data from a behavioral surveillance system, in this case the BRFSS, are useful to evaluate the effect of a health promotion intervention. Further, the study demonstrates the utility of comparing different data sources when assessing a population-wide change in health promotion policy.     

三峡库区蓄水前后（1997-2009年）以生物媒介传播疾病为重点的人群健康状况监测与评价

目的 评价1997-2009年三峡库区人群健康状况以及蓄水对健康的影响.方法 在三峡库区选择9个县(区)的17个乡镇(街道)设立疾病和生物媒介监测点,1997-2009年连续系统收集人口出生死亡、传染病、生物媒介等监测数据.采用时间和空间分析以及蓄水前后比较,分析疾病流行状况及其影响因素,评价库区人群健康状况.结果 三峡库区监测点2003年蓄水后7年室内平均鼠密度(2.22％)比蓄水前6年平均鼠密度(4.38％)下降49.32％;蓄水后室外平均鼠密度(2.76％)比蓄水前平均鼠密度(4.43％)下降37.70％.蓄水后人房年均蚊密度[35.09只/(间·人工小时)]较蓄水前[54.24只/(间·人工小时)]下降35.31％.蓄水后畜圈年均蚊密度[125.75只/(间·人工小时)]比蓄水前[179.46只/(间·人工小时)]下降29.93％.2003年蓄水后,流行性乙型脑炎(乙脑)、疟疾、钩端螺旋体(钩体)病和流行性出血热(出血热)发病率分别较蓄水前下降22.88％、84.85％、95.03％和81.82％.在蓄水后,钩体病、疟疾和出血热各年发病率均处于较低水平(＜0.4/10万),乙脑历年发病率＜2/10万,下降幅度略低于重庆市和宜昌市.各年粗死亡率低于重庆市和湖北省的平均水平,标化死亡率为3.77％ ～ 5.12％,低于全国平均水平.平均婴儿死亡率为11.83‰,低于全国平均水平.结论 2003年三峡水库蓄水后未诱发疟疾、乙脑、钩体病、出血热等生物媒介传播疾病的明显升高,尚未发现水库蓄水对人群死亡率造成影响,库区人群总体健康状况较好.     

某气田建设项目职业病危害控制效果评价

目的辨识某气田建设项目运行期间可能产生的职业病危害因素,评价其防护措施及控制效果。方法通过对现场进行职业卫生学调查、职业危害因素检测和职业健康监护收集相关资料,采用检查表法和定性、定量分析法进行综合评价。结果苯系物和噪声是该气田项目的主要职业病危害因素。油罐量油处和冷却塔苯系物短时间接触容许浓度超标,其他作业点检测结果均符合国家职业卫生标准。结论该项目职业病危害控制措施可行、有效,但需要加强对苯系物的职业病危害控制措施。     

Changes in the role of general practitioners in child health surveillance

Background: Changes in their Contract in 1990 gave general practitioners the opportunity to become more involved in child health surveillance. This study aimed to describe and compare child health surveillance services provided by general practitioners before and after the changes of the 1990 GP contract.Methods: A questionnaire was sent to all general practices within the Nottingham Health Authority area in 1990, and this process was repeated in 1994, ascertaining the services provided for child health surveillance. Outcome measures were: the reported provision of services, keeping of records and facilities for following up non-attenders. Also recorded were the training and qualifications of general practitioners and their attitudes towards child health surveillance.Results: Response rates were 62% in 1990 and 80% in 1994. More practices were involved in the provision of child health surveillance services in 1994, more held a baby clinic and more reported having a recall system for non-attenders. There was little change in the training or qualifications of GPs in child health between 1990 and 1994. In 1994, there was evidence of GPs meeting regularly with Health Visitors. There remained a small number of practices who were not interested in child health surveillance.Conclusion: The 1990 GP contract appears to have increased the provision of child health surveillance services by GPs and improved liaison with Health Visitors in general practice.     

某新建2×600MW火电项目职业病危害控制效果评价

目的评价新建2×600 MW火电项目职业病危害控制效果。方法通过职业卫生现场调查、检测、职业健康检查作定性、定量评价,采用检查表法评价项目的选址、总体布局和设备布局。结果该项目选址、布局、职业病防护措施和辅助用室等基本符合国家有关法规标准,主要职业病危害因素为粉尘、噪声、高温和工频电场,经检测有2个粉尘作业点STEL超限值,4个粉尘作业点CTWAPC-TWA的2倍,6个岗位噪声8 h等效连续A声级超过职业接触限值,开关站工频电场强度超过5 kV/m。结论该项目为职业病危害严重的建设项目,职业病防护措施可行、有效,但需加强粉尘和噪声的职业病危害控制措施。     

2013 - 2014年河南省疾病监测点死因监测数据完整性评价

目的 了解河南省疾病监测点2013 - 2014年死亡数据的漏报情况,评价死因监测系统数据的完整性。方法 采用多阶段整群抽样的方法,于2015年6 - 10月共抽取36个疾病监测点324个行政村（居委会）开展漏报调查,收集2013年1月1日 - 2014年12月31日所有户籍人口的死亡情况,与中国疾控中心死因报告系统的死亡资料进行比对,计算漏报率。结果 2013 - 2014年共查死亡个案9 372例,其中漏报死亡个案1 289例,2年平均漏报率为13.75%。2013年漏报率高于2014年,差异有统计学意义（χ2 = 58.90,P＜0.05）;农村漏报率高于城市、新增监测点漏报率高于老监测点、不同年龄之间的漏报率差异均有统计学意义（P＜0.05）。结论 河南省疾病监测点死因监测数据的完整性正在逐步提高,漏报率还处于比较高的水平,仍需要通过加强死因数据的报告和管理工作,健全死亡数据交换机制,才能从根本上减少漏报。     

某回收铅冶炼项目整改前后职业危害调查

摘要:目的　调查某回收铅冶炼项目作业环境整改对铅浓度的影响,为同类型企业铅的职业危害防治提供依据。方法　采用职业卫生现场调查和现场检测相结合的方法,测定工作场所时间加权平均浓度,对铅超标岗位进行整改治理,评估整改后作业场所防护设施的效果。结果　现场检测结果显示整改前作业岗位铅时间加权平均浓度均超标,其超限倍数最高为13.1倍,整改后作业岗位铅时间加权平均浓度均合格,铅超限倍数为1.73倍。企业整改后铅浓度明显下降、作业环境明显改善、职业卫生管理明显加强。结论　小型铅冶炼企业应完善防护设施,严格遵守职业病危害防护设施的“三同时”,加强职业健康日常监督管理。     

某光盘生产线职业病危害因素检测结果分析

目的通过对某可录类光盘生产线职业病危害因素的识别与分析,确定职业病危害的关键控制点。方法采用现场职业卫生学调查和职业危害因素检测检验方法进行分析。结果可录类光盘生产线主要存在的职业病危害因素为苯及苯系物、丙烯酸丁酯和噪声。检测结果表明,5个工种作业工人接触苯、甲苯、二甲苯、丙烯酸丁酯浓度均低于国家职业接触限值;对6个接触噪声的工种进行了噪声等效声级测定,作业工人接触的8h等效声级均未超过职业接触限值的规定。结论可录类光盘生产线存在的职业病危害的防治应从职业卫生管理、严格佩戴个人防护用品以及职业健康监护等方面着手综合采取切实可行的防护设施或措施。     

操作过程规范图评价室内质量控制方法的研究

目的　探讨从分析质量 计划模型导出“操作过程规范 (OPSpecs)” ,并用于评价满足室间质评性能准则所需的精密度、准确度和质控方法。方法　常规操作规范以OPSpecs图形式表示 ,其描述了当由特定质控方法提供期望的质量保证水平时 ,不精密度和不准确度的操作限。结果　OPSpecs图能用来比较不同质控方法的操作限和选择适合于特定测定方法精密度和准确度的质控方法。将测定方法的不精密度和不准确度绘制在OPSpecs图上作为操作点 ,然后将其与候选质控方法的操作限相比较。结论　对所有自动化分析仪试验项目 ,均能采用类似方式进行质控方法的选择和设计。     

大冶市2008-2012年疾病预防控制工作绩效分析

目的 了解大冶市2008-2012年疾病预防控制工作缋效考核情况,为下一步更好地做好本项工作提供依据.方法 数据来源于中国疾病预防控制缋效考核系统以及历年来大冶市疾病预防控制工作绩效考核自查评估报告.按区域绩效和机构绩效对历年来得分情况进行比较,对失分较大的指标和项目进行分析.结果 2008-2012年大冶市区域绩效考核得分分别为678.60分、762.80分、830.98分、845.91分和734.77分,2008-2010年得分一直呈上升趋势,年平均增长了7.62％,2012年稍有下降;2012年实现目标值的指标数有12个,占指标总数的66.67％（12/18）,平均完成度为81.90％.2008-2012年大冶市疾控机构缋效考核得分分别为789.20分、804.90分、869.00分、898.94分和908.44分,得分一直呈上升趋势,年平均增长了3.58％;得分比较低的主要集中在健康危险因素监测与干预和技术指导与应用研究等方面;2012年实现目标值的指标数有83个,占指标总数的82.18％（83/101）,平均完成度为90.90％.结论 加强政策倡导和工作人员能力建设是做好绩效考核的重要举措.     

An evaluation of the occupational health risks to workers in a hazardous waste incinerator

A study was conducted to evaluate the health impact of airborne pollutants on incinerator workers at IZAYDAS Incinerator, Turkey. Ambient air samples were taken from two sampling points in the incinerator area and analyzed for particulate matter, heavy metals, volatile and semi-volatile organic compounds (VOCs and SVOCs) and dioxins. The places where the maximum exposure was expected to occur were selected in determining the sampling points. The first point was placed in the front area of the rotary kiln, between the areas of barrel feeding, aqueous and liquid waste storage and solid waste feeding, and the second one was near the fly ash transfer line from the ash silo. Results were evaluated based on the regulations related to occupational health. Benzene, dibromochloropropane (DBCP) and hexachlorobutadiene (HCBD) concentrations in the ambient air of the plant were measured at levels higher than the occupational exposure limits. Dioxin concentrations were measured as 0.050 and 0.075 pg TEQ.m(-3), corresponding to a daily intake between 0.007 and 0.01 pg TEQ. kg body weight(-1).day (-1). An assessment of dioxin congener and homologue profiles suggested that gaseous fractions of dioxin congeners are higher in front of the rotary kiln, while most of them are in particle-bound phases near the ash conveyor. Finally, the necessity of further studies including occupational health and medical surveillance assessments on the health effects of the pollutants for the workers and the general population in such an industrialized area was emphasized.     

Gender difference in work-family conflict among Japanese information technology engineers with preschool children

Since the Family Policy Act, which requires companies to develop action plans to support their employees who have children in an attempt to reverse the declining birthrate in Japan, was enacted in 2003, many Japanese organizations and occupational health staff have become interested in work-family conflict (WFC), especially WFC in employees with young children. A cross-sectional survey of regularly employed information technology (IT) engineers with preschool children in Japan was conducted to examine the gender difference in WFC, relationship of WFC with outcomes, and predictors of WFC by gender. Data from 78 male and 102 female respondents were analyzed. There was no significant gender difference in total level of WFC. However, the level of work interference with family (WIF) was significantly higher in males than in females and the level of family interference with work (FIW) was significantly higher in females. Regarding outcomes, WIF was significantly related to depression and fatigue in both genders. Moreover, different predictors were related to WIF and FIW by gender. A family-friendly culture in the company was related to WIF only in males. To prevent depression and cumulative fatigue in employees with young children, occupational practitioners have to pay attention to not only employees' work stress but also their family stress or amount of family role in both genders.     

探讨低流行区麻风病疫情监测的策略

放松低流行区疫情监测工作,麻风病极有可能卷土重来。文章探讨了在麻风病低流行区,特别是麻风病处于基本消灭后的地区应采取尽可能利用现有卫生资源、注重成本一效益、主要以被动方式早期发现病人的基本策略。阐述了疫情监测工作要充分利用防病体制改革带来的资源优势;基础工作应从专业机构转移到综合性医院;注重培训方法,提高综合性医院医生参与防病的意识与责任感;主动检查家庭内接触者;采取被动监测复发的策略并强调消除疫情监测中基本消灭不等于完全控制、LEC不能取代疫情监测以及基层防保人员不再是疫情监测的主力军的认识上的几个误区。     

Temporal and geographical variation in epidemics determined from the results of an infectious disease surveillance system in Japan description of epidemic patterns by data-based criteria for epidemic periods

OBJECTIVE: After developing criteria for epidemic periods for 16 infectious diseases, we investigated temporal (annual and monthly) and geographical (regional) variation in epidemics. METHODS: Data from an infectious disease surveillance system for the years 1993 to 1997 were used for the analysis. The weekly number of patients per monitoring station was calculated from the data and used in developing criteria for an epidemic period. Based on these latter, we calculated the average number of epidemics occurring at each public health center in a year, an average length of the epidemic period, and the average number of patients per monitoring station reported during an epidemic period. These figures were used to explore temporal (annual, monthly) and geographical (regional) variation. RESULTS: With most diseases, the average number of epidemics occurring at a public health center was 0.3-0.5 per year and the average length of an epidemic period was 6-12 weeks. The average number of patients per monitoring station reported during an epidemic period differed according to the diseases. These indices showed that there were few annual differences, but great monthly differences, in most diseases. The average number of epidemics occurring in a public health center showed regional differences with some diseases. CONCLUSION: Temporal and geographical variation in epidemics for 16 infectious diseases was established by developing criteria for an epidemic period.