北京市宫颈癌患者住院费用及其影响因素分析

目的 分析2006年至2010年北京市城镇职工宫颈癌患者住院费用的变化情况及其影响因素,为制定合理的医疗费用控制措施提供依据.方法 利用1146例宫颈癌患者的住院费用资料,通过描述性分析和多元逐步线性回归分析等方法探讨患者的住院年龄和住院费用情况,以及住院费用的影响因素.结果 5年间,宫颈癌患者的初次住院年龄无明显变化,住院年龄有所上升,次均住院费用随年龄分组逐渐上升,次均住院费用、次均药品费用和次均药品费比例随年份均呈上升趋势.多元逐步线性回归结果表明,住院天数、自付比例、药品费比例和是否手术是影响住院费用的重要因素.结论 宫颈癌的住院费用仍在不断增长,合理缩短住院天数、确定适宜的自付比例、降低药品费比例是降低住院费用的有效途径.     

某专科医院参保乙肝住院患者个人自付比例及影响因素分析△

目的：通过分析某市传染病专科医院乙型肝炎住院医保患者的个人自付比例及其影响因素,探索降低乙肝患者经济负担的有效措施。方法：通过医院HIS系统收集2021年-2023年3年内乙型肝炎住院医保患者的相关数据,运用Mann-Whitney U检验、Kruskal-Wallis H检验等方法分析影响患者个人自付比例的因素,采用灰色关联度回归分析住院总费用与各住院费用分项的相关性。结果：参保乙肝住院患者的平均住院费用为2.097万元,平均个人自付金额为0.832万元,个人自付比例为39.67%。影响自付比例的因素主要有性别、年龄、住院天数、年份、疾病严重程度、职业、是否手术（操作）和婚姻状况等。灰色关联度分析显示患者个人负担与综合医疗服务费、诊断费、药品费有较强的相关性。结论：女性、低年龄组、住院天数较长或较短、疾病较重、农民和工人职业、未婚状态、有手术的患者,其个人自付比例较高。可通过加强患者健康宣教、规范临床路径管理和缩短住院天数减轻患者的经济负担。     

医保住院病人自付比例分析

目的:分析医保住院病人的自付比例及其影响因素.方法:收集广州市112家医院70 792例医保住院病人的住院费用及有关信息.结果:不同级别医院医保病人个人自付比例存在差异;在职职工住院费用中的自付比例偏高,自付比例平均为50.99%(中位数为57.10%);自付比例与平均住院费用之间的秩相关系数为-0.73(P＜0.01),随着自付比例的增加,其相应的次均住院费用总体上呈下降趋势.结论:必须加强费用控制,减轻在职职工医保住院病人的自付比例;自付比例受多方面因素的影响,必须辩证看待;使用自付比例的中位数能较好反应真实水平.     

5种常见病医保患者住院费用比较研究

目的 比较5种疾病医保患者的住院费用,并对住院费用的影响因素进行分析,为新医改的深入开展提供科学依据,为医疗保险管理部门控制费用不合理增长、避免医疗资源过度浪费提供政策建议.方法 运用方差分析比较不同疾病医保患者住院费用及其各部分费用均值的差异性;运用多元线性回归分析住院费用的影响因素.结果 5种疾病医保患者住院费用及其构成、自费、统筹、超支费用均存在显著差异.结论 住院费用构成不合理,药费仍占主要构成;住院天数是影响住院费用的最主要因素;医保超支现象普遍,医院自身负担重.     

结构方程模型在医保肝硬化患者住院费用影响因素分析中的应用

目的 应用结构方程模型(SEM)分析天津市医保肝硬化患者住院费用的影响因素,为探索有效的单病种医疗费用控制方式提供参考.方法 从天津市2003-2007年医保住院患者资料库中抽取2 313例肝硬化患者的病历资料,结合专业知识建立初始通径图,采用LISREL 8.7拟合SEM.结果 患者年龄、性别对住院费用有直接影响,效应分别为-0.04和0.12,通过住院天数产生间接影响,效应分别为-0.10和-0.08;患者临床特征和医院级别对住院费用直接效应分别为0.55和0.17;住院天数对费用的效应为0.62.结论 SEM是分析住院费用影响因素的一种有效方法.合理控制住院天数、加强三级医院的监管可遏制住院费用的上涨.     

山东省老年医保患者住院费用及影响因素路径分析

目的了解山东省老年医保患者住院费用情况,探讨老年医保患者住院费用影响因素,为降低老年人疾病经济负担提供依据。方法基于第五次国家卫生服务调查山东省的部分数据,选取≥60岁的老年医保住院患者1 184例,利用SPSS 17.0软件包对老年医保患者住院费用进行统计描述、聚类分析和相关分析,用Amos 21.0软件包进行影响因素路径分析。结果山东省老年医保患者人均住院费用为10 993.78元,中位数为5 000元,人均住院天数为13.77 d;聚类分析结果显示,20.8%的老年患者住院费用偏高,50.9%的患者住院费用中等,28.3%的患者住院费用较低。路径分析结果显示,住院天数、医院级别、是否手术是影响住院费用的主要因素,路径系数分别为0.435、0.374、-0.271;医院级别、居住地、婚姻状况可通过影响住院天数间接影响住院费用,间接路径系数分别为0.035、0.035、0.028。结论多种因素共同作用影响住院费用,可探索多种方式减轻老年医保住院患者的费用。     

医保患者住院医疗费用及其影响因素分析

目的 以分析控制住院医保患者医疗费用增长关键因素为目的.方法 选择某三级综合医院2006年住院医保患者1 823人和自费患者6 509人为研究对象,利用统计软件SPSS13.0,采用非参数统计以及多重线性回归分析等方法,对住院医保患者医疗费用及其影响因素进行分析.结果 医保患者的日均费用低于自费患者,住院天数、次均住院费用高于后者;多重逐步回归分析的结果显示,住院天数、药费比例、手术与否等因素是影响次均住院费用的主要因素.结论 医保政策在控制日均费用方面发挥了作用缩短住院天数和降低药费仍然是控制医保患者费用增长的途径.     

天津市参加医保农民工患者住院费用及影响因素分析

目的:了解医保农民工患者住院费用构成及影响因素,为控制住院费用的不合理增长提供参考依据.方法:收集天津市2009-2011年医保农民工患者资料共6 377例,对其住院费用情况进行回顾性分析.结果:天津市2009-2011年医保农民工患者次均住院费用为11 578.77元;影响住院费用的主要因素有住院天数、医院等级、是否急诊和是否手术等.结论:控制农民工住院费用增长的措施有缩短住院天数、选择低级医院、扩大医保报销范围及加强健康教育等方法.     

海南省新农合患者住院费用结构与影响因素分析

目的:了解海南省新型农村合作医疗住院患者医疗费用现状、构成情况与影响因素。方法:利用Excel建立数据库,采用SPSS软件做频数分析,分析住院费用的构成,采用χ2检验及多因素二分类Logistic回归分析对医疗费用影响因素分析。结果:平均住院8.9天;人次均住院费用8 976.84元,人均药费占住院费的35.81%;住院费用个人自付率在38%～56%之间;住院人数排名前10位的病种中人次均住院费用最高的疾病是脑梗死(9 268.97元);人均次住院费用最高为神经内科10 777.58元;一级医院、二级医院、三级医院住院病人人次均住院费用为2 644.18元、5 731.55元,13 900.90元;单胎顺产、头位顺产人次均个人自付金额占人次均住院费用的80%左右。结论:海南省新型农村合作医疗患者住院费用药费占比较高;各层医院的住院病人人均医疗费用均呈现倍数逐层剧增;住院费用个人自付率高;疾病负担重;医疗资源配置绝大多数在医院;住院费用的影响因素包括:年龄、性别、住院天数、医疗机构等级。建议:提倡日间手术及家庭病床等非住院治疗;加强监管和宣传教育活动;将医保基金支付封顶线改为参保人自付封顶线;强制基层首诊,加强基层建设。     

四川省老年慢性病患者住院费用构成及影响因素分析

[目的]分析四川省六类老年慢性疾病患者住院费用构成情况及影响因素,为减轻老年慢性疾病患者住院经济负担提供建议。[方法]通过文献研究了解我国老年慢性病患病状况,对性别、年龄等进行描述性分析,平均住院日和次均住院费用采取单因素分析,住院费用影响因素采用回归分析。[结果]老年慢性病患者次均住院费用是6656.59元,平均住院日是9.92d;各年龄组的次均住院费用和平均住院日差异均有统计学意义。老年慢性病患者住院费用中平均药占比为39.32%,平均检查治疗费占比为35.41%。除老年性白内障外,其余五类慢性病的药占比几乎都超过40%。除年龄外,疾病类型、医院性质、医院所在地区、医院等级、医保付费方式、性别和住院天数等多因素共同影响住院费用。[结论]平均住院日越长,住院费用越高。慢性病患者住院费用主要构成部分是药品费和检查治疗费,药品费占比几乎达40%以上。疾病类型、医院性质、住院天数等多种因素共同影响慢性病患者住院费用。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.