A five-year study comparing early retirements on medical grounds in ambulance personnel with those in other groups of health service staff: Part I: Incidences of retirements

The objective of this study was to compare morbidity betweenambulance staff and other groups of health service workers,to facilitate planning of occupational health (OH) services.A retrospective study of employees of The Eastern Health andSocial Services Board, Northern Ireland was conducted. Subjectswere 181 men and 353 women assessed at OH between 1988–92and found eligible (on the basis of permanent incapacity) toapply for early retirement on medical grounds (EROMG). Ambulancepersonnel showed a high rate of EROMG (55.9/1,000 per annum)both compared with previous ambulance studies (5.7–22.5/1,000),and with other groups in the present study (manual 24.8/1,000,nursing 5.9/1,000 and non-manual 2.6/1,000). Indirect standardizationwas used to correct for age-sex differences between groups,by deriving standardized early retirement ratios (SERR). Ambulanceand manual staff showed high SERRs (636, Cl=558–714 and164, Cl=149–179), whereas nursing and non-manual staffshowed low SERRs (91, Cl=75–107 and 38, Cl=25–52),(all results except that for nursing staff being significantat <0.001). There is evidence that ambulance staff are agroup with high morbidity, and thus deserving of particularattention in terms of preventative and health promotional activities.Other issues requiring consideration in relation to ambulancestaff are redeployment and lowering of the retirement age.     

2009年青海省医疗卫生机构人员吸烟状况调查

目的了解医疗机构工作人员的吸烟和被动吸烟情况及提供戒烟服务的能力。方法采用简单随机方法抽取西宁市、格尔木市及互助县20家医疗机构1412名工作人员和采用拦截法抽取322名患者及家属进行相关调查。结果抽取的医疗机构工作人员吸烟率为24.80%,其中男性吸烟率为53.77%;对吸烟危害相关知识、吸烟与疾病的关系以及被动吸烟与疾病的关系平均知晓率分别为64.32%、63.54%和72.38%;23.64%的门诊医生从不询问或很少询问患者的吸烟情况,仅18.33%的患者及家属得到过医生提供的戒烟服务;20家医疗机构均不是无烟场所,仅1家有明显的禁烟规定。结论医疗机构的控烟环境尚未形成,需要通过行政干预推动无烟场所创建,努力提高全省控烟履约能力。     

社康中心医务人员手卫生现状调查及干预效果的研究

目的了解社康中心医务人员的手卫生执行现状,评价综合干预措施的效果。方法采取培训与教育、监督与管理和完善洗手设施等干预措施,比较医务人员手卫生干预前后各项指标的差异。结果被调查的420人平均手卫生依从率由35.1%提高到61.2%,手卫生正确执行率由34.5%提高到72.22%,手部样品合格率由87.9%提高到97.3%,三项指标干预前后差异均有统计学意义(P0.01)。结论采取综合干预措施能有效提高社康中心医务人员手卫生依从性,但干预措施需要坚持长期执行并不断完善。     

南宁市社区卫生服务机构医务人员工作满意度及其影响因素研究

目的了解南宁市社区卫生服务机构医务人员的工作满意度及其影响因素。方法采用分层随机抽样的方法,于2015年11—12月在南宁市6城区随机抽取12个社区卫生服务机构184名医务人员进行问卷调查。调查内容主要包括医务人员的基本情况及对社区卫生服务机构的满意度情况。采用单因素和多重线性回归的方法分析影响总满意度的因素。结果社区卫生服务机构医务人员的总满意度一般,均值为(3.80±0.46)分,六个维度中工作回报维度满意度最低(3.40±0.45)分,总体情况维度最高(4.13±0.73)分;单因素分析中婚姻状况(F=5.243,P=0.006)和是否愿意继续从事现在的工作(T=3.458,P=0.001)对总满意度影响差异有统计学意义;多重线性回归分析中,职称和是否愿意继续从事现在的工作进入回归模型,为Y=4.604-0.517 X1-0.114X2。结论社区卫生服务机构医务人员工作满意度有待提高;不同婚姻状况、职称和是否愿意继续从事现在的工作对医务人员工作满意度有一定影响。     

医务人员参与大专院校健康课堂对在校女大学生生殖健康影响促进的研究

目的探讨医务人员参与大专院校健康课堂对在校女大学生生殖健康影响的促进作用。方法选择3186名在校女大学生为研究对象,分析在校女大学生对生殖健康的需求、了解程度及了解途径,并有目的的开设生殖健康教育课程。结果 3186名女大学中74.54%的学生对生殖健康知识有所了解,主要途径为电影及网络。开设医务人员参与健康课堂后,女大学生生殖健康认知、婚前性行为危害、掌握避孕节育知识、女性生殖系统疾病、性病艾滋病防治知识（92.12%、92.97%、74.23%、84.06%、88.26%）明显高于开设健康课堂前。结论大学女生对生殖健康的认识有待加强,开设医务人员参与大专院校生殖健康课堂可提高生殖健康认知水平。     

基层医务人员对分级诊疗制度实施的认知调查--以武汉市为例

目的探讨基层医务人员对分级诊疗制度的认知、态度及影响分级诊疗制度实施的因素,为进一步完善分级诊疗制度的实施提供科学依据。方法采用自行问卷设计,整群抽样,对武汉市武昌区和青山区共1 858名医务人员进行问卷调查。结果 91.8%的基层医务人员认为实施分级诊疗是必要的;53.3%的医务人员认为分级诊疗制度实施效果一般;48.3%的医务人员并无转诊经历。接诊下转病人能力方面,民营办医疗机构>企业办医疗机构>政府办医疗机构,差异具有统计学意义(P<0.05);转诊病人经历方面,企业办医疗机构>民营办医疗机构>政府办医疗机构,差异具有统计学意义(P<0.05)。结论分级诊疗制度在落实方面仍然存在一些困难,提高基层医疗机构的服务能力、政府加强政策引导、组建紧密型医联体是深入推进分级诊疗制度实施的重要途径。     

A follow-up study on the association of working conditions and lifestyles with the development of (perceived) mental symptoms in workers of a telecommunication enterprise

AIM: This study investigated the association of working conditions and lifestyle with mental health in Japanese workers. METHODS: A follow-up study was carried out in the Kanto district of Japan of workers in a telecommunications enterprise who received their first annual health check-up between 1992 and 1996 and were between 20 and 54 years old. Workers who reported mental symptoms, had a past history of disease, or current illness at their first check-up were excluded from the analysis. In total, the study included 23 837 workers. The association between working conditions and lifestyle and the development of mental symptoms was investigated by pooled logistic regression analyses. RESULTS: Working long hours and part-time work, as opposed to normal daytime hours of work, were factors associated with the development of mental symptoms in males, as were smoking, short sleeping hours, little physical exercise, rarely taking three meals a day, frequently eating within 1 h before sleep, much preference for salty meals and little preference for vegetables. Consumption of alcohol was negatively associated with the development of mental symptoms in males. Overall, the results suggested that the lower the Healthy Work and Lifestyle Score, the higher the risk of developing mental symptoms. CONCLUSIONS: Working conditions and lifestyle, especially food preferences, have an apparent influence on the mental health of Japanese workers. Moreover, the Healthy Work and Lifestyle Score indicates that working conditions and lifestyle appear to have a cumulative influence upon the mental health of Japanese workers.     

Barriers and enablers to health service access amongst people with diabetes: An exploration of the perceptions of health care staff in regional Australia

Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social–ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.     

新疆生产建设兵团医务人员突发急性传染病监测预警知识、态度和行为调查

目的 了解医务人员对突发急性传染病监测预警知识、态度和行为现状,分析医务人员对突发急性传染病监测预警的影响因素。方法 采用多阶段随机整群抽样,调查抽样地区一、二、三级医疗机构的医务人员,共纳入2 497名医务人员的数据进行分析。利用描述性方法和χ2检验分析不同人口学特征医务人员监测预警态度和知识的现状及差异,多因素logistic回归模型分析医务人员监测预警知识得分的影响因素。结果 医务人员对突发急性传染病监测预警知识掌握总得分率为81.81%;传染病症状患者异常增加时,97.60%的医务人员认为本人具有监测报告责任;医务人员认为突发急性传染病早期发现的影响因素依次是医生的诊断能力（97.24%）、诊断条件与技术（96.72%）、医生的敏感度（96.56%）、责任心（89.03%）;首诊医生接诊疑似突发急性传染病未上报的主要原因中,76.47%表示不能确定是突发急性传染病,64.71%表示报告后行政干预多,担心承担责任,55.89%表示报告程序复杂、增加工作量;接受过培训（OR = 2.157,95%CI:1.394 ~ 3.338）、职称（中级OR = 1.411,95%CI:1.158 ~ 1.719;副高及以上OR = 2.009,95%CI:1.587 ~ 2.544）、一级医院（OR = 1.540,95%CI:1.232 ~ 1.925）、北疆（OR = 1.262,95%CI:1.051 ~ 1.516）、传染病相关科室（OR = 1.326,95%CI:1.066 ~ 1.650）是突发急性传染病监测预警知识合格率的独立保护因素（均P＜0.05）。结论 医务人员对于具有一定的监测预警能力,仍需加强针对性培训与演练,提高医务人员监测预警能力。     

医疗服务价格改革政策快速终结的启示——基于政策行动者视角的案例研究

地方政策创新是我国公共行政领域的鲜明特征。国内既有研究多关注地方政策创新经验总结和政策出台,相对忽视地方政策创新终结。本文运用公共政策过程的理论和概念分析案例—重庆市医疗服务价格政策创新快速终结的原因。研究发现,政策制定过程中相对封闭的政策网络、政策执行过程中部分政策目标群体的抗争性策略、公众议程与媒体议程的互激等是政策创新迅速终结的主要原因。本研究有助于理解地方政策创新"昙花一现"这类非常态政策终结的逻辑机理,为提升我国卫生决策与改革的质量提供参考。     

新医改后患者和医务人员满意度研究——以上海为例

目的:研究新医改实施后,医务人员的工作满意度和患者满意度情况。方法:采用问卷调查法,对上海地区8家社区卫生服务中心和4家综合性医院的医务人员和患者进行调查。结果:共回收有效问卷1 001份,其中患者问卷499份,医务人员问卷502份。医务人员和患者的总体满意度都较好。患者对行政监管、就医环境、服务态度和服务能力方面的满意度较好,对药品供应、医疗费用方面的满意度较低。医务人员对工作回报的满意度最低,对医院内工作环境的满意度水平最高。社区卫生服务中心的医务人员和患者的满意度普遍比综合医院好。结论:上海地区的医务人员和患者的总体满意度较好。今后应进一步加强知识宣传,优化诊疗流程,控制医疗费用,改善医疗执业环境和工作待遇。     

Do patient experiences on priority aspects of health care predict their global rating of quality of care? A study in five patient groups

Background Patient‐given global ratings are frequently interpreted as summary measures of the patient perspective, with limited understanding of what these ratings summarize. Global ratings may be determined by patient experiences on priority aspects of care. Objectives (i) identify patient priorities regarding elements of care for breast cancer, hip‐ or knee surgery, cataract surgery, rheumatoid arthritis and diabetes, (ii) establish whether experiences regarding priorities are associated with patient‐given global ratings, and (iii) determine whether patient experiences regarding priorities are better predictors of global ratings than experiences concerning less important aspects of care. Setting and participants Data collected for the development of five consumer quality index surveys – disease‐specific questionnaires that capture patient experiences and priorities – were used. Results Priorities varied: breast cancer patients for example, prioritized rapid access to care and diagnostics, while diabetics favoured dignity and appropriate frequency of tests. Experiences regarding priorities were inconsistently related to global ratings of care. Regression analyses indicated that demographics explain 2.4–8.4% of the variance in global rating. Introducing patient experiences regarding priorities increased the variance explained to 21.1–35.1%; models with less important aspects of care explained 11.8–23.2%. Conclusions Some experiences regarding priorities are strongly related to the global rating while others are poorly related. Global ratings are marginally dependent on demographics, and experiences regarding priorities are somewhat better predictors of global rating than experiences regarding less important elements. As it remains to be fully determined what global ratings summarize, caution is warranted when using these ratings as summary measures.     

宣威市新型农村合作医疗参合农民卫生服务利用公平性分析

目的调查分析新型农村合作医疗试点县宣威市农民的卫生服务需求和利用,为制定合理的新农合政策提供依据。方法采用分层整群抽样调查2个乡镇1221户农户,共计4540人。调查农民卫生服务的需求和利用情况。结果两周患病率8.0%,就诊率11.7%,未就诊比例22.0%;住院率5.8%,未住院率8.4%。两个乡镇的就诊率、未就诊率和未住院率均存在统计学差异,经济发展好的卫生服务利用较高。不同收入农民住院率间存在统计学差异。结论新农合应关注公平性问题。     

医养结合下老年人医疗消费行为影响因素分析——以南京市为例

目的:在"医养结合"背景下,老年人能否合理、有效、充分的利用医疗资源,建立良好的医疗消费行为和消费意向,对于实现健康养老、提高老年人生活幸福感具有重要意义。方法:基于南京地区的微观调查数据,利用计划行为理论和结构方程模型对影响该地老年人医疗消费行为和消费意向进行系统分析,从行为态度、主观规范和知觉行为控制分析医疗消费行为的影响因素。结论:老年人感知看病行为的难易程度与其医疗消费行为意向不存在显著因果关系;老年人的医疗消费行为意向受到其所处的社会网络中各类社会关系的影响;老年人的医疗消费行为受到行为信念、规范信念、行为态度和主观规范的作用。     

医疗集团下基层医疗机构病人感知质量研究——以江苏省镇江市为例

目的:基于需方角度对江苏省镇江市康复医疗集团和江滨医疗集团下基层医疗机构质量进行对比分析。方法:在每一集团覆盖区随机抽取1个区,在该区再随机抽取1个基层医疗机构,利用初级卫生保健质量评价工具中文版进行需方调查。采用描述性统计和多元线性回归分析方法进行数据分析。结果:康复医疗集团下基层医疗机构PCAT得分(25. 21)显著高于江滨医疗集团下基层医疗机构(β=2. 191,95%CI:1. 586,2. 797)。除了"与基层机构联系程度"、"协调(信息系统)"两个维度外,其余核心维度康复医疗集团PCAT得分均显著高于江滨医疗集团PCAT得分。结论:基于PCAT,康复医疗集团下基层医疗机构病人感知质量要好于江滨医疗集团;管理和技术层面的紧密协作以及相关利益分配机制的形成是造成二者差异的可能原因。     

学术期刊开展知识服务相关情况的调查及分析——以江苏省医药类学术期刊为例

【目的】 考察江苏省医药类学术期刊开展知识服务的相关情况,为小型医药类学术期刊社开展知识服务提供路径和方法。【方法】 通过文献调研归纳出医药类学术期刊开展知识服务的路径和具体形式。搜索江苏省50种医药类学术期刊的官方网站和官方微信公众号,调查各刊开展知识服务的情况和程度。【结果】 医药类学术期刊开展三个层次的知识服务,包括基本服务、知识检索、知识发现、工具与应用、移动和社交服务及多媒体服务。期刊知识服务情况与期刊影响力有关。江苏省大部分医药类学术期刊已经开展了各种形式的知识服务,但各刊在知识服务层次和形式方面都还有提升空间。【结论】 江苏省医药类学术期刊应完善知识服务形式,挖掘知识服务深度,培养复合型编辑人才,运用先进出版技术,扩大用户体量、增强用户黏性,利用期刊集群开展出版融合服务,有条件地开展付费知识服务尝试,为期刊发展赢得更多空间。     

Persistence of the immune response after vaccination with the Japanese encephalitis vaccine,IXIARO® in healthy adults: A five year follow-up study

Immunization with the Japanese encephalitis (JE) vaccine IXIARO® results in protective neutralizing antibody levels for one year. Since persistence of protective titer levels beyond one year was unknown, a 5?years follow-up study was conducted. Additionally, data were stratified to compare the persistence of protective neutralizing antibodies against JE in people with or without tick-borne encephalitis (TBE) vaccination.Four weeks after the primary series, the percentage of subjects with PRNT50 titer ≥1:10 in the intent-to-treat population was 99%; the rate after 5?years was 81.6%. By month 24, 36, 48 and 60, the percentages were still 90.7%, 91.7%, 90.1%, 85.9%, respectively in the population who had received TBE vaccine compared to 67.9%, 71.9%, 69.1%, 63.8% in the population who had not. No long-term safety concerns were identified.These data indicate that vaccination with IXIARO® is able to induce protective titers that persist up to 60?months after the primary immunization.Clinical trial registry number NCT00596102.