CT下沉基层社区卫生服务中心，如何做好防护

<正>随着我国医疗改革的进一步深化,如今X射线计算机断层成像（CT）技术已全面提速进入基层社区卫生服务中心。基层社区卫生服务中心通过与医联体上级协作单位合作,提供远程CT影像诊断,这意味着居民就诊只需在社区医院检查,就能享受到三级医院的医疗诊断服务。认识CT CT是计算机技术与X射线断层摄影技术交融的成果,能得到身体内部组织和器官的三维图像,是疾病诊疗中必不可少的医用诊断设备。相比单次X射线照片,     

社区卫生服务的实践与思考

开展社区卫生服务,以病人为中心,与慢病防治相结合,建立家庭健康档案,进行社区诊断,完善服务措施,规范化管理,发挥了基层医疗机构在技术、设备、管理方面的优势,使社区卫生服务的范围拓宽、效益明显、群众满意。提出了社区卫生服务中存在的问题及建议。     

社区卫生诊断开展现状及其在社区卫生工作中的作用探讨

社区卫生诊断是社区卫生服务的重要内容和关键环节．通过对社区卫生诊断的概念、发展现状、目的、内容、方法和工作步骤等内容的阐述,讨论了社区卫生服务诊断在社区卫生服务工作中的重要作用,并从卫生行政部门、社区卫生服务机构和社区卫生工作者3个层面说明如何利用社区卫生诊断资料。     

浅谈社区卫生人员继续教育的重要性

进一步培养全科医生热爱、忠诚社区卫生服务事业的精神,全面提高其对社区常见病多发病的诊断、鉴别诊断、转诊、预防保健和健康教育技能,逐步转变服务理念,掌握社区医疗的基本理论和基础知识,具备向个人、家庭和社区提供综合性、连续性、协调性和高情感性服务的基本技能,而且具有一定的社区卫生服务组织管理能力,从而为居民健康作最好的守护。采取文献研究法和描述统计法。社区卫生人力资源现状直接影响到社区卫生服务功能的发挥,同时也决定了社区卫生服务的水平。     

社区卫生服务的实践与思考

开展社区卫生服务,以病人为中心,与慢病防治相结合,建立家庭健康档案,进行社区诊断,完善服务措施,规范化管理,发挥了基层医疗机构在技术、设备、管理方面的优势,使社区卫生服务的范围拓宽、效益明显、群众满意.提出了社区卫生服务中存在的问题及建议.     

发展社区卫生中医药服务功能的策略分析

社区卫生服务作为城市卫生服务体系的基础，服务定位于常见病、多发病的诊断治疗，与居民联系最为密切，应解决和承担居民大部分卫生服务需求。而中医药服务的诊断治疗技术简便、资源丰富、成本低廉，大力发展社区卫生中医药服务，更好地提高其利用水平，不仅有利于社区卫生服务“六位一体”功能的实现，     

天津市东丽区慢性病防治及卫生服务调查报告

目的通过社区卫生诊断,确定社区主要健康问题及危险因素,提出优先干预项目,制定社区卫生服务工作规划。方法通过开展社区卫生诊断工作,依据"社区卫生诊断技术手册",收集天津市东丽社区现有资料并进行居民卫生、服务对象满意度以及社区卫生服务机构调查。结果影响天津市东丽社区居民健康较大的慢性非传染性疾病主要是高血压、糖尿病、冠心病、脑卒中、恶性肿瘤,而影响居民健康的危险因素主要是吸烟,饮酒,肥胖,不合理饮食。结论综合干预手段应是今后慢性病防治的工作重点。     

社区卫生服务中开展健康教育应注意的问题

为在社区卫生服务中更好地开展健康教育工作 ,笔者对南京市城区 10个街道的社区卫生服务中的健康教育工作现状进行了调查。现就其中较突出的几个问题 ,进行一些探讨。1　社区卫生服务中健康教育的领导与管理从调查看到 ,健康教育已列入社区卫生服务的项目 ,但组织领导与管理较混乱 ,有卫生部门 ,有民政部门 ,有街道办事处负责与管理 ,没有统一的健康教育组织领导与管理。社区卫生服务的重点是医疗 ,基本上很少开展健康教育工作。健康教育工作应统一归口于卫生部门组织领导与管理 ,健康教育专业机构实施健康教育的业务技术指导与培训 ,民政部…     

第一讲社区卫生服务基本理论

社区卫生服务机构是以全科医生为骨干,以人的健康为中心,以社区居民的主要健康问题为重点的“六位一体”的基层卫生服务组织。随着城乡卫生服务体系的逐步完善,社区卫生服务在整个卫生服务体系中将发挥越来越大的作用。为了进一步把国家关于加快社区卫生服务发展的政策、措施落到实处,我刊自本期起,陆续刊发杭州师范学院医学院郭清教授等同志主编的《社区卫生服务系列讲座》。该讲座共分10讲,主要包括社区卫生服务的基本理论、诊断与评价、营销策略、法学常识等内容。我们希望通过讲座,能够更深入地普及社区卫生服务的基本理论、政策等知识,增强各级政府和社区居民参与社区卫生服务的主动性和自觉性,充分发挥社区卫生服务组织的功能,更好地为增进人民健康、全面提高人民的生活质量提供帮助。     

社区卫生服务的诊断与评价

1社区卫生服务诊断1.1基本概念社区卫生服务诊断是社区卫生工作者运用流行病学、卫生统计、社会医学和卫生经济学等调查研究方法对社区卫生状况进行调研,发现社区存在的主要卫生问题及影响因素,提出利用社区卫生资源最佳解决社区主要卫生问题的过程。1.2目的、意义社区卫生服务诊断是社区卫生服务的向导,又是社区卫生服务关键的步骤之一。只有通过全面、完整的社区卫生服务诊断,了解和掌握社区卫生服务的需要、需求以及社区卫生资源的利用状况,针对社区存在的主要卫生问题,才能制定出有效、可持续的社区卫生服务计划。一个完整的社区卫生服…     

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.     

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.     

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.     

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.     

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.     

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.