陕西省卫生系统的反应性分析

卫生系统反应性是卫生系统对公众普通合理需求与期望的认知和适当的反应。世界卫生组织所采用的反应性分为“对人的尊重”和“以服务对象为中心”两大部分。利用国家第三次卫生服务调查资料,通过对陕西省卫生系统反应性现状的分析,指出所存在的问题和改进措施,为陕西省卫生系统绩效改善、卫生政策的制定提供客观依据。     

我国中、西部县域卫生系统绩效评价框架

县域卫生系统是在县域内的,与居民健康相关的各个子系统组成的整体.是城乡卫生统筹建设的重点.我国中、西部县域卫生系统绩效评价框架以县域卫生总绩效目标为评价标准,由功能、中间目标和最终目标层面,结合卫生服务管理、服务提供、筹资与支付子系统等组成12个评价维度.评价框架从整体上反映了县城卫生系统的绩效,并重点关注农村基本卫生体系建设,对于推进中、西部县域卫生系统建设有重要意义.     

《塔林宪章》:增加财富与促进健康的卫生系统

在欧洲,人人享有卫生保健的理念已经纳入了各国政府经济社会发展的战略目标。2008年6月,WHO欧洲委员会部长级会议通过了"增加财富与促进健康的卫生系统——塔林宪章"(The Tallinn Charter:HealthSystems for Health and Wealth)的卫生改革战略性框架文件,提出了投资于健康就是投资于人类发展、社会和谐与财富增长的卫生发展战略,进一步强调卫生系统必须要满足日益增长的卫生保健需求与健康期望。围绕重组初级卫生保健服务体系,增加政府卫生投入,整合卫生服务资源与模式,提高卫生系统反应性,改善卫生服务质量,加强公共卫生、疾病预防和健康促进,建立基于问责机制的卫生系统绩效评估模式,加强卫生部门治理,以及实施卫生技术评估等问题,一些国家采取了一系列改革措施,完善卫生筹资机制,改革政府卫生投入方式,明确卫生改革优先领域等,促进了卫生服务供给模式转变与卫生服务绩效改善,这也为我国进一步深化医药卫生体制改革提供了许多借鉴。本期首先介绍《塔林宪章》的主要内容,今后将陆续推出关于欧洲卫生改革发展的文章,以供读者参考。     

公立医院公益性质淡化原因与实现途径

改革开放以来，我国公立医院的规模以前所未有的速度扩大，但是卫生服务的绩效和公平性明显下降。世界卫生组织（WHO）第五十三届卫生大会发表的（2000年世界卫生报告——卫生系统：改善绩效》对全球191个成员国的卫生绩效进行排序，我国总体绩效列第144位，卫生筹资与分配公平性列第188位。这一状况引起了我国政府和社会各界的强烈关注，并促使我们对20多年卫生改革进行深刻反思。其中最主要的问题是，迅速扩张、拥有庞大卫生资源的公立医院为何未能履行其社会职能，其公益性质为何会日渐淡化？     

卫生筹资与卫生系统绩效之间的关系及对中国的启示研究

目的:探索卫生筹资对卫生系统绩效的影响,为筹资模式的设计提供依据.方法:以经济合作发展组织(OECD)29个国家为研究样本,将其筹资模式分为税收与社会保险筹资两种方式,采用多元线性回归模型,构建卫生筹资模式及有关变量与卫生系统绩效间的回归模型.结果:税收筹资模式国家的卫生系统绩效总体优于社会保险模式的国家.政府卫生投入、卫生支出、GDP等筹资指标与卫生系统绩效正向相关.结论:税收筹资模式能更好地改善卫生系统绩效.中国卫生筹资应优先考虑税收筹资制度.     

陕西省卫生系统反应性及居民满意度分析

文章利用第四次国家卫生服务调查资料,对陕西省卫生系统反应性及居民满意度进行分析,了解其现状,研究表明陕西省卫生系统在就医距离、医患沟通等方面有较大改善空间,可进一步合理布局医疗机构,加强医患沟通交流,以期促进医疗卫生水平的提高及卫生系统绩效的改善,为人群提供良好的医疗卫生服务。     

印度尼西亚卫生系统面临的主要卫生经济问题及改革取向

在分析了印度尼西亚医疗卫生服务提供系统和卫生系统绩效基础上,展示了印度尼西亚卫生系统面临的主要问题和挑战。其中,包括慢性病疾病负担沉重、医疗服务和资源分配不均、农村卫生服务可及性较差以及政府卫生筹资比例较低等。目前印度尼西亚卫生系统的改革取向是实现公平和自治目标,通过社区和私立部门以及公民的参与,实现公平的卫生服务和卫生资源的可得性,增强卫生服务体系,改善公民健康。     

欧洲各国基于问责制的卫生系统绩效评估

通过改善卫生系统绩效以获得最大健康效益是每个国家卫生改革与发展所面临的首要问题,欧洲各国通过建立相关的问责机制,采取明确权责和促进落实等具体措施,推动和促进了卫生系统绩效评价的实施与发展,这也为我国开展卫生系统绩效评估提供了许多可以借鉴和学习的经验。     

国家卫生系统绩效测量与统计指标的概念框架

卫生系统绩效评价是2000年世界卫生组织提出的先进的卫生系统绩效评价方法,建立绩效测量与统计指标的概念框架是完善国家卫生服务系统功能的基础.定义衡量目标实现进度的关键绩效指标（KPI）,并建立KPI测量标准和标尺是得出绩效评分和位次的主要步骤.本研究根据国家卫生信息标准基础框架——国家卫生信息数据模型,对模型中的超级实体“卫生业务”中的“绩效目标”子实体做了扩展,兼顾国际可比性和我国的实用性,提出了由8个KPI组成的国家卫生系统绩效测量指标集,并阐述了指标的内容、测量标准及其意义,同时还简要讨论了数据元的标准化、指标标尺的制定等有关问题.     

推行"6208"公示制引导医疗机构改善质量绩效

改善医疗质量绩效是目前各国政府为之努力的一项工作,许多国家卫生改革的初衷都是为改变政府职能--阻止继续提供低质量、高成本的卫生服务,提高管理整个卫生系统和政策决策的能力.大庆市卫生局推行"6208"公示制,在引导医疗机构改善质量绩效方面进行了尝试.     

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.     

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.