乳腺癌患者生命质量的影响因素分析

目的：探讨和分析乳腺癌患者的生命质量及其影响因素。方法：采用癌症病人生活功能指数量表（FLIC）对128例现患乳腺癌患者进行生命质量的流行病学调查,对所得125份合格资料进行生命质量的评价、单因素分析和多元线性回归分析。结果：125例患者生命质量的FLIC得分均值为62．3分,95％可信区间为59．63～65．00分,因病借钱、治疗方式、手术效果是影响乳腺癌患者生命质量的主要因素。结论：普及乳腺癌的相关知识,减轻病人经济负担,加强对医务人员业务知识的培训和指导,提高乳腺癌的诊疗水平,完善医疗保健制度,有利于提高乳腺癌患者的生命质量。     

公立医院门诊患者生活满意度影响因素研究

目的研究医疗服务满意度、患者医疗质量感知和患者信任对上海市门诊患者生活满意度的影响程度,为提高患者生活满意度提供参考。方法在文献研究基础上,通过问卷调查收集实证数据,运用有序Probit模型对影响因素进行分析。结果医疗服务满意度、患者医疗质量感知及患者信任对患者生活满意度的影响程度在不同级别公立医院有所差别。结论改进我国医疗卫生服务质量,增强患者医疗服务满意度和信任度能够提高患者生活满意度,对促进我国医疗卫生事业的发展具有十分重要的意义。     

基于有序PROBIT模型的患者生活满意度的实证研究

目的 :研究上海市门诊患者生活满意度的影响因素,为提高患者生活满意度提供操作参考。方法 :运用文献研究确定影响患者生活满意度的相关因素,通过问卷调查收集实证数据,运用有序PROBIT模型对影响因素进行分析。结果 :医疗服务满意度、患者医疗质量感知以及患者信任是患者生活满意度的影响因素,其影响效果具有显著性。结论 :改进我国医疗卫生服务质量,增强患者医疗服务满意度和信任度能够提高患者生活满意度,而提高患者生活满意度对改善医患关系、促进我国医疗卫生事业的发展具有十分重要的意义。     

居民基层医疗卫生服务满意度的影响因素分析—以梅州市为例*

目的了解梅州市基层医疗卫生服务基本情况,并对基层卫生服务满意度的影响因素进行分析。方法采用便利抽样的方法对梅州市具有基层医疗卫生机构就医经历的居民采用自制的梅州市基层医疗卫生服务调查问卷进行调查,共调查596例。结果居民对基层医疗卫生服务满意度的综合评价得分为(71.46±16.23)分。不同的年龄、身体状况、基层医疗政策熟识度和新型农村合作医疗的认知了解程度等对居民基层医疗卫生服务满意度综合评价得分差异有统计学意义(P0.05)。结论梅州市居民对基层医疗卫生服务满意度的综合评价呈中等水平,对影响基层医疗卫生服务满意度的主要因素有更深层次的认识,并对提高基层医疗卫生服务的质量提出了可行性建议。     

老年慢性病患者生命质量现状及影响因素研究

目的：了解我国老年慢性病患者的生命质量状况,探究其影响因素,为制定相关政策提供依据。方法：采用多阶段抽样方法,针对120个城市的居民进行横断面研究;应用量表进行问卷调查,探究老年慢性病患者抑郁、自我效能、疾病感知与生命质量的相关性;运用多元线性回归方法分析老年慢性病患者生命质量的影响因素。结果：老年慢性病患者生命质量得分为22.90±2.81分,已婚、周围有基层医疗卫生机构的老年慢性病患者生命质量较高,疾病感知与抑郁对老年慢性病患者生命质量产生显著负向影响,自我效能对老年慢性病患者生命质量产生显著正向影响。结论：我国老年慢性病患者生命质量偏低,应加强居家照护,提升基层医疗卫生服务能力,开展健康教育,综合提升老年人的健康素养。     

胃癌患者生命质量及其影响因素研究

目的了解胃癌患者生命质量情况并分析其影响因素,为提高和改善患者生命质量提供依据。方法以2015年7-8月江苏省肿瘤医院住院胃癌患者为研究对象,使用一般情况调查表和癌症病人生命质量测定量表体系-胃癌量表QLICP-ST,对胃癌患者进行一对一的问卷调查。结果胃癌患者生命质量总体状况得分为72.51。影响因素分层分析结果显示,性别、BMI、肿瘤分期、性格、对待疾病的信心、治疗情况、对医疗服务和费用的满意程度是胃癌患者生命质量总体状况得分的影响因素。生命质量状况得分多重回归分析显示:BMI越高的患者,总体生命质量越高;而医疗服务满意度越差、对待疾病的信心越低、性格越内向、治疗后疗效越差的患者,总体生命质量越差。结论胃癌患者生命质量总体情况有待改善,根据相关影响因素采取有针性的措施,有助于提高和改善胃癌患者的生命质量。     

基层医疗卫生服务质量评估及其影响因素探讨

目的：测评基层医疗卫生服务的质量,并探讨影响其服务质量的因素。方法：采用约翰霍普金斯大学的基层医疗卫生服务患者评估量表（简化版）对福州市区1所三级综合医院、3所社区卫生服务中心及3所社区卫生服务站的242名就诊者进行调查,同时采取半结构式访谈方法探求8位卫生行业管理者对服务质量及其影响因素的观点。结果：社区卫生服务中心的综合得分最高,在两种计分方式中分别得到14．38和15．93;满意度为93．5％;在影响基层医疗卫生服务质量的五类因素中,卫技人员的因素得到了8位受访者的共同认可。结论：通过对卫技人员的投入、培养和双向转诊系统的完善,有助于改善基层医疗卫生服务的质量。     

深圳市门诊和住院服务满意度评估及比较分析

目的：测量和评估患者对医疗卫生服务的满意度，为政府部门和医院改善患者满意度提供政策依据和建议。方法：对深圳市15家医院的门诊患者（n=1057）和住院患者（n=666）进行满意度问卷调查，应用描述性分析方法、Likert标准评分法、方差分析、主成份分析等研究方法评估满意度及其影响因素。结果：①评分情况：门诊、住院满意度总得分分别为63.45和84．27。门诊满意度评分与住院满意度评分有显著性差异，后者高于前者；②主成份分析：服务态度、服务质量、服务交流、医患关系是医院门诊和住院服务重要建设内容；结论：深圳市医院门诊服务患者满意度较低，处于一般的水平，而住院服务患者满意度较高。     

大型综合医院临床护士工作满意度调查

目的：探讨临床护士工作满意度及影响临床护士工作满意度的相关因素，为提高临床护士工作满意度提供参考依据。方法采用一般情况调查表、工作满意度量表，对160名护士进行调查分析。结果临床护士工作满意度总分为151．83±27．22分，其中福利待遇得分最低，工作氛围得分最高。多元回归分析显示，护士受教育程度及婚姻状况是影响护士工作满意度的因素。结论提高护士的受教育程度可以改善临床护士工作满意度，稳定护士队伍。     

社区就诊患者满意度调查及影响因素分析

目的：了解患者对社区卫生服务的满意程度及其主要影响因素，为加强社区卫生服务内涵建设提供决策参考依据。方法：采用二阶段分层整群随机抽样的方法，抽取浙江省6个县（市、区）。对其30个社区卫生服务中心的1500名就诊患者进行自填式问卷调查，并运用单因素分析和Logistic回归分析筛选出主要影响因素。结果：回收有效问卷1410份，总体满意率为81．7％，影响患者满意度的主要因素依次为医疗安全、就诊费用、服务内容和服务态度等。结论：社区卫生服务机构必须从加强医疗安全、降低医疗费用、拓展服务内容、改善服务态度等方面进一步加强内涵建设，提高社区卫生服务水平，不断提高患者满意度。     

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.