基于职业规范管理的产后母婴家庭照护评价指标构建

目的:从职业规范化管理角度构建产后母婴家庭照护评价指标,持续改进月嫂服务质量。方法:在查阅国内外相关文献资料基础上,通过调研咨询和专家会议初步拟订"产后母婴家庭照护评价指标草案",然后采用德尔菲法对指标草案进行两轮专家咨询;以积极系数、权威程度、协调程度检验专家咨询的可靠性;运用优序图、层次分析法确定指标权重。结果:两轮积极系数分别为0.92、0.87,专家权威系数0.918,变异系数0.000～0.2067,协调系数波动在0.595～0.857之间。经两轮专家咨询后,意见趋向集中,评价指标包涵3个一级指标,6个二级指标、30个三级指标。结论:专家权威程度及专家意见协调程度高,结果可取;所构建的产后母婴家庭照护评价指标可作为衡量月嫂服务质量的测评工具。     

利用Delphi法和层次分析法构建医学援外培训效果评价指标体系

目的 科学构建医学援外培训效果评价指标体系,为精准评价医学援外培训效果提供有效参考。方法 在系统分析案例单位承办的91期援外培训项目交流座谈纪要和学员满意度调查问卷的基础上,初步制定了医学援外培训效果评价指标体系草案,再采用Delphi法进行专家咨询,通过问卷回收率和权威系数分别反映专家积极性和权威性;专家意见集中程度用条目相关性均值和CV表示,专家意见协调程度用肯德尔协调系数(Kendall’s W值)表示。最终制定的医学援外培训效果评价指标体系共包含4个一级指标(反应层、学习层、行为层和结果层),11个二级指标(培训需求、培训内容和培训师资等)和42个三级指标(驻外机构服务、基础技能考核及新技术新业务开展情况等)。结果 三轮咨询均发放18份问卷,每轮均收回18份,回收率100%。第一、第二、第三轮专家咨询的判断系数(Ca)分别为0.906,0.883,0.911,熟悉程度系数(Cs)分别为0.789,0.878,0.878,三轮专家咨询的权威系数分别为0.847,0.881,0.895。以属性必要性为例,第一轮一级指标、二级指标、三级指标的专家意见协调程度的Kendall’s W值...     

基于德尔菲法构建我国恶性肿瘤相关监测系统评价指标体系

目的构建一套评价指标体系,用于评价我国现有与恶性肿瘤相关的监测系统,为我国未来建立完整、有效的恶性肿瘤监测系统提供科学依据。方法利用改良的德尔菲法进行两轮专家咨询,通过分析结果来筛选修善指标,并利用专家评分计算指标权重,建立最终的评价指标体系。结果两轮咨询的专家积极系数分别为85. 00%和94. 74%,平均专家权威系数为0. 835;第二轮咨询所有指标重要性和可行性评分的专家意见协调系数分别为0. 578(P 0. 01)和0. 589(P 0. 01);最终构建的评价指标体系包括3个一级指标、10个二级指标和25个三级指标。结论本研究构建的评价指标体系专家积极性高、权威程度和协调程度好、指标权重计算合理,可以尝试用于相关监测系统的评价,为今后建立我国恶性肿瘤监测系统提供参考依据。     

Delphi法在临床路径质量评估指标体系构建中的应用

采用Delphi法构建临床路径质量评估指标体系,并通过分析专家积极系数、权威程度和协调程度来检验方法的可靠性。分析结果显示,两轮咨询专家的积极系数分别为100%和84%,专家的权威程度平均值在0.8以上,各级指标的专家意见协调系数在0.2～0.6之间(P<0.05)。因此,只有专家的积极性较高,权威性和协调性较好,构建的临床路径质量评估指标体系才能为评价临床路径实施效果提供有效依据。     

脊髓灰质炎减毒活疫苗强化免疫评价指标体系的构建

[目的]建立脊髓灰质炎疫苗(Oral Poliomyelitis Attenuated Live Vaccine,OPV)强化免疫筛选指标体系。[方法]采用文献分析和两轮Delphi专家咨询确立指标体系。运用协调程度、积极系数和权威系数对专家咨询的可靠性进行检验。[结果]两轮专家咨询积极系数为86.67%和83.78%,专家权威程度为0.751,专家意见的协调系数为0.539。建立了包含7个一级指标,25个二级指标组成的OPV强化免疫范围综合评价指标体系。[结论]专家咨询积极性较高,权威性、协调性较好。建立的评价指标体系可以较全面的对OPV强化免疫工作进行综合评价。     

基于精益管理的公立医院绩效评价指标体系构建研究

目的 以精益管理为理论基础构建公立医院绩效评价指标体系,为全面客观评价公立医院绩效提供依据。方法 采用文献研究法构建指标条目池,以精益管理的五大核心理念为理论框架筛选指标条目,构建初始指标库。采用德尔菲专家咨询法对指标体系进行优化调整,专家咨询的可靠性用积极系数、权威程度、协调程度进行检验,依据各指标的平均数、标准差和变异系数进行指标删选。最后,采用专家评分法赋予指标权重。结果 经过两轮德尔菲专家咨询,最终构建了一套包含5个一级指标、15个二级指标、48个三级指标的公立医院绩效评价指标体系。两轮专家咨询的积极系数分别为88.00%和90.91%,权威系数为0.85,协调系数W检验差异均有统计学意义(P<0.01)。结论 所构建的公立医院指标体系科学合理,可靠性高,具有一定的创新性和适用性,可以为客观全面评价医院绩效水平提供依据。     

江苏卫生健康事业高质量发展评价指标体系研究

[目的]构建科学合理、可操作性强的江苏卫生健康事业高质量发展评价指标体系,为区域内卫生健康高质量发展的评估提供参考依据.[方法]采用德尔菲法,经过2轮专家咨询确定指标体系,运用层次分析法确定各级指标权重值.[结果]经两轮专家咨询得到的专家积极系数为93.75％和100％,专家权威系数0.86,专家意见协调系数重要性、可...     

湖北省小型灭螺工程绩效评价指标体系研究

目的 构建湖北省小型灭螺工程绩效评价指标体系.方法 采用文献分析法、Delphi法、AHP法,确定一、二级和三级指标及其权重,并利用实证分析进行验证其可行性.结果 专家咨询积极系数为86％,专家权威程度Cr=0.86,第一轮专家函询结果协调系数为0.591,且P＜0.01,第二轮专家协调系数为0.363,且P＜0.01,经检验后有显著性;最终确定的33个指标由3个一级指标、9个二级指标、21个三级指标构成.结论 专家意见的协调性好,可信度高,构建的湖北省小型灭螺工程绩效评价指标体系结果可取.     

应用改良Delphi法构建医疗安全（不良）事件管理指标体系

目的基于标准化管理视角构建医疗安全（不良）事件管理指标体系。方法应用循证法、经验参照法建立指标体系草案，采用改良Delphi法，提升预测指标体系的准确性。结果医疗安全（不良）事件管理指标体系包括3个一级指标，15个二级指标，70个三级指标。三轮问卷应答率分别是96％、94％、86％；专家权威系数为0.88；变异系数随着咨询次数增加而减小，专家意见趋势集中。结论专家意见协调程度较高，研究构建的医疗安全（不良）事件管理指标体系结果可取。     

慢性病患者健康素养评价指标体系Delphi法构建

目的基于Delphi法构建慢性病患者健康素养评价指标体系,为提高慢性病的管理效果提供参考依据。方法采用Delphi专家咨询法构建慢性病患者健康素养评价指标体系,应用Fuzzy综合评判法计算各级指标的权重系数。结果 2轮专家咨询的积极系数分别为90.0%和96.3%,专家权威系数分别为0.802 5和0.868 9;重要性、可操作性和敏感性第1轮专家意见协调系数分别为0.336 5、0.365 3和0.268 9,第2轮专家意见协调系数分别为0.451 8、0.461 8和0.441 9,差异均有统计学意义(均P0.05),专家意见的协调性较好;经过2轮专家咨询后建立了慢性病患者健康素养评价指标体系,该指标体系包括一级指标4个、二级指标42个,重要性、可操作性和敏感性的权重值分别为0.386、0.325和0.289。结论本研究构建的慢性病患者健康素养评价指标体系具有客观性、可靠性和可取性,可为慢性病患者健康素养的评价提供依据。     

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.     

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.     

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.     

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.