基于社会生态理论的我国老年人住院服务利用影响因素研究

目的从社会生态视角探讨老年人住院服务利用的影响因素,预测老年人条件期望费用和非条件期望费用,为合理有效分配卫生资源提供依据。方法以CLHLS调查中的2011年60岁及以上老年人为研究对象,以住院概率和住院费用反映其住院服务利用情况,采用两部模型法分别构建住院概率和住院费用影响因素的社会生态模型,探讨影响住院服务利用的微观、中观和宏观因素,并测算老年人条件期望费用和非条件期望费用。结果共纳入8483例老年人,住院率为24.6%,平均住院费用为8082.8元。老年人住院服务利用主要受微观、中观和宏观因素的影响,微观系统中患慢性病、自评健康差、睡眠质量不好的老年人住院服务利用较高;中观系统中在婚老年人住院服务利用较高;宏观系统中居住城市和拥有一种以上社会保障的老年人住院服务利用较高。老年人的条件期望费用为8397.32元,其中以男性、城市、80～89岁老年人较高;非条件期望费用为2478.92元,其中以男性、城市、70～79岁老年人较高。结论老年人住院服务利用行为受社会生态多层因素的影响,个人特征中的慢性病和自评健康,个人行为中的睡眠质量,家庭环境中的婚姻状况,社会环境中的居住地和社会保障水平是老年人住院服务利用的重要影响因素;不同特征老年人条件和非条件期望费用不同,应合理有效分配卫生资源,促进老年人卫生服务利用的公平性。     

广西玉林市农村老年人卫生服务需要、需求和利用调查

目的了解广西玉林市60岁及以上老年人卫生服务需要、需求和利用现状。方法采用分层随机抽样的方法,对广西玉林市2个县6个乡镇9个行政村653名老年人进行卫生服务家庭健康询问调查。结果调查地区老年人的两周患病率为375.2‰,慢性病患病率为51.6%。老年患者的两周就诊率为48.9%,住院率为18.5%。43.2%%的未就诊患者与64.7%的未住院患者是缘于经济困难未就诊和未住院。就诊的老年患者中89.5%就诊时选择村卫生室或乡镇卫生院;约50.0%的农村老年患者住院服务选择在县级医院。调查地区老年人的次均门诊医疗费用为106.7元,其中65.3%的患者全部自己支付门诊费用;平均住院费用为5080元,其中获得报销费用2281元,报销额占平均住院费用的比例为44.9%。结论广西玉林市农村老年人的卫生服务需要、需求和利用程度较高;疾病经济负担是影响农村老年人卫生服务利用的主要因素;新型农村合作医疗的补偿水平有待提高。     

山西省慢性病患者住院服务利用现状及影响因素研究

目的 了解2013与2018年山西省慢性病患者住院服务利用差异及住院服务利用的影响因素,为完善慢性病管理政策提供依据。方法 利用2013、2018年山西省第五、六次卫生服务调查慢性病患者数据,运用stata 16.0进行统计检验,组间比较采用χ²检验或t检验、住院影响因素分析采用logistic回归,住院床日的影响因素分析采用负二项回归。结果 慢性病患者住院率由2013年的13.63%上升为2018年的18.77%;2013和2018年在县级医院进行住院治疗占比分别为53.88%和57.77%;过去一年需住院未住院原因主要是经济困难;第六次卫生服务调查的次均住院费用为10 266.97元,高于第五次调查的次均住院费用(6 933.91元);饮酒(OR=1.355,95%CI:1.279～1.436)和患慢性病数(OR=1.701,95%CI:1.435～2.017)是住院服务利用的危险因素(P<0.05)。城市(RR=0.833,95%CI:0.714～0.971)、体育锻炼(≥3次/周)(RR=0.884,95%CI:0.799～0.979)、体检(RR=...     

城镇居民基本医疗保险报销比例蒙特卡洛模拟测评

目的:探讨不同医疗保险报销比例对心肌梗死住院病人直接经济负担的影响.方法:根据天津市城镇居民基本医疗保险数据库2007年316例心肌梗死病人数据资料,运用蒙特卡洛模拟仿真技术,模拟当前天津市城镇居民基本医疗保险补偿模式,并对不同医院级别报销比例进行模拟探讨.结果:(1)报销比例依次提高10％,一、二、三级医院住院费用人均收入比分别下降1.3％、2％和5％,住院费用相当的劳动时间分别减少0.15个月、0.23个月、5个月; (2)在报销比例为75％时,三级医院个人住院直接经济负担有明显下降趋势; (3)当各级医院报销比例下降或上升5％时,心肌梗死病人人均住院费增加或减少约700元,住院费人均收入比增加或减少2％,会减轻天津市心肌梗死病人总经济负担约3.75亿元.结论:报销比例的变化对三级医院住院患者直接经济负担影响较大,运用蒙特卡洛随机模拟仿真技术能有效的模拟城镇居民基本医疗保险补偿模式,为我国卫生保险政策的制定提供了指导和参考.     

农村老年人身心健康状况与虐待关系

目的 了解湖北省麻城市农村地区老年人身心健康状况,探讨其与虐待的关系,为采取干预措施提供参考依据.方法 采用随机整群抽样方法,对在湖北省麻城市农村地区抽取的3个办事处17个行政村共2 000名≥60岁老年人进行问卷调查.结果 麻城市农村老年人身心健康指数得分为(13.35 ±4.78)分,身心健康问题检出率为43.50％ (870/2 000);受虐待、受身体虐待、受情感虐待、被疏于照顾、受经济剥削农村老年人身心健康指数得分分别为(11.39±4.68)、(11.29±4.32)、(10.65 ±4.43)、(11.94 ±4.89)、(10.08±4.08)分,均低于未受虐待、未受身体虐待、未受情感虐待、未被疏于照顾、未受经济剥削老年人的(14.45 ±4.47)、(13.45 ±4.78)、(14.36 ±4.50)、(13.61 ±4.71)、(13.41 ±4.77)分(均P＜0.01);广义线性回归分析结果表明,控制其他变量后,男性身心健康指数得分比女性高0.82分;60岁～组老年人身心健康指数得分比≥80岁老年人高1.03分;文盲老年人身心健康指数得分比初中及以上文化程度老年人低0.59分;患慢性病老年人身心健康指数得分比未患慢性病老年人低0.91分;抑郁老年人身心健康指数得分比无抑郁老年人低4.45分;受情感虐待老年人比未受情感虐待老年人低2.00分.结论 麻城农村老年人身心健康状况较差,情感虐待是影响老年人身心健康状况的一个重要因素.     

某三甲医院不同医保老年人医疗费用报销水平比较

目的分析职工医保与居民医保老年人的住院费用及报销水平,为完善医保相关政策提供参考。方法选取2013年浙江省某三甲医院住院老年人为研究对象,对享有职工医保与居民医保对象的住院及医保报销费用进行描述性分析。结果两类医保对象的住院疾病种类前6位的疾病均为慢性病,职工医保老年人占全年住院人次的39.14%,居民医保老年人占40.61%,职工医保老年人次均住院费用10 783元,药费占43.88%;居民医保老年人次均住院费用11 078元,药费占43.95%。两类医保对象相比,居民医保老年人住院费用高,报销比率低,药费是两类医保对象住院费用的主要构成部分。结论老年人住院费用较高,医院应加强药品费用等监控;同时政府部门应适当提高居民医保的报销水平,减轻居民医保老年人的经济负担。     

贵州黔南民族地区农村留守与非留守老年人慢性病及日常生活功能受损情况调查

目的比较贵州黔南民族地区农村留守与非留守老年人慢性病情况及日常生活功能受损情况。方法在贵州黔南民族农村地区,采用多阶段整群抽样方法,抽取符合要求的老年人进行调查,内容包括一般情况、慢性病患病情况及日常生活功能情况等。结果贵州黔南民族地区农村留守与非留守老年人慢性病患病率分别为69.13%、64.25%(P0.05),两者慢性病患病率前3位的疾病从高到低均为风湿性关节炎、颈腰椎等骨骼肌肉病、高血压。留守老年人ADL和IADL的受损率分别为20.24%、47.86%,非留守老年人ADL和IADL受损率分别为22.03%、44.99%,差异均无统计学意义(P0.05)。结论贵州黔南民族地区老年人慢性病患病率高,尤其是留守老年人;留守与非留守老年人日常生活功能受损分布大致相同,慢性病与日常生活功能受损共患情况突出;在民族地区应因地制宜制定慢性疾病防治对策和提供合理的养老服务、老年人健康照护服务,从而预防或减缓老年人慢性病流行和日常生活功能损害。     

福建省2008年新农合131万住院病例基本规律研究

[目的]研究福建省2008年新型农村合作医疗（NCMS）131万人次住院病例的有关规律,以及高额住院费用的影响因素。[方法]收集全省2008年76个县市区131万个住院病例数据库（含27项指标）并分析有关规律,用SPSS软件包以logistic回归和ROC曲线,研究产生高额住院费（万元以上）的影响因素。[结果]乡、县、县外的病例数分别占42．7％、33．6％和23．7％,次均住院费为3904元,实际补偿比33．0％,次均补偿额1289元,次均住院9．5d,不可报销费用占比26．8％。导致高额住院费用的主要因素是“到县外住院”、“住院天数多”和“不可报销费用占比高”。[结论]加强县内医院建设,力争“小病不出乡,大病不出县”、尽量缩短住院天数,控制范围外费用占比,是控制高额住院费用的重点措施。     

不同人群慢性病住院费及其因素分析

目的分析不同人群慢性病住院费水平,为制定慢性病住院费标准和控制对策提供依据。方法用Kolmogorov-Smirnov Z法和Kruskal-Wallis H法进行不同人群慢性病住院费用的比较,确定慢性病住院费用的主要因素采用回归分析方法。结果慢性病例均住院费,城市居民都高于农村居民,自费人群显著低于享有医保的人群;住院日、入院病情、医保情况、伴随病等因素影响慢性病的住院费。结论采取科学规范的诊疗措施,减少无效住院日是控制慢性病住院费水平的关键。     

中国贫困老年人卫生服务需求与利用研究

目的了解我国贫困老年人群的卫生服务需求和利用现状及其影响因素。方法利用2015年中国健康与养老追踪调查(CHARLS)全国数据,以国家贫困线标准筛选4041名贫困老年人作为研究对象,分析其卫生服务需求和利用的现状,运用Andersen健康行为模型和两部模型法,从倾向特征、能力资源和需要因素等方面分析我国贫困老年人门诊服务利用的影响因素。结果所调查的贫困老年人过去一个月的患病率为15.5%,慢性病患病率为78.8%,而就诊率仅为12.0%,应就诊未就诊比例高达86.7%,门诊费用中位数为350元。两部模型结果显示,个人特征、地区及家庭因素、身体健康状况及健康行为是影响贫困老年人是否就诊的主要因素,而疾病严重程度是影响患者就诊费用的最重要因素。贫困老年人的非条件门诊期望费用为183元,自评健康差的老人比自评健康一般或好的老人分别高出249元和336元,比患有慢性病和ADL功能受损的贫困老人门诊费用分别高119元和89元。结论我国贫困老年人的门诊服务需求较高,但利用不足。应从倾向特征、能力资源和需要因素提高老年人卫生服务利用以改善健康状况,尤其重点关注高龄、低教育程度、非在婚、自评健康状况差、慢性病患者和ADL功能受损贫困老年人的卫生服务利用,发展针对性的养老保险和医疗救助制度,同时持续扩大医保报销范围、提高报销比例,完善贫困落后地区的医疗卫生服务体系。     

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.     

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.     

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.