社区肢残人辅助器具使用全科医学照顾干预效果分析

目的了解社区肢残人辅助器具需求及使用状况,并对全科医学照顾干预作效果分析。方法全科医生采用入户面访对调查对象进行前后二次问卷调查,问卷调查内容包括：一般的人口学资料、残疾程度及生活自理能力、辅助用品使用情况等相关内容并对全科医学照顾干预前后二次数据进行卡方检验及相关资料分析。结果全科医学照顾干预后比干预前肢体残疾人士使用辅助器具上升了9．68个百分点,使用辅助器具局部症状改善或治愈以及跌倒人数干预前后有统计意义（P〈0．01）,肢体残疾人生活自理能力干预前后对照有统计意义（P〈0．05）。结论适合个性化的肢残人士器具使用服务提升了残疾人“人人享有康复服务”社区卫生服务平台,提高肢残人士器具使用率和干预评估是提高肢残人士生活自理能力的有效措施。     

全科团队疾病预防知识培训效果及需求调查

为了更好地为全科团队提供优质的社区疾病预防控制工作的指导服务,使全科团队更好地服务于社区,服务于家庭,在取得全科团队《社区疾病预防控制工作规范》培训经验基础上,我们对部分社区的全科团队成员进行了培训、指导及需求调查。     

长宁区社区疾病预防控制工作规范试点培训近期效果评估

为评估对社区全科团队人员进行《长宁区社区疾病预防控制工作规范》的培训效果，我们组织了区疾病预防与控制中心相关业务科室的业务骨干对49名社区全科团队成员进行了业务培训，并就其近期效果进行了评估。现报道如下。     

三城市社区全科医学培训现状与需求分析

目的了解社区全科医学培训现状及需求情况，为制订相应的培训策略和方法提供依据。方法采用定性与定量相结合的方法，调查成都、沈阳、上海三城市社区卫生服务中心或服务站的全科医学培训及需求情况。结果在所调查的171名医生中，接受过全科培训的占39，8％；162名护理人员中，接受过全科培训的占12．3％；67名预防保健人员中，接受过全科培训的占35，8％。接受过全科培训的医务人员对培训效果的评价并不高，但对全科医学培训却有着较高的需求。结论建议建立全科医生培养基地，强化对社区卫生服务人员的培训，提高人员素质。     

全科服务团队开展社区康复模式的实践

目的评价全科服务团队开展社区康复的工作模式。方法对本团队责任区内1344名≥60岁老年人进行筛查，有康复需求的43名慢性病患者开展家庭、站点的康复训练。结果经过1年多康复训练，有效率83％。结论全科服务团队开展社区康复是一种方便、可行、有效、能被患者接受的康复模式。     

某社区肢体残疾成年人社会支持现况调查

目的了解某社区肢体残疾成年人的社会支持现况，探讨影响其社会支持的相关因素。方法随机抽取社区中99名肢体残疾成年人作为残疾组，98名健康人作为健康组；以残疾人一般情况调查表和社会支持评定量表做问卷调查，并比较两组调查结果。结果残疾组的客观支持、主观支持和支持利用度得分以及支持总分均明显低于健康组，其差异有统计学意义（P〈0．01）。结论建立残疾人社会支持网络，在政策、制度上给予其保障，为残疾人提供更多社区服务，帮助其获得更多社会支持。     

上海金山工业区残疾人“1+1+1”家庭医生签约服务效果评价

目的 了解上海市金山工业区家庭医生的康复服务能力情况以及“1+1+1”家庭医生签约服务后残疾人机体功能改善、满意度、医疗费用支出情况,为后续精细化干预提供支持。 方法 通过自拟问卷于2016年8－10月和2017年8－10月调查金山工业区14名家庭医生基本情况及掌握康复服务技能种类等以及733名残疾人的基本人口学信息、残疾特征信息和机体功能改善情况、满意度情况和医疗支出情况等。 结果 14名家庭医生年龄集中在20~50岁,均具有多种康复服务技能,能为残疾人提供个性化的“1+1+1”签约服务。733名残疾人男女性人数比为1.08:1,肢体残疾人数最多,为334人(45.57%),残疾等级中四级残疾人数最多,共342人(46.66%)。“1+1+1” 家庭医生签约上门服务人数和康复治疗人数较家庭医生制团队服务分别增加130人和312人。接受“1+1+1”家庭医生签约服务后,186名(25.38%)残疾人机体功能改善,47名(6.41%)残疾人机体功能恢复。签约残疾人满意度有一定提升,满意和非常满意人数总和由签约前的585人(79.81%)升至签约后的714人(97.41%)。签约残疾人医疗费用则呈现下降趋势,同比下降22.82%。 结论 “1+1+1”家庭医生签约服务能够提升残疾人对康复服务的满意度,改善残疾人机体功能,降低残疾人医疗支出。     

广州市东山区残疾人致残因素和康复情况调查

目的 了解残疾人致残因素和康复情况，为残疾人社区卫生服务提供科学依据。方法 1998年10月由调查人员以问卷方式，对广州市东山区部分街道的残疾人进行。结果 残疾人的致残因素中，疾病致残者占58.23%，先天致残占23.10%，伤害致残占18.67%。残疾人中62.80%未接受过康复治疗，先天致残者这一比例为73.90%。结论 要采取各种措施预防残疾的发生，加强有关残疾康复重要性及康复效果的宣传，搞好对残疾康复治疗的社区服务。     

全科团队卫生服务需求调查

目的了解社区居民对全科团队卫生服务的需求，为制定相关的服务对策提供依据。方法采用分层整群抽样方法，随机抽取社区17个里委共1360名居民进行问卷调查。结果居民对全科团队知晓比为29．0％；经宣传后认为需要全科团队服务者为44．1％；愿意与全科团队签约者占38．0％。结论全科团队要通过提供优质服务，提高综合服务能力等措施以提高在居民中的知晓比，获得社区居民的认可；在服务过程中要善于利用现代化通信手段，包括电话预约、网络咨询等以扩展服务对象，提高服务效率；注意加强卫生服务站点建设。     

关于组建全科服务团队的思考

全科服务团队是社区卫生服务网络的核心和灵魂,团队成员通过建立伙伴式的协作和支持关系,可以把预防、医疗、保健和康复服务扩展到家庭和社区,更好地提高社区居民的健康水平。而政策的支持、资金的投入、健全的团队及成员考核系统、良好的合作与竞争机制和高素质的全科医生是全科服务团队发展的重要条件。     

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.