成都市细菌性痢疾预警指标体系构建

[目的]建立一套科学合理的适合成都市细菌性痢疾暴发或流行的预警指标体系,为各级疾病预防控制机构提供理论依据,为相关研究提供方法学参考.[方法]在系统查阅文献的基础上,建立细菌性痢疾预警指标体系草案;采用专家咨询法对拟定的指标体系进行研究认可,运用综合指数法和界值法筛选指标;采用层次分析法确定预警指标的权重.[结果]第1轮咨询问卷的Cronbach's α系数为0.78;两轮专家咨询的专家积极系数分别为100%,90%;咨询专家意见协调系数为0.41;专家权威系数为0.86.通过两轮专家咨询和层次分析法确定细菌性痢疾预警指标体系,包含2个一级指标,7个二级指标和19个三级指标,其中细菌性痢疾聚焦性病例的出现、细菌性痢疾病例或疑似病例报告数及死亡数、食品卫生质量合格率和餐具消毒合格率的权重较大.[结论]本研究建立的指标体系可根据指标的可获得性程度,在资料不完整的情况下优先考虑权重较大的指标,不仅能在目前已开展的工作基础上有效使用,而且为进一步扩展细菌性痢疾的监测范围和频度提供了指导依据.     

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...     

城市医院支援乡镇卫生院形式评估指标体系构建——基于河北省实践

目的：建立一套有代表性、可操作性强的城市医院支援乡镇卫生院形式评价指标体系。方法：通过文献研究、专题小组讨论法、深入访谈法建立初始指标体系,运用德尔菲专家咨询法结合综合评价与变异系数法筛选指标,建立最终的评价指标体系,并运用层次分析法确立了各级指标的权重系数。结果：通过两轮咨询,建立了包括有效性、可推广性两个一级指标、8个二级指标、57个三级指标在内的城市医院支援乡镇卫生院形式评价指标体系。结论：本研究建立的指标体系具有较好的科学性、有效性和可操作性,可广泛用于评价城市医院支援乡镇卫生院各种形式的效果。     

基于德尔菲法及层次分析法构建免疫规划疫苗遴选评估框架

目的 构建非免疫规划疫苗纳入深圳市免疫规划的评估框架。方法 通过文献分析，初步形成指标框架；于2022年3—7月采用2轮德尔菲专家咨询法对15名专家进行问卷调查(，以)修改完善指标，确定指标体系；采用层次分析法确定指标权重。结果 2轮专家咨询的专家积极系数C_aj专家权威系数(Cr)均值为0.84；第一轮、第二轮专家咨询所有指标综合评分的协调系数(W)分别在0.199～0.465、0.253～0.442之间(P均<0.05)；最终确定了由4个一级指标、13个二级指标和34个三级指标形成的指标体系，分别从疾病评价(疾病负担、经济负担、防控优先性)、疫苗评价(疫苗安全性、疫苗效果、疫苗属性)、能力评价(决策过程、资金、供应、人力、监测)和效益评价(经济效益、社会效益)等4个维度进行评价，其中所有三级指标的组合权重系数在0.003～0.279。结论 本研究构建的深圳市免疫规划疫苗遴选评估框架具有创新性与可靠性，可为深圳市免疫规划疫苗遴选提供参考。     

应用模糊综合评价法构建深化医药卫生体制改革考核指标体系

[目的]构建深化医药卫生体制改革考核指标体系,为深化医改考核工作提供评价工具.[方法]基于"结果链"理论,通过文献研究法和头脑风暴法构建指标池,形成初步的考核指标体系,发放正式调查问卷,选取20位专家进行2轮Delphi专家咨询,权重通过模糊综合评价法确定.[结果]经过2轮专家咨询后得到专家积极系数分别为80.0％和1...     

基于德尔菲法的乡镇卫生院精神卫生服务绩效评价指标体系研究

目的 构建乡镇卫生院精神卫生服务绩效评价指标体系,为乡镇卫生院精神卫生服务绩效评估提供客观参考。方法 结合我国和广西相关政策,通过文献分析法及专家访谈法,初步构建评价指标体系,采用Delphi法经2轮专家咨询,确定绩效评价指标及其权重系数。结果 2轮咨询专家积极系数分别为87.5%和100%,总体权威系数为（0.84±0.01）;2轮指标总体协调系数分别为0.221、0.267（P均＜0.001）。最终构建的评价指标体系包括:一级指标3项,按权重从小到大的指标依次为结构（0.3472）、过程（0.3282）、结果（0.3247）;二级指标11项;三级指标49项。结论 该研究基于Delphi法构建的乡镇卫生院精神卫生服务绩效评价指标体系,能较为客观地评估乡镇卫生院精神卫生服务水平。     

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。     

基于德尔菲法和模糊层次分析法的公共场所卫生诚信评价指标体系构建

[目的]构建公共场所卫生诚信评价指标体系,为开展公共场所信用监管提供科学依据。[方法]通过文献分析和现场调研,初步确定公共场所卫生诚信评价指标。采用德尔菲法专家咨询法,选取卫生行政部门、科研院校、公共场所卫生监督等相关领域的20名专家进行2轮咨询,对评价指标进行评分和筛选,并采用模糊层次分析法确定指标权重。[结果]两轮咨询专家积极系数均为100%;咨询专家对权威程度为(0.83±0.05);第一、二轮总体指标的专家协调系数分别为0.213(P0.05)和0.424(P0.05)。最终形成的由6项一级指标、21项二级指标组成的公共场所卫生诚信评价指标体系。[结论]通过德尔菲咨询法与模糊层次分析法相结合构建公共场所卫生诚信评价指标体系,专家积极性、权威程度和协调程度较高,指标体系科学合理。     

入境国际航行船舶传染病防控风险评估指标体系构建

目的研究建立入境国际航行船舶传染病防控风险的评估指标体系。方法采用德尔菲法确定评估的指标体系,通过2轮专家咨询修改指标体系,筛选指标,确立指标体系;应用层次分析法计算指标权重,形成判断矩阵并进行一致性检验。结果第1轮、第2轮咨询的专家积极系数分别为95.00%,84.21%,专家权威系数为(0.85±0.03)。第2轮咨询Kendall′s W=0.455,χ2=298.42(P0.001),具有统计学意义。通过2轮专家咨询建立了国境口岸传染病防控风险的综合评价指标体系,包括3个一级指标、14个二级指标和42个三级指标;应用AHP法确定了各指标的权重,各判断矩阵的一致性检验结果 CR均0.10,具有较好逻辑一致性。结论本研究专家积极性、权威程度和意见协调性均较高,表明指标的可信度较高,同时建立的指标体系结构合理,包含了船舶传染病防控检疫工作的核心内容,具有较强的针对性。     

乡镇卫生机构管理人员培训评价指标体系建立研究

目的：筛选合适的指标作为乡镇卫生机构管理人员培训评价指标,用于指导乡镇卫生机构管理人员培训工作。方法：采用改良特尔菲（Delphi）专家咨询法,对江苏省卫生厅、市卫生局、社区卫生服务中心、乡镇卫生院、高校等单位从事卫生管理教学、科研或卫生行政管理的专家进行两轮函询。结果：该研究专家咨询的权威系数0.75。两轮专家咨询的积极系数分别是74.07%和100%,和谐系数分别是0.571和0.832。通过两轮咨询,根据专家评价和打分,确定I级指标5个,II级指标25个,并给各指标赋予权重。结论：建立了一套评价乡镇卫生机构管理人员培训的指标体系。     

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.     

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.     

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.