安徽省乡镇卫生院卫技人员专业结构与质量的研究报告

该研究抽样调查了安徽省５７８所乡镇卫生院。卫技人员占职工总数８９．０％：中西师（士）占３７．８％、检验占４．７％、放射占３．６％，均基本达到一级医院基本标准。但医护之比＝１∶０．４，严重失调、卫技人员质量低下，无专业学历者占３９．７％，其中３５岁以下占４８．７％，医生中具有大专及以上学历仅占１１．７％，无专业学历占３１．９％；师级以上技术职务中不具备大专及以上学历占８４．２％，在士级不具备中专学历的占２６．３％。预测将有６０．３％的卫技人员需要接受正规化、系统化教育。防保人员每院２．８人，但分布不均，仅有４８．５％乡镇卫生院拥有专职防疫人员，无专业学历占４４．８％，明显低于其他类别卫技人员。该研究认为，要把医学教育重点放到乡镇卫生院在岗人员的培训上，采用“学历教育与专业证书教育”并重策略；调整医护比例，调整专业结构；发展合作医疗制度，理顺卫生体制与运行机制，使农村卫生人力开发与卫生系统之间协调发展。     

广西卫生防疫体系卫生检验人力资源现况调查分析

目的 对广西县级以上卫生防疫机构卫生检验人力资源进行调查分析，为改善和加强卫生检验人才队伍提供依据。方法 设计统一调查表格，组织专业调查人员深入各机构进行调查，建立人力资源数据库并进行统计分析。结果 2002年广西103家县级以上卫生防疫人员有6709人，卫生检验人员923名占13．76％，其中县级检验人员占同级卫生防疫人员的12．86％，地市级占15、73％，省级占16．06％；全省(区)卫生检验人员中本科及以上学历占6．93％，大专占33．59％，中专占53．09％，无学历占5．63％；而县级本科学历仅占2．0％，还有76个县(区)(占86．36％)无一名检验专业本科人员；职称构成：主任技师1名占0．11％，副主任技师30名占3．25％，主管占44．86％，技师占33．5％，技士占13．11％；县级高级职称仅1．00％，82个县(区)无一名高级职称检验人员；专业构成：检验专业占71．83％、医疗卫生占13．87％，化学占2．49％，其他占6．18％；卫生检验人员平均年龄36．6岁；平均工龄16．1年。结论 广西卫生检验人才队伍有一定规模，大中专学历和中、初级职称检验人员构成了全省卫生检验队伍主体，尤其是县级卫生防疫机构高学历、高职称卫生检验人才十分匮乏，表明加强卫生检验人才队伍培养和引进高素质多领域检验人才已刻不容缓。     

社区卫生管理人员基本状况与分析

目的对山东省七城市社区卫生管理人员数量、年龄、性别和管理工作年限、受教育形式、专业及学习时间、学历等基本状况的进行调查与分析，以探讨有针对性地开展社区卫生管理人员的培训工作；方法对山东省七城市485名社区卫生管理人员进行现场问卷调查；结果社区卫生管理人员平均年龄为39．5岁；全日制中专以上学历者占68．7％；专业平均学习时间为25．85月；77．3％的人员管理工作年限在5年以上；41．6％的人员临床医学专业毕业。结论调查的社区卫生管理人员平均年龄低于全国卫生管理干部的平均年龄；社区卫生管理人员的学历层次偏低；卫生管理专业毕业的人数较少；社区卫生管理人员的学历层次和专业化培训有待提高。     

绍兴县社区卫生人力资源调查与分析

目的：了解绍兴县社区卫生人力资源现状，为加强社区卫生人才建设提供参考依据。方法：对绍兴县所有社区卫生服务中心和服务站进行问卷调查，了解其卫生技术人员的相关情况并进行统计分析。结果：全县共有社区卫生服务技术人员1356人．30岁以下占51．7％，社区医生占53．4％，中专及以下学历占60．8％，初级职称占62．4％，正式在编人员占68．2％。结论：需优化专业结构，加强防保和护理力量；需加强在职教育，提高人员业务素质；需提升职称层次，提高专业技术水平；需加强政策支持，吸引和留住社区人才。     

某区社区卫生服务中心药学服务现况调查

目的了解本区社区卫生服务中心开展药学服务的现况。方法2007年8月，以自行设计的调查问卷对本区8个社区卫生服务中心107名临床医师和50名药剂人员展开调查。结果157名调查对象中，认为社区卫生服务中心药剂人员目前开展的业务内容为发药的有142名，占90．4％；为病人用药咨询和指导的126名，占80．3％；医院用药情况分析并反馈于临床的88名，占56．1％。对于药物服务概念的知晓率，药剂人员为72．0％，临床医生为38．3％，差异有统计学意义（P〈0．05）。对于合格药剂人员应具备的知识结构问题，选择丰富药物知识的156名，占99．4％；临床知识的139名，占88．5％；良好人际沟通技能的125名，占79．6％。认为开展药学服务有障碍的73名，占46．5％；在73份认为开展药学服务有障碍的原因分析中，位于前3位的分别是：药剂人员自身知识不足71名（97．3％），领导不够重视34名（46．6％），临床医生抵触25名（34．2％）。98．0％的药剂人员和96．3％的临床医生认为开展药学服务有必要。对于社区卫生服务药剂人员可开展药学服务内容的认识，位于前3位的是：为病人用药咨询和指导（92．4％）；发药（86．0％）；医院用药情况分析并反馈于临床（82．2％）。结论药学服务的理念还需进一步贯彻；要克服障碍，发挥药师作用，开展形式多样的药学服务。     

上海市虹口区社区卫生人力资源研究

目的了解虹口区社区卫生人力资源现况，为做好社区卫生人力资源配置提供依据。方法以虹口区8所社区卫生服务中心2005年末全体在岗的临床医疗、护理、医技、公共卫生、卫生监督等岗位人员为调查对象，在调查员指导下，由被调查单位人事干部填写问卷。结果虹口区在编在岗社区卫生人员年龄≥45岁者占60．6％，30～44岁者占19．2％；5年内退休者占30．1％；编制外聘用人员占在岗医务人员的11．3％。本科及以上学历为8．2％；副高及以上技术职称者占l_1％，具有中级技术职称资格者占31．3％，已聘至中级技术岗位者占21．5％。结论虹口区社区卫生人员年龄偏大，30～44岁年龄组断层明显，人力配置总体不足；本科及以上学历者偏少，副高及以上技术职称比例偏低，中级职称职数不足。政府应加快制定并落实社区卫生人力资源的支持性政策；各社区卫生服务中心应加大留住、引进与培养人才的力度。     

云南边疆少数民族地区卫生专业技术人员现状分析与对策建议

目的了解边疆少数民族地区医疗卫生人才现状,为农村基层卫生人才培养提供科学依据。方法通过调查表对4个县级医院进行问卷调查,并对红河州2006年《云南省农村卫生机构基本信息调查表》资料进行统计分析。结果县级医院医护人员中有大学本科学历的仅占8．5％,医护比为1：0．88,临床医生、护士职称构成均以初级职称为主,分别占55．2％和57．3％。乡镇卫生院卫技人员中有大学本科学历的仅占4．9％,无学历人员占7．3％。乡村医生具备中专学历的仅占42．5％,高中及以下学历的占57．5％：乡村医生取得执业（含执业助理医师）医师资格仅占3．8％;平均每千农业人口拥有乡村医生0．8人,每千农业人口注册护士比例只有0．18。结论农村基层卫生人才缺乏,护理人力资源明显短缺,乡村医生队伍数量明显不足。卫生技术人员学历层次低,整体素质和能力普遍偏低。     

广州市全科医学教育社区卫生服务实践基地卫技人员调查分析

目的:了解广州市全科医学教育社区卫生服务实践基地卫技人员队伍现状,为促进全科医学教育师资队伍建设提供依据.方法:采用问卷调查的方式对广州市全科医学教育社区卫生服务实践基地的在岗卫技人员进行普查.结果:广州市19家全科医学教育社区卫生服务实践基地共有卫技人员1849名,平均每家拥有卫技人员97人,公卫医师占6.00%;卫技人员中25～54岁占80.53%;大专以下学历人员占66.47%;高级职称、中级职称、初级、无职称人员分别占5.25%,17.85%,67.65%,9.25%;医(仅全科医师)护比为1∶0.95.结论:广州市全科医学教育社区卫生服务实践基地卫技人员队伍中,护士和公卫医师数量不足,学历、职称偏低,人力资源结构有待改善.     

西部一贫困县医院卫生技术人员现况研究

目的 了解尼勒克县人民医院卫生技术人员现况及总体特征，发现人力结构存在的问题，针对存在的问题提出结构调整的对策，为医院自身改革发展和上级主管部门在进行卫生规划时提供决策依据。方法 采用全面调查方法，通过对全院160名在岗在编职工发放调查表获取一般资料，调查结果用Excel软件统计数据，并用该软件进行有关相对数据指标的分析。结果(1)全院在职职工160名，其中卫生技术人员137名，占85．63％；(2)全院职工平均年龄35．29岁，卫生技术人员平均年龄34．56岁，医疗、护理、医技专业年龄结构都有断层；(3)医院卫生技术人员学历层次偏低，缺乏高学历人才，且无专业学历者较多，占16．06％；(4)医院高级职称集中在50岁以上年龄组，中级职称集中在35岁以上年龄组，业务人员中心在中青年，存在明显技术结构断层现象；(5)专业配比不合理，医护比为1：1．01，医技比为3．25：1，医药比为4．33：l。结论人员数量与医院规模有一定差距．卫生技术人员比重偏大，管理人员数量不足，医生数量多，护士、医技人员数量不足。医院缺乏高职称、高学历的学科带头人及卫生技术人才，应尽快培养或引进人才，以实现医院快速发展，达到人员结构优化的目标。     

浙江省农村卫生技术人员基本素质调查

目的分析浙江农村卫技人员的年龄、学历、职称、专业等基本素质,探讨其存在的主要问题.方法随机调查浙江省农村基层卫技人员,采用Access建立数据库、SPSS10.0进行统计处理.结果浙江乡镇卫生院卫技人员40岁以下占62.5%,乡村医生中50岁以上者占一半以上.农村卫技人员中本科学历仅占2.8%,人专学历28.8%,中专学历占43.4%,其余为无正规学历者.职称结构中,主治及以上占11.8%,医师占29.6%,医士37.0%,其余为卫生员和无职称人员.专业结构中临床医学占52.9%,护理占20%左右.结论浙江省乡镇卫生院卫技人员年龄较轻,乡村医生年龄过大,其专业以临床医学为主,学历和职称过低,不能满足社会需求,应加强其培养与考核.     

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.