剖析我国基本公共卫生服务均等化推进中的问题

深入剖析了我国基本公共卫生服务均等化推进中几类关键问题以及问题之间的相互作用关系:(1)认识不清,将"基本公共卫生服务"理解为"基层公共卫生服务",使落实基本公共卫生服务变成"基层"一家之责;将"基本公共卫生服务"代替"公共卫生服务",忽视常规服务项目开展。(2)职能错位,公共卫生服务开展的主体——专业公共卫生机构被"边缘化";职能缺位,项目推进缺乏全流程的职责分工。(3)协调不力,基本公共卫生服务项目推进的效率较低。(4)推进项目开展的工作经费总量不足,分配不均;公共卫生人员的数量、素质均难以满足项目的执行。因此,要有效落实基本公共卫生服务,首先需要扭转错误观念,其次需要建立协调沟通机制、明确全流程的工作内容与职责分工等。     

深圳市基本公共卫生服务工作中存在的问题及建议*

通过对深圳市基本公共卫生服务工作进行现场调查与资料查阅,梳理深圳市基本公共卫生服务工作中存在的问题并提出相关建议,旨在为深圳市基本公共卫生建设提供更全面、更有针对性的指导。分析发现,现阶段深圳市基本公共卫生服务工作中存在的问题包括:基层慢性病管理信息化程度不足,基本公共卫生服务各系统无法互联互通;现有社区健康中心整体布局与居民健康需求存在差距;基本公共卫生项目的考评与服务经费关联机制欠成熟;现行基本公共卫生服务项目年人均补助标准与基本公共卫生服务项目需求不匹配;基层公共卫生机构专业技术人员缺乏并且薪资待遇低。未来工作改进建议:加强基层公共卫生信息系统建设;加强社区健康中心服务能力建设;完善基本公共卫生服务经费保障机制;适当提高基本公共卫生服务经费补助标准;提高基层公共卫生医生待遇。     

乡村两级医疗卫生机构国家基本公共卫生服务项目职责分工及经费分配研究

目的明确乡村两级医疗卫生机构应承担的国家基本公共卫生服务项目职责及经费分解比例。方法采用文献检索、专家研讨和专家咨询的方法,对主要调查内容开展研究。结果基本公共卫生服务项目中,除建立居民健康档案、健康教育、传染病报告、慢性病管理等项目由乡村两级医疗卫生机构分别开展外,大部分项目由乡镇卫生院和村卫生室共同开展。按照人均15元基本公共卫生服务经费标准,分配至乡镇卫生院的服务经费应在8.11～8.90元,约占53.7%～58.9%,分配至村卫生室的服务经费应在6.20～6.99元,约占41.1%～46.3%。结论分解任务,明确乡村两级医疗卫生机构的职责,有助于促进各项工作任务得到有效落实,同时,明确补助标准,有助于提高基本公共卫生服务经费的使用效率和效果。     

基本公共卫生服务的补偿或支付标准国内外研究概况

目的:探讨国内外补偿标准,探究适应中国国情的基本公卫补偿机制,推动基本公卫服务健康有序发展.方法:通过文献学习法,罗列并分析当前国内外关于基本公卫服务补偿支付标准的利与弊.结果:基本公共卫生服务补偿标准有按照签约人头数向社区卫生服务机构以及家庭医生支付提供公共卫生服务的补偿费用;有少数按服务项目支付,按照服务项目的数量与质量进行补偿;也有部分基于时间收费来补偿.结论:基本公共卫生服务的补偿或支付标准的核算是国家基本公共卫生服务项目落实的起始也是极为关键的环节,它关系到政府对相关机构的基本公共卫生项目的经费投入与任务要求之间能否相适应.依据中国基层实情,有必要对基层实施的国家基本公共卫生服务项目成本进行测算,明确国家基本公共卫生服务项目成本现状、差距和经费投入需求,创新补偿标准机制.     

县级卫生监督工作中亟待解决的问题及建议

作者根据县级卫生监督机构运行的基本情况,阐述了目前县级监督机构存在的亟待解决的问题:(1)所配置的人力与所承担的责任和职责不相称;(2)有限的力量受到城市创建工作的牵制;(3)经费问题仍然困扰着不少县级卫生监督机构;(4)由于某些监测工作要求脱离实际、基层检测手段有限、费用难以落实等因素至使卫生监测工作难以开展;(5)县以下缺乏运行高效的基层卫生监督网络。针对上述存在问题,作者提出如下建议:(1)适度调整编制,加强县及县以下卫生监督力量;(2)卫生行政部门应重点保障卫生执法工作经费;(3)理顺监测机制,真正落实基层的卫生监督工作;(4)上级卫生行政部门制定的工作计划和要求应有所侧重并贴近基层卫生监督工作实际。     

基层基本公共卫生服务项目管理模式探讨

目的探讨基层基本公共卫生服务项目管理模式,提升管理质量和效果。方法建立完善管理机制,明确职责分工,加强培训、指导和考核,整合家庭医生签约服务、社区网格化服务管理和示范区建设等工作协作支持,强化信息化技术支撑,多途径突破基本公共卫生服务项目工作瓶颈。结果居民健康档案动态使用率稳步提高,各类重点人群管理较为规范,居民服务满意率有所提升。结论提高基本公共卫生服务项目质效,需要强化责任落实,狠抓指导考核,促进项目工作与相关领域融合发展,加强信息化建设,提高工作效率。     

卫生部关于疾病预防控制机构指导基层开展基本公共卫生服务的意见

卫疾控发〔2012〕42号各省、自治区、直辖市卫生厅局,新疆生产建设兵团卫生局:根据《"十二五"期间深化医药卫生体制改革规划暨实施方案》的要求,按照"保基本、强基层、建机制"的基本原则,为进一步提高基本公共卫生服务均等化水平,切实保障基层医疗卫生机构落实基本公共卫生服务的质量和效果,结合《各级疾病预防控制中心基本职责》,现就疾病预防控制机构及其他专业防治机构指导基层开展基本公共卫生服务提出以下意见。     

农村基本公共卫生服务开展利用情况研究

目的:了解农村基本公共卫生服务的开展、利用情况,为继续推进基本公共卫生服务提供对策和建议。方法:采用随机抽样的方法,对北京市郊区的三个区县共32个乡镇进行函调以及问卷调查。结果:(1)调查地区基本公共卫生服务均已得到不同程度开展,不同区县间、开展的服务项目间均存在显著差异;(2)不同区县在服务利用情况上存在明显差异,并且卫生室/站是农村居民的首诊机构;(3)农村居民对基本公共卫生服务的认知情况较好,认识程度和是否愿意接受基本公共卫生服务之间呈显著相关。建议:(1)采用多元化的手段落实基本公共卫生服务项目的开展;(2)加强对基本公共卫生服务项目的宣传;(3)从群众实际需求出发提供切实可行的基本公共卫生服务;(4)健全农村卫生服务体系,提高公共卫生服务能力。     

江苏省农村基本公共卫生服务政府购买现状实证研 究

目的对江苏省农村基本公共卫生服务政府购买现状进行研究,为保障基本公共卫生服务均等化进程的稳步推进提出合理化政策建议。方法采用现场问卷调查、关键知情人访谈、专题小组讨论、观察法开展研究。结果地方政府尚未完全履行筹资职责;服务和经费的层级分配不相符;财政补偿为主的购买方式难以适应卫生工作发展需要;考核方式存在不足;经费管理和使用缺乏具体指导意见。结论强化政府筹资职责;科学进行成本测算;合理安排基本公共卫生服务和经费的层级分配;健全考核和评估机制。     

美国妇幼卫生管理体制 组织机构和职责分工

<正> 美国的妇幼卫生工作,由联邦、州(市)、县三级管理。联邦一级负责制定法令、政策、条例和技术标准、分配经费、进行宏观控制和指导、提供咨询、下达项目。州(市)一级负责制定地区性规划和某些法令、技术标准、分配经费、进行技术指导和咨询,组织落实项目并进行评价。县一级负责项目计划的制定以及项目的组织、检查、总结,开展基层妇幼卫生服务工作。一、联邦的妇幼卫生管理机构及其职责联邦政府设卫生和人类服务部(DHHS),主管全国公共卫生服务、社会保险及其他福利事业。公共卫生服务工作则由该部下设的公共卫生服务署(PHS)主管。PHS相当于我国     

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.