济宁市“万名保健医生进农户”效果评价

目的 对济宁市“万名保健医生进农户”政策实施效果进行全面评价,从而为该政策的进一步实施与推广提供参考依据.方法 采用多阶段分层随机抽样方法,分别对参与济宁市“万名保健医生进农户”活动的农村居民、乡村医生及入村医务人员进行现场问卷调查与访谈.结果 签约农村居民对人村医务人员的服务水平、服务内容、服务态度、服务主动性的满意率均超过90.0％;有98.3％的乡村医生表示曾经接受过入村医务人员的主动指导;分别有87.0％、68.4％的乡村医生和入村医务人员认为该项活动的实施将使上级优质卫生资源下沉农村.结论 “ 万名保健医生进农户”政策有利于提升农村卫生服务水平.在进一步优化的基础上,其具备一定的推广意义.     

济宁市“万名保健医生进农户”政策执行问题及适宜模式探讨

采用霍恩-米特模型,从政策目标与标准、政策资源、执行机构特性、执行方式、政策执行环境以及政策执行人员偏好角度,分析济宁市“万名保健医生进农户”政策执行过程中的问题与障碍.基于能级和人岗匹配原理,构建政策可持续发展适宜模式,并对其进行论证,从而为政策的优化和进一步推进提供建议.     

健康乡村数字化建设工作的思考

我国优质医疗资源总量不足、结构不合理、分布不均衡,已成为制约健康乡村建设的重要原因之一,互联网医疗是改善这种卫生资源结构性失衡的良好工具,可在一定程度上缓解供需矛盾。本研究以健康乡村数字化建设为切入点,从政策体系、人才培养、平台建设等方面探索数字化转型时期,互联网医疗推进健康乡村建设的优化策略,从而推动更多医疗资源向乡村倾斜,助力健康乡村建设。     

四川省国家级贫困县农村居民卫生服务利用研究

[目的]了解四川省国家级贫困县农村居民对乡村卫生服务的利用情况.通过分析贫困地区的卫生状况,了解人群卫生服务利用状况,探索卫生资源的合理配置方式和卫生保健工作重心,为评价卫生服务效果和制定卫生政策提供客观依据.[方法]在每个县分层随机抽取农村居民共852人进行面对面访谈.[结果][1]村卫生站是最能满足农村居民卫生服务需要的基层卫生机构.[2]村民对预防保健服务利用情况不足.[3]村民对计划免疫服务的利用不足.[结论]农村居民对预防保健和计划免疫服务利用不足,村卫生站应该在这些方面加以改进,以提高卫生服务水平.     

浙江迈向整合型医疗之路

<正>新一轮深化医药卫生体制改革以来,浙江省相继出台一系列政策法规,为构建整合型医疗卫生服务体系提供政策利好。2013年6月,《浙江省人民政府办公厅转发省卫生厅等5部门关于推进城市优质医疗资源下沉实施意见的通知》印发。《通知》创造性地提出了通过推进城市医院下沉合作办医,促进优质医疗资源的有效配置,加强     

关于做好县域巡回医疗和派驻服务工作的指导意见

<正>近日,国家卫生健康委、国家中医药管理局、国家疾病预防控制局联合印发《关于做好县域巡回医疗和派驻服务工作的指导意见》,要求进一步强化县级医院和基层医疗卫生机构服务能力,采取“固定设施、流动服务”的方式,推动服务重心下移、优质医疗资源下沉,适应农村居民健康服务需求,持续巩固拓展基本医疗有保障成果。内容如下。为贯彻落实中共中央办公厅、国务院办公厅《关于加快推进乡村人才振兴的意见》和国家卫生健康委近期印发的《卫生健康系统贯彻落实以基层为重点的新时代党的卫生与健康工作方针若干要求》（国卫基层发[2022]20号）、《巩固拓展健康扶贫成果同乡村振兴有效衔接的实施意见》（国卫扶贫发[2021]6号）,     

服务为本建立"农民家庭合同保健"制度

近年来 ,我们在县委、政府和上级主管部门的领导、支持下 ,在全县积极推行了农民家庭合同保健工作 ,为探索和建立新时期的农民健康保障办法做了一些尝试 ,收到了较为满意的效果。1　主要做法我们开展的农民家庭合同保健是在乡村卫生服务管理一体化和农村社区卫生服务的基础上 ,以农村基层卫生机构为依托 ,以乡村卫生人员为骨干 ,以辖区内农户和重点人群为对象 ,以预防保健为重点 ,以“人人享有卫生保健”为目标 ;采取合同形式 ,为农村居民提供基本医疗预防保健服务的一种新型健康保障办法。开展这一工作应坚持“政府引导、互助共济、自愿有…     

北京市迎来乡村医生队伍建设新机遇

乡村医生是医疗卫生服务队伍的重要组成部分,是最贴近亿万农村居民的健康“守护人”。近年来,随着经济和社会发展,乡村医生政策的滞后引发“进人难”、“留不住”、老龄化等问题,人才队伍建设陷入困局。北京市根据自身实际情况,适时出台相关政策,在乡村医生队伍建设方面进行了积极的实践与探索。     

山西 “十个下沉”强基层

正山西省卫生计生委自2013年起,全面实施优质医疗资源下沉战略,先后制定出台了推进优质医疗资源、医疗技术、机构建设、设备配置、卫生经费、学科专科、培训项目、医疗服务、医保支付、信息资源"十个下沉",提升基层卫生服务能力与诊疗水平。人才资源下沉为基层打造高素质队伍医改启动以后,山西省重新对县乡医疗卫生机构和社区卫生服务机构的编制进行了核定,将编制向基层倾斜,县级公立医院的     

做好乡村医生培训与执业考核 加强乡村医生队伍建设

<正>乡村医生队伍自上世纪五十年代诞生以来,为保护农民健康发挥了积极作用。党的十六届六中全会在构建社会主义和谐社会的总体部署中提出了建立覆盖全体城乡居民的基本保健制度,为群众提供安全有效、方便、价廉的公共卫生和基本医疗服务的目标。在农村卫生服务体系中,村卫生室承担农村常见疾病的预防治疗、妇幼保健、健康教育、康复等工作,提供常见病、多发病的一般诊治和转诊任务。据统计,对常见病、多发病的门诊服务,半数以上农民首选在村卫生室就诊。因此,提高乡村卫生服务能力,适应农村居民基本卫生服务需求,是建立完善农村居民基本卫生保健服务体系的重要内容。但是,由于乡村医生自身知识与技术水平所限,延误诊断治疗、操作不规范导致医疗差错造成事故的事件时有发生。加强乡村医生培训,提高乡村医生的素质已成为当前完善农村卫生服务体系的重大课题。《乡村医生从业管理条例》对乡村医生培训、考核、注册的管理提出了明确要求,也为卫生行政部门对乡村医生培训与考核提供了法律依据。     

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.     

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.     

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.     

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.