国外社区医疗运行制度研究综述——城市社区医疗及其就诊问题系列研究（二）

通过有关国外社区医疗和社区卫生服务的研究文献,分析国外社区医疗与社区卫生服务的关系和国外社区医疗就诊制度的显著性特点,总结国外社区医疗运行制度的成功经验及其存在不足,为我国发展城市社区医疗服务和完善社区医疗就诊制度提供借鉴。     

城市医疗供给制度对社区医疗就诊的影响分析——城市社区医疗及其就诊问题系列研究

分析我国城市社区医疗供给制度包括社区首诊制和双向转诊制度、城市医疗服务体系和医疗服务供给制度的现状及其对社区医疗就诊的影响.指出严格执行社区首诊制和双向转诊制度,完善城市医疗服务体系和医疗服务供给制度是发展城市社区医疗服务,提高社区医疗就诊率,实现“小病在社区,大病到医院”的重要举措和关键所在.     

城市医疗救助制度的发展路径——基于发展型社会政策的视角

发展型社会政策注重社会投资,尤其是人力资本投资,注重对社会问题进行上游干预等,这些理念对医疗救助制度具有借鉴意义.文章在分析发展型社会政策的内涵及我国城市医疗救助制度基础上,提出在制度设计理念和政策操作两个层面来完善我国城市医疗救助制度.     

城市社区医疗机构功能定位及准入制度缺陷分析——城市社区医疗及其就诊问题系列研究

分析我国城市社区医疗机构的功能定位缺陷及其导致的准入制度不严、门槛过低,补偿机制不完善、人才培养机制不健全、培训制度难以落实等都影响患者对社区医疗的选择。提出完善社区医疗机构的功能定位和准入制度也是发展城市社区医疗服务,提高社区医疗就诊率,实现"小病在社区,大病进医院"的重要举措。     

美国Medicare支付互联网+医疗服务的政策分析与启示

互联网+医疗服务是我国“互联网+”战略在医疗健康领域的重要布局,也是医疗服务的重要发展方向。为促进我国互联网+医疗服务良好发展,完善基本医疗保险对互联网+医疗服务的支付政策,文章梳理并分析了美国Medicare关于互联网+医疗服务支付的地理条件、服务范围、支付方式与利益分配,并从准入和监管两方面提出了我国互联网+医疗服务的医保支付的完善策略。     

国外医疗保险制度发展与研究

医疗保险制度是当今世界不同社会制度国家普遍实行的一种医疗服务模式。世界各国医疗保险制度形式多样,不同的国家,其医疗保险模式亦有所不同。该文从医疗保险制度实施、改革与发展,对国外医疗保险制度及主要模式进行了分析、比较和研究,以期对我国医疗改革和医疗保险制度的建立和完善提供有益的借鉴。     

部分发达国家上门医疗服务模式分析及对我国的启示

随着我国老龄化的加剧,上门医疗服务模式存在的问题日益凸显,如工作人员配备不足、风险高和法律政策不完善等。以典型地区美国、日本和英国为例,探究在家庭医生制度模式下上门医疗服务如何运行,对我国家庭医生的上门医疗服务发展具有一定启示。     

发展集团化医院的实践与体会

一、组建医疗集团的必要性与意义 当前,我国医疗市场及医院投资来源的多元化正在成为不争的事实。入世后,国外资本逐步渗入中国市场,也使国外雄厚的投资实力以及先进的管理模式进入中国医疗市场成为可能。人民群众在有更多选择机会、享受高质量的医疗服务的同时,也意味着医疗市场的争夺将更加激烈,国内医院的生存空间被进一步压缩。而另一方面,国内医疗市场仍不规范,国家的配套制度有待完善。在这种情况下,组建医疗集团,实     

医疗保险制度改革：现代医院的机遇与挑战

医疗保险制度的改革,是我国完善社会保障制度与国际发展接轨的一项重要举措.作为医保定点医院,我院承担着为广大参保病人提供优质的医疗服务和保证医疗保险基金安全有效使用的双重责任,医院的经营、管理、发展面临着机遇和挑战.如何服务好医保,促进医院的发展,是目前医保定点医院面临的新课题.     

实施分级医疗制度 确保医保基金安全高效运行

目前我国优质医疗资源过分集中,实施分级医疗制度能够均衡医疗资源、合理分流患者、节约医保基金支出。目前正是加大投资构建完善分级医疗的大好时机,在建设中需要合理布局、整合现有资源、吸收民间资本,加强基层医疗机构建设和人才培养,并完善首诊和转诊制度。     

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.