北京市公共卫生医师规范化培训试行首届学员第一年培训情况调查研究

为了解北京市公共卫生医师规范化培训工作试行现况,以及为进一步推进规范化培训试行工作提供依据,采用定量资料分析、定性小组访谈及文献比较的方法,调查北京市公共卫生医师规范化培训试行首届学员第一年培训情况。结果显示:北京市公共卫生医师规范化培训试行工作对培养公卫医师具有积极作用,但其在组织管理、基地建设、师资培养、培训安排、考核评价、经费保证等均有待改进。北京市公共卫生医师规范化培训试行工作十分必要,但专业轮转培训时间安排要符合公共卫生实际工作的运行规律,加强专业轮转的出科考核,缩短培训周期,进一步提高培训效果,并为建立公共卫生医师规范化培训制度做好基础准备工作。     

北京市公共卫生医师规范化培训海淀区传染病基地的实践与探索

【摘要】随着我国规范化住院医师培训工作的完善和体系的建立,急需建立公共卫生医师规范化培训工作,更新原有的培养模式,改革人才培养体系,逐步建立起一套完整的公共卫生医师规范化预防人才培养体系。经过多年努力,北京市于2011年出台《北京市公共卫生医师规范化培训细则》,并开始进行规范化培训,海淀区疾病预防控制中心（CDC）作为规范化的传染病基地,通过第一批学员的学习,对培训规范、对象、时间、教材、课程、考试结果进行介绍和分析,对培训中存在的不足提出设想,使基地学员在专业基础知识、基本技能、沟通技巧、外语水平、职业道德等方面进行规范化的培训,加速培养出有一定水平的高质量的疾控人才。     

北京市公共卫生医师培训制度建立与执行情况调查

目的调查北京市市、区两级疾病预防控制中心(CDC)公共卫生医师相关培训制度,为进一步完善北京市公共卫生医师规范化培训试点工作提供依据。方法采用问卷调查方法,对北京市市、区两级19家CDC,以及2004～2010年期间预防医学专业不同学历毕业入职的327名公共卫生医师进行调查。结果 19家单位,公共卫生医师相关培训制度多由单位自行制定;各项制度的建立与执行存在不同程度的缺失与不足。结论北京市需要建立覆盖预防医学专业不同学历毕业的公共卫生医师规范化培训制度,并进行统一有效的组织管理。     

我国公共卫生医师规范化培训的现状

通过调研我国住院医师规范化培训体系的建立过程及培训取得的成效等基本情况,探讨开展公共卫生医师规范化培训的必要性,认为开展公共卫生医师规范化培训是符合医学人才培养规律,也是我国公共卫生事业发展的迫切需求。通过研究国外公共卫生人才培养和公共卫生医师规范化培训和分析国内公共卫生专业人才培养的具体情况,为我国试行启动公共卫生医师规范化培训工作提出了一系列建议,包括健全管理规章制度,健立组织管理体系;保证配套经费和薪酬待遇;基地遴选要切合疾病预防控制专业特点;加强师资力量建设;配套效果评价,坚持管办分离以及适时探讨与研究生教育衔接问题。     

上海市黄浦区公共卫生医师规范化培训的实践与探索

目的 :探索建立公共卫生医师规范化培训的方法和制度,为今后全面实施和推行公共卫生医师规范化培训提供经验。方法 :通过专家论证,明确培训目标、对象、课程设置、课时安排、考核方法、效果评估等。根据培训方案对黄浦区疾病预防中心30名学员开展公共卫生医师规范化培训。结果 :经过为期10个月的培训,所有学员均通过理论考试、技能考试及撰写研究报告或论文等综合手段的考评,通过率100.0%。77.0%以上的学员对各项课程的整体评价为"很好"。结论 :通过本次培训,学员充实和丰富了公共卫生专业的相关理论知识,提升了专业技能、服务技能和管理技能,同时积累了办学经验,可为全市开展公共卫生医师规范化培训提供借鉴。     

疾病预防控制管理者对公共卫生医师规范化培训态度及认知的调查研究

目的 了解疾病预防控制管理者对公共卫生医师规范化培训的态度及认知,为推动我国公共卫生医师规范化培训工作提供参考依据。方法 对314名省级和地市级的疾病预防控制管理者进行问卷调查。结果 调查对象对于开展公共卫生医师规范化培训,93.1%的认为有必要,90.8%的表示支持,92.6%的认为应由国家统一规定内容、形式、教材,81.3%的认为应由国家培训师资,73.2%的认为应由国家组织培训考核评估;培训内容认知排在前三位的是流行病学相关、卫生法律法规、行业标准和规范;有41.4%的调查对象认为新入职公共卫生专业人员达不到实际工作基本要求。结论 省市两级疾病预防控制管理者对开展公共卫生医师规范化培训形成普遍共识。培训工作应注重政策保障并先行试点,同时明确国家和地方职责和分工,建议在国家层面统一培训内容、形式、教材和组织师资培训,而考核评估等由国家总体部署和各地细化落实相结合,协调推进试点工作。     

疾病预防控制机构公共卫生医师规范化培训的内涵建设思考

规范化培训是医师,包括公共卫生医师成长的重要阶段,当前疾病预防控制机构公共卫生医师规范化培训正在进行试点,关于公共卫生医师的规范化培训应包含什么内容,以及如何进行培训,都在摸索和积累经验的过程中。文章就“规范化”为切入点,对公共卫生医师规范化培训中涉及的师资选择、教学内容、教学过程、教学主客体、教学条件、教学管理体系等内涵设计提出建议,旨在提供思路,以规范公共卫生医师规范化培训的建设。     

重视非卫生专业医学生的预防医学教学是医学教育中的重要战略措施

世界大多数国家的医学教育体系中,公共卫生专业是在医学临床教学之后作为高层次的(硕士、博士学位)教学内容而设置。我国在50年代初,为了适应卫生事业发展的需要,在6所医学院校中成立了公共卫生专业(现称预防医学专业)。随后各省市、自治区先后建立了这一专业。几十年来,众多的卫生专业毕业生在相应的卫生防疫保健机构中,为开展预防工作发挥了重要作用。但同时却相对地忽视了学生人数比卫生专业多10余倍的医学专业学生的公共卫生教学改革。因此,重视这一大批非预     

实施规范化住院医师培训的思考

住院医师规范化培训是指对从事临床医疗工作不久的医学院校毕业生进行规范化的、系统化的临床工作培训,使其成为符合工作岗位需求的医学专业人员.卫生部于1993年颁发了《临床住院医师规范化培训试行办法》后,促使我国住院医师培训制度基本建立,虽然取得了一定的成绩,但由于不同地区间、医院等级间、医院体制间存在差异,因而取得的成效也不尽相同.笔者就本院医师规范化培训的现状、存在的问题进行探讨.     

浙江省公共卫生医师规范化培训认知与需求分析

目的：了解浙江省公共卫生医师对其规范化培训的认知与需求情况,探讨基层公卫医师规范化培训必要性与可行性,为更好开展规范化培训提供科学依据。方法：选择整群抽样的方法,结合现场座谈和问卷调查对目标人群进行调查。结果：大多数调查对象认为公卫医师规范化培训重要且必要,但76.86%认为脱产参加公卫医师规范化培训困难很大或较大;培训对象：74.38%认为全部公共卫生医师不论学历都应该参加公卫医师规范化培训;培训期限：绝大多数认为无论本科还是硕士,以1年较为合适;培训内容：超过85.00%的调查对象认为传染病预防与控制、慢性病、健康教育、营养与食品卫生、环境卫生及职业卫生等16个专业需要和非常需要培训;福利保障：85.95%认为选派学员工资福利待遇应予以保障。结论：基层公卫医师脱产培训困难较大,需优化培训内容,灵活培训模式,避免增加基层公共卫生机构工学矛盾;同时增加培训投入,保障学员工资福利待遇,逐步建立并完善公共卫生医师培训体系。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.