社区肢残人辅助器具使用全科医学照顾干预效果分析

目的了解社区肢残人辅助器具需求及使用状况,并对全科医学照顾干预作效果分析。方法全科医生采用入户面访对调查对象进行前后二次问卷调查,问卷调查内容包括：一般的人口学资料、残疾程度及生活自理能力、辅助用品使用情况等相关内容并对全科医学照顾干预前后二次数据进行卡方检验及相关资料分析。结果全科医学照顾干预后比干预前肢体残疾人士使用辅助器具上升了9．68个百分点,使用辅助器具局部症状改善或治愈以及跌倒人数干预前后有统计意义（P〈0．01）,肢体残疾人生活自理能力干预前后对照有统计意义（P〈0．05）。结论适合个性化的肢残人士器具使用服务提升了残疾人“人人享有康复服务”社区卫生服务平台,提高肢残人士器具使用率和干预评估是提高肢残人士生活自理能力的有效措施。     

新疆独山子石化医院医护人员心理健康状况调查

目的调查医护人员的心理健康状况,探讨相应对策,以期达到提高医护人员心理健康水平。方法采用国际通用的SCL-90症状自评量表、生活满意度量表,对新疆独石化医院临床213名医护人员进行问卷调查。结果该院医护人员SCL-90测试阳性构成比为57.4%。生活满意度:一般的为52.33%,满意的为43.52%,不满意的为4.14%。结论针对调查结果,应制定相对应措施,帮助他们提高心理调适能力,减轻和消除心理压力,从而提高医疗护理质量。     

Lessons Learned: Medical and Health Care Management for Emergency Workers at the TEPCO Fukushima Daiichi APP Accident

During the emergency work at the Fukushima Daiichi Atomic Power Plant (APP), the Tokyo Electric Power Company (TEPCO) and the Japanese government experienced various problems in medical and health care management issues, including special medical examinations, on-site triage and initial treatment, patient transportation, lodging and food, and long-term health care for emergency workers. To resolve these problems, the Ministry of Health, Labor and Welfare (MHLW) issued a series of compulsory directives and provided administrative guidance to TEPCO. Based on the experiences and lessons learned, the MHLW recognized that the proper management and implementation of medical and health care management in response to a similar accident would require sufficient measures and systematic preparation, including the following:

1. In case of large-scale nuclear accidents, the government needs to assist in dispatching medical staff to the affected plants.

2. Nuclear facility operators, medical facilities and fire departments should make an agreement to clarify the division of the roles played prior to the accident and should conduct emergency drills periodically with the full attendance of related personnel to identify and resolve the problems.

3. Operators need to develop a support base at a safe distance from the plant and to prepare to develop makeshift lodgings in case of emergency.

4. Operators need to come to an agreement to share food stocks among closely located nuclear plants and prepare cooking equipment that can be used in case of blackout to provide warm foods and drinks to as many workers as possible.

5. It is necessary to conduct long-term follow-up for emergency workers, including health care system, medical examinations and mental health consultations.     

Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India

Background:

Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI).

Objective:

To study prevalence and response to needle stick injuries among health care workers.

Materials and Methods:

Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test.

Results:

A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury.

Conclusions:

The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.     

陕西省大荔县农村残疾人心理健康评估调查分析

[目的]了解目前农村残疾人的心理健康状况,为未来残疾人心理卫生服务工作提供参考依据. [方法]采用整群抽样方法,抽取4个村的残疾人260名(精神残疾和智力残疾除外),使用症状自评量表(Symptom Check List-90,SCL-90)进行问卷调查. [结果]大荔县残疾人SCL-90量表的9项因子平均分为1.73～2.19.各因子分≥2的检出率在38.6％～56.6％,前5位检出率为56.6％～51.4％,分别是强迫症状、抑郁、精神病性、躯体化、人际关系.男性和女性残疾人的因子得分在人际关系、抑郁、焦虑、恐怖方面的差异有统计学意义,均为女性表现更明显. [结论]当地农村残疾人普遍存在心理问题,社会应予高度重视,需要帮助残疾人改善心理健康状况,提高生活质量和沟通能力.     

The Medical Skills Centre at the University of Calgary Medical School

The aim of the Medical Skills Centre at the University of Calgary is to provide a predictable learning environment and standardized teaching methods in the area of clinical skills teaching. The centre uses volunteer patients and trained actors for all levels of medical education and evaluation. A computer database enables easy access to groups of patients and varying medical issues. This article describes the organization and operation of the Medical Skills Centre and notes a variety of courses which use the unique facilities of the centre.     

城市失能老人口腔保健意识和行为现况调查

目的了解城市失能老人的口腔保健意识和行为现状,为开展失能老人口腔健康教育提供依据。方法采用自制调查问卷对杭州市拱墅区两个街道的全部95名失能老人的口腔保健意识和行为现状进行调查和统计分析。结果 10.53%的失能老人表示需要口腔保健知识,5.26%的失能老人定期检查牙齿,24.21%的失能老人知道牙齿疾患不良后果,70.53%的失能老人每天刷牙,18.95%的失能老人自觉口腔不适,以上各项男女老人差异无统计学意义(P>0.05);30.53%的失能老人表示有口腔不适将会就诊,男性失能老人就诊意愿更高,男女差异有统计学意义(P<0.05)。结论城市失能老人口腔保健意识较为欠缺,口腔保健行为不良,应加强对城市失能老人的口腔健康教育,提高口腔保健意识。     

Acknowledging the extra care parents give their disabled children

Around 150,000 families in the UK care for a severely disabled child under the age of 16. Many of these families receive assistance from the Family Fund Trust, which provides grants and information relating to the care of a severely disabled child. The aim of this study was to identify patterns of extra care needs among severely disabled children known to the Trust. Extra care needs are requirements for care not experienced by similarly aged non-disabled children. The research comprised analysis of 40,000 records from the Trust database and qualitative exploration of the extra care needs of disabled children with parents and Trust staff. Although all children require parenting, the care parents give disabled children generally exceeds that given to a non-disabled child. Quantitative analysis showed that the majority of children in the sample required extra assistance or supervision with multiple areas of daily life. With each of five activities (washing, dressing, meal times, during the night and keeping occupied), >70% of children needed extra help and, on average, each child needed extra help or supervision in six areas of daily life. Cluster analysis indicated distinctive combinations of extra care needs. Qualitative material indicated variety in extra care tasks undertaken (physical help, supervision, guidance) and causal factors (physical limitations, cognitive difficulties, behavioural problems). The findings confirm that severely disabled children have considerable extra care needs in many areas of daily life. Parents want professionals to recognize and offer explicit acknowledgement of the extra care they give their disabled children.     

怀化市171名医用放射作业人员健康状况分析

目的了解怀化市医用放射作业人员的健康状况,为放射防护工作提供依据。方法整理2007年度以来怀化市疾病预防控制中心进行职业健康检查的医用放射作业人员的健康档案资料,用SPSS11.5 for windows软件进行数据统计分析。结果心电图、腹部B超、肝功能、外周血象、血压、X线胸片异常检出率分别为22.81%、20.47%、12.28%、11.11%、8.19%、2.92%。结论该市医用放射作业人员总体健康状况较好,但心电图异常率较高,提示不仅要做好职业放射防护工作,还要做好心血管疾病的防治工作。     

医院工作人员SARS感染的原因及预防对策

目的 探讨医院工作人员在收治严重急性呼吸综合征(SARS)过程中受到感染的原因及预防对策，以减少医院感染的发生。方法 对我院从2003年2～4月约3个月收治SARS过程中受到感染的医院工作人员的临床特征及感染的原因及在此过程中所不断完善的预防对策做一回顾性分析。结果 我院感染SARS19名工作人员中11名护士、8名医生，通过近距离接触患者或接触患者的呼吸道分泌物等途径传播，在收治过程中，通过不断完善消毒隔离及个人防护措施、加强宣传教育，医院感染得到有效控制。结论完善医院感染管理监督机制、强调个人防护是减少SARS医院感染的关键。     

商丘市医务人员工作场所暴力与工作能力的相关分析

目的探讨医务人员遭受工作场所暴力和工作能力之间的关系,为预防工作场所暴力的发生、提高工作能力提供依据。方法采用工作场所暴力量表(WVS)和工作能力指数量表(WAI)对河南省商丘市507名医务人员遭受工作场所暴力的情况和工作能力进行了调查,并用自制表格调查所有研究对象的一般情况。结果30~44岁年龄组医务人员工作场所暴力得分高于45岁及45岁以上年龄组,护士组工作场所暴力得分高于医生和医技人员组(P<0·05);文化程度为初中及以下者工作能力得分比其他文化程度者低(P<0·05);遭受工作场所暴力与工作能力呈负相关,相关系数为-0·250(P<0·01);多因素分析表明,在控制了其它因素后,遭受工作场所暴力是工作能力下降的危险因素,其OR值为8·44。结论遭受工作场所暴力对医务人员的工作能力有影响,应采取措施预防和控制工作场所暴力的发生。     

黄浦区医务人员吸烟状况与戒烟服务情况的调查

目的了解黄浦区医疗卫生单位医务人员的吸烟现况及向病人提供戒烟服务的情况。方法对本区申报参加上海市无烟医疗卫生的单位,以问卷的方式进行调查。结果黄浦区医务人员的吸烟率为13.7%;96.0%的医务人员知晓本单位开展无烟医疗机构,95.5%的医务人员赞同创建无烟医疗机构;10.7%的病人主动寻求医务人员提供戒烟帮助,35.4%的医务人员主动向病人提供戒烟服务;14.1%的医务人员曾经得到过戒烟方法与技巧的培训,43.7%的医务人员打算学习戒烟的方法与技巧。吸烟者与非吸烟者在支持创建无烟医疗机构、提供戒烟服务的态度上存在差别。结论创建无烟医疗卫生机构应做好吸烟医务人员的戒烟工作;医务人员对病人提供戒烟服务的意识和能力均有待提高。     

大连市医用X射线工作者健康状况动态观察

目的为了保障放射工作人员的健康,观察长期接触小剂量照射对放射工作人员的影响,为职业病诊断提供基础资料。方法应用前瞻性流行病学研究方法,对大连市从事医用X射线工作人员进行4年的观察研究分析内在变化及影响因素,同时选取非接触射线的人群进行对照。结果医用X射线工作人员神经衰弱综合征、手部损伤发生率、眼晶体混浊、及外周血象、微核异常率及染色体畸变率等指标明显高于对照组,经统计学分析,差异有统计学意义。结论长期小剂量电离辐射对放射工作人员健康具有一定的影响,加强放射防护工作,定期健康监护,贯彻职业病防治法对保证放射工作人员健康与安全尤为重要。     

医务人员鼻前庭机会致病菌携带的调查

目的了解重症监护病房（ICU）医务人员鼻前庭带菌情况,以加强ICU医务人员医院感染的预防与控制。方法采用常规方法对ICU工作的93名医务人员和对照组的98名医务人员的鼻前庭拭子进行培养和菌种鉴定。结果从191名医务人员的鼻拭子中分离到214株机会致病菌,其中金黄色葡萄球菌8株,携带率4.19%,均为甲氧西林敏感金黄色葡萄球菌（MSSA）,凝固酶阴性葡萄球菌131株,携带率93.71%,主要是表皮葡萄球菌和溶血葡萄球菌,其中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占50.3%,革兰阴性杆菌27株,携带率14.14%,主要是肺炎克雷伯菌和阴沟肠杆菌,未发现产超广谱β-内酰胺酶（ESBLs）细菌;ICU医务人员鼻前庭金黄色葡萄球菌携带率（6.5%）、MRCNS的携带率（60.2%）、革兰阴性杆菌的携带率（26.9%）均明显高于普通科室（P〈0.05）。结论医院内医务人员间鼻前庭机会致病菌携带率较高,不同科室医务人员之间的机会致病菌的携带存在明显差异,应加强医院医务人员自身感染的预防与控制,特别是长期在ICU工作的医务人员。     

医护人员对预防保健科的认知情况调查研究

目的了解医护人员对医疗机构内预防保健科的认知情况,为预防保健科的发展提供更加合理的政策建议。方法采用不完全随机抽样的方法,在省市级和县区级医院中各抽取4～6家综合医疗机构。对被选定医疗机构的预防保健科所有工作人员的基本情况进行调查。在内科、外科、妇产科、儿科随机抽取10名医护人员作为调查对象。结果在所调查的医护人员中,95.1%的人认为保健科在疾病控制、甚至传染病控制中起作用,60.5%的人认为预防保健科是公共卫生管理科室,86.4%的人对预防保健科工作比较满意,87.7%的人关注预防保健科的发展,63.3%的人认为预防保健科的现状能适应目前工作,预防保健科需要改革(75.9%)。同时建议加强对预防保健科工作的宣传;改善办公条件;提高人员业务素质,提高人员待遇;加强与一线科室的联系;增加保健科的人员;加强预防宣传教育工作,政府承担经费等方面。结论要加强预防保健科人员与医护人员的沟通,同时调整保健科工作人员数量和专业结构。     

流出地农村外出务工人员预防艾滋病健康教育综合干预效果评价

[目的]在流出地对农村外出务工人员预防艾滋病健康教育综合干预效果进行评价。[方法]采用社区干预试验方法,对干预地区实施参与式预防艾滋病健康教育综合干预措施。于干预前后,对干预地区(干预组)和对照地区(对照组)采用问卷调查农村外出务工人员的艾滋病知识、态度,干预前、后分别调查1006人和1010人。[结果]干预后,干预组艾滋病相关知识知晓率由29.38%提高到55.72%,正确态度总持有率由43.38%提高到57.41%;与对照组比较明显提高(P<0.001)。[结论]参与式农村预防艾滋病健康教育综合干预在农村外出务工人员中是一种有效的工作模式。     

Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi,Kenya

ABSTRACT

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation.     

新冠疫情下基层医务工作者心理状况的调查与研究

目的:评估在疫情期间,基层医务人员的个人心理状况并对基层医务人员心理状况进行分析。方法:2020年2—4月以上海市浦东新区上钢社区卫生服务中心为调查点,选取30名参与疫情防控工作的医务人员为调查组,并以1∶2的比例选择未参加疫情防控的医务人员为对照组,以焦虑自评量表,斯坦福急性应激反应量表及匹兹堡睡眠量表为调查工具,调查比较医务人员的相关心理状况及心理状况产生的影响。结果:研究组在焦虑评分上高于对照组,且具有统计学意义。在应激反应上,无论是单方面还是总得分,研究组得分都高于对照组,且具有统计学意义;在睡眠质量上,研究组总得分也高于对照组,其中在睡眠障碍和日间功能障碍方面具有统计学意义,而其他方面无统计学意义。结论:通过本次调查,我们发现在疫情情况下,参与疫情防控的基层医务人员更易产生焦虑,且更易产生应激反应,同时其睡眠状况较差。     

The Ambulatory Integration of the Medical and Social (AIMS) model: A retrospective evaluation

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.