Factors associated with back problems among emergency medical technicians

INTRODUCTION: Back problems are a common complaint among emergency medical technicians (EMTs). It is hypothesized that the likelihood of reporting back problems will be associated with the individual and work-related characteristics of a national sample of EMTs. METHODS: A case-control analysis was performed on 579 EMTs wherein cases were the 104 subjects who reported new back problems in 2004. Controls were 475 subjects who reported no back problems in 2003 and 2004. RESULTS: EMTs dissatisfied with their current assignment were significantly more likely to report back problems (OR = 9.33; 95% CI = 3.04-28.67), as were EMTs reporting good or fair fitness when compared to excellent fitness (OR = 3.39; 95% CI = 1.54-7.45, OR = 3.43; 95% CI = 1.37-8.56). CONCLUSIONS: Results from this analysis suggest that there are two modifiable factors associated with self-reported back problems among EMTs, satisfaction with current assignment and self-reported physical fitness.     

On the job illness and injury resulting in lost work time among a national cohort of emergency medical services professionals

BACKGROUND: The objective of this study was to estimate the prevalence and incidence of job-related illness or injury resulting in lost work time among a national cohort of Emergency Medical Services (EMS) professionals. Also, it was hypothesized that individual and work life characteristics were associated with the occurrence of illnesses or injury. METHODS: Data for this analysis were obtained from the Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS), a prospective study of EMS professionals. The outcome variable of interest was self-reported absence from their EMS job due to an EMS work related illness or injury. The prevalence and incidence of injury with lost work time was estimated using cross-sectional and follow-up data. Multivariable logistic regression analyses were performed to determine if individual and work life characteristics were associated with occupational injury. RESULTS: The prevalence of job-related illness or injury with time away from work was estimated at 9.4%, while the 1-year incidence was estimated at 8.1 per 100 EMS providers. The results from the logistic regression model fit to follow-up data indicate that increasing call volume (OR=3.12 for very high vs. moderate, 95% CI 1.40-6.97), an urban work environment (OR=2.79, 95% CI 1.65-4.72) and a history of back problems (OR=1.72, 95% CI 1.06-2.78) were associated with reporting job-related illness or injury. CONCLUSIONS: Results from this analysis provide estimates of the prevalence and incidence of on the job illness and injury resulting in lost work time among a national cohort of EMS professionals.     

卫生应急人员对突发事件风险评估的认知分析

目的 :了解我国卫生应急人员对突发公共卫生事件风险评估的认知状况,从文化程度、职称情况、单位性质、单位级别等方面进行比较,为提高卫生应急人员风险评估的认识和能力提供依据。方法 :采用问卷调查的方法,对全国(大陆地区)31个省(自治区、直辖市)承担突发公共卫生事件应急处置的卫生应急工作人员进行调查。采用描述性分析和χ2检验对调查数据进行分析。结果 :我国卫生应急人员对风险评估概念熟悉程度较低,且不同学历、不同职称、不同工作年限、不同机构、不同层级之间的认知存在一定差异;对风险评估工作内容的认知也存在分歧。结论 :应加强风险评估培训,健全风险评估制度,以全面提高卫生应急人员对风险评估的认知水平。     

从医务人员新型冠状病毒感染思考医疗机构的职业卫生工作

在COVID-19流行期间,医务人员受到新型冠状病毒的影响,让人们再次反思医疗机构的职业防护问题。就医疗机构在紧急（异常）状态下启动职业防护、识别“异常”状态、针对可能的“异常”采取必需的应急准备、个人防护用品的最适化、职业卫生工作常态化以及多学科的融合等话题进行了讨论,期望引起重视整合,推动医疗机构的职业卫生工作。提出政府和职业卫生专业机构要在指导、帮助医疗机构做好相关工作方面发挥重要作用。     

北京市亚运村社区居民医疗卫生服务利用分析

目的了解北京市亚运村社区居民医疗卫生服务利用情况。方法分别于2004和2005年选择自2000年起居住在亚运村社区常住居民600户,选取15周岁以上1 765人,作为队列研究基线人群,使用自行设计的《北京市典型社区居民调查表》,了解居民卫生服务利用情况;分别于2006、2007年采用相同问卷进行随访调查。结果基线调查、2006和2007年随访调查结果显示,过去1个月内,有病未就诊比例分别为36.44%,31.46%和25.70%,差异有统计学意义(P<0.05)。未就诊原因的前3位分别为自感病轻、医疗费用太高、自我医疗。2次随访调查结果表明,该社区居民经常就诊机构均为社区卫生服务中心(站)。2007年随访结果显示,选择医院就诊原因的前3位分别为离家近方便占61.62%,可以报销医疗费占58.33%,医疗技术和设备好占21.13%;基线调查、2006和2007年随访结果显示,医疗费用包括药费、治疗费、检查费等均呈不断下降趋势,差异均有统计学意义(P<0.05)。结论在北京市社区医疗卫生服务全面推广中,社区居民的医疗卫生服务利用和满意度均有一定程度提高,但需继续巩固。     

急诊室医护人员心理健康状况及干预效果评价

目的 了解综合医院急诊室医护人员的心理健康状况,并探索心理干预的方法和结果,为建立针对性的心理干预措施提供科学依据.方法 对辽宁省沈阳市6所综合医院急诊室医护人员进行症状自评量表(SCL-90)测评,筛选出209人测评结果超出全国常模组;将其随机分为2组,干预组108人,对照组101人.对干预组进行心理干预治疗.在干预3,6,12个月时分别进行症状自评量表(SCL-90)的双盲评估.结果 急诊室医护人员SCL-90测评结果中躯体化、强迫、人际敏感、焦虑、敌对、恐怖、偏执和精神病性8项因子分均高于全国成人常模(P<0.05).女性较男性症状明显,护士较医生明显.干预组通过综合心理干预治疗,随访期间SCL-90总分值呈逐步下降趋势,结束时达(130.69±39.09),趋于正常水平.对照组随访前后各项数值变化不大,结束时为(134.96±39.31),仍明显高于常人,2组干预后差异有统计学意义(P<0.05).结论 急诊室紧张的工作特点和工作环境使医护人员形成较大精神压力,易引发心理问题.有针对性的进行心理干预,可提高医护人员心理健康水平.     

Prevalence of burnout among public health nurses in charge of mental health services and emergency care systems in Japan

Objectives The Community Health Act came into effect in 1997 in Japan. This act altered the work system for public health nurses (PHNs) in public health centers (PHCs) nationwide from region-specific to service-specific work. Such major changes to working environment in the new system seem to be exposing PHNs to various types of stress. The present study examined whether prevalence of burnout is higher among PHNs in charge of mental health services (psychiatric PHNs) than among PHNs in charge of other services (non-psychiatric PHNs), and whether attributes of emergency mental health care systems in communities are associated with increased prevalence of burnout. Methods A questionnaire including the Pines burnout scale for measuring burnout was mailed to 525 psychiatric PHNs and 525 non-psychiatric PHNs. The 785 respondents included in the final analysis comprised 396 psychiatric PHNs and 389 non-psychiatric PHNs. Results Prevalence of burnout was significantly higher for psychiatric PHNs (59.2%) than for non-psychiatric PHNs (51.5%). When prevalence of burnout in each group was analyzed in relation to question responses regarding emergency service and patient referral systems, prevalence of burnout for psychiatric PHNs displayed significant correlations to frequency of cases requiring overtime emergency services, difficulties referring patients, and a feeling of “restriction”. Conclusions Prevalence of burnout is high among psychiatric PHNs, and inadequate emergency mental health service systems contribute to burnout among these nurses. Countermeasures for preventing such burnout should be taken as soon as possible.     

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow‐ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow‐up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow‐up recommendations. This model allowed us to disentangle follow‐up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take‐up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed.     

Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry

The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces.     

浙江省突发公共卫生事件网络报告质量评价

  目的  评价天津市医疗机构卫生应急能力,揭示医疗机构各项应急能力的内在联系,为有效推动天津市卫生应急能力建设工作提供参考依据。  方法  于2015年10月 — 2016年2月采用普查方法对天津市89家二级及以上医疗机构相关工作人员进行问卷调查,并采用因子分析法进行建模,评价天津市医疗机构卫生应急能力。  结果  天津市医疗机构120院前急救、发热门诊情况、肠道门诊情况、传染病救治能力、医疗机构血液管理、实验室检验能力、卫生应急保障和储备、医院感染控制能力、疾病监测报告能力、卫生应急培训情况、公众宣传和媒体沟通管理11个卫生应急能力指标得分分别为（0.73 ± 0.81）、（4.64 ± 4.48）、（4.74 ± 4.26）、（0.35 ± 0.48）、（2.04 ± 1.20）、（3.11 ± 1.90）、（3.17 ± 1.79）、（10.70 ± 1.72）、（1.52 ± 0.53）、（7.48 ± 3.44）、（1.22 ± 1.19）分;因子分析结果显示,11个卫生应急能力指标可归为基础准备因子（5个指标）、临床治疗因子（3个指标）、应急意识因子（3个指标）3个因子,累计方差贡献率为61.910%;综合评价模型为综合能力得分 = 0.668 × 基础准备因子得分 + 0.172 × 临床治疗因子得分 + 0.159 × 应急意识因子得分;基础准备因子的权重最大（0.668）,其次依次为临床治疗因子（0.172）和应急意识因子（0.159）;天津市89家二级及以上医疗机构中,卫生应急能力较强的22家（24.72 %）,卫生应急能力处于中等水平的45家（50.56 %）,卫生应急能力较弱的22家（24.72 %）。  结论  基础准备因子在天津市医疗机构卫生应急能力中占有重要地位;天津市卫生应急能力处于中等水平的医疗机构较多。     

我国公共卫生与医疗服务融合现状及对策

  目的  了解广东省广州市基本医疗和基本公共卫生融合情况,为进一步推进广州市医防融合提供科学依据。  方法  于2019年12月 — 2020年1月采用便利抽样方法抽取广州市11个区开展国家基本公共卫生服务项目工作的7416名基层医疗卫生机构医务人员进行网络问卷调查。  结果  广州市最终有效调查的7305名基层医务人员中,1148人（15.72 %）仅从事基本医疗,2713人（37.14 %）仅从事基本公共卫生,3444人（47.15 %）存在基本医疗和基本公共卫生融合。3444名基本医疗和基本公共卫生融合人员中,融合1项者541人（15.71 %）,融合2～4项者1164人（33.80 %）,融合5～7项者1012人（29.38 %）,融合 ≥ 8项者727人（21.11 %）;居于基本医疗和基本公共卫生融合前3位的国家基本公共卫生服务项目依次为健康教育2522人(73.23 %)、居民健康档案管理2428人(70.50 %)和高血压患者健康管理2201人(63.91 %)。广州市不同特征基层医务人员比较,不同辖区、性别、职业、医疗机构类别和是否全科医师的基层医务人员基本医疗和基本公共卫生融合情况差异均有统计学意义（均P < 0.001）,其中非中心城区融合高于中心城区,男性融合高于女性,职业以临床医师融合最高、公卫医师融合最低,医疗机构类别以村卫生室融合最高、社区卫生服务站融合最低,全科医师融合高于非全科医师。  结论  广州市基本医疗和基本公共卫生融合较好的国家基本公共卫生服务项目为健康教育、居民健康档案管理和高血压患者健康管理,但应重视在中心城区、女性、公卫医师、社区卫生服务站和非全科医师中的融合。     

Quality management of occupational health services: The necessity of a powerful medical profession

Over the past few years there has been a growing interest inquality management in occupational health services. In thisarticle the central role of the medical profession in this areais highlighted from a personal point of view. It is argued thata powerful and active profession is needed as a countervailingpower in the field of tension between employees and the company,and for balancing the interests of these two main clients. Therefore,the medical profession should develop a policy on quality andapply quality management on national and local levels to reacha high professional level. In this way the profession can maintainthe clinical autonomy that is necessary to be a countervailingpower. Elements of such quality management are national guidelines,local peer review and intercolleagual visitation. These activitiesmust be incorporated in the quality management of the occupationalhealth services unit.