震灾伤员救治医务人员再次应对大地震的心理应激反应研究

目的分析震灾伤员救治医务人员再次应对大地震的心理应激反应,探索构建提高我国震灾救援医务人员心理应对能力的模式。方法汶川地震发生后,对医务人员进行及时的心理干预、灾害医疗护理培训等综合措施。采用方便抽样的方法抽取参与汶川及玉树两次震灾伤员救治的骨外科医务人员作为研究对象进行自身前后对照,采用症状自评量表(SCL-90),由心理咨询师采用统一、规范的指导语指导调查对象完成调查问卷,比较分析骨外科医务人员在汶川和玉树地震发生后1周的心理状况。结果同一震灾伤员救治医务人员在参与玉树与汶川地震救治1周后,其SCL-90的各因子均值、因子阳性项目数及心理问题发生率等存在显著差异,其恐怖心理显著降低。结论能够增强医务人员再次面对大地震的心理应对能力,对震灾伤员提供更有效的救援。     

北京市六类残疾人康复需求现状分析

目的 了解北京市残疾人的康复需求及服务现状.方法 采用统计描述和统计推理对北京市第二次残疾人抽样调查中确诊为六类残疾4852名残疾人的康复需求数据进行分析,据此推测北京市总体康复需求现状.结果 城市残疾人的康复意识和康复需求均高于郊区残疾人,儿童对康复训练的需求最高占75.23%,老年人对辅助器具和与医疗服务的需求最高,分别是57.05%和66.86%;一级、二级残疾人以社区和家庭康复为主;三级、四级残疾人以机构康复为主.视力和肢体残疾人对机构康复的需求较大,分别为85.23%和59.91%;76.95%的智力残疾人有社区和家庭服务的需求;精神、视力和肢体残疾人的医疗服务需求较高,分别是92.80%、86.77%和68.24%;听力残疾人对辅助器具的需求高达83.09%;智力、言语和精神残疾人对康复训练与服务的需求分别是84.36%、77.42%和62.82%.除医疗服务外,残疾人对其他方面的需求与救助均较低.结论 残疾人的需求和曾接受服务之间有较大差距,应加强宣传,促使残疾人树立正确康复观.     

地震紧急医疗救援中存在的问题与对策

分析了汶川地震紧急医疗救援中在医疗救援队伍反应速度、医疗救援准备工作、卫生资源统筹协调、指挥机构职能发挥、志愿队伍救援能力等方面存在的问题,并提出相应的对策:争分夺秒,快速展开救援;救援医生要掌握全面的急救技能和全科知识;医疗救援要有重点、分阶段、有条不紊地展开;梯次配置医疗救援队伍,合理使用医疗资源;充分发挥医疗卫生指挥机构的职能作用;加大国家投入,提高全民防灾意识,提高国家应对各种灾难的能力.     

破坏性地震医疗救护应急预案制定要点

制定破坏性地震医疗救护应急预案对于减少因地震所造成的死亡伤残意义重大。要根据地震灾害的特点和各地的实际情况制定具体的、切实可行的预案。要抓住应急原则、应急组织、应急通讯、应急医疗队、应急装备、应急药品、应急血源、应急车辆、应急生活设施、应急强化训练、伤亡及疫情的统报、境外申请救援问题、伤员的分流转运与接收安置等要点制定预案。     

中国老年残疾人口康复服务利用现状及影响因素分析

目的：探索中国老年残疾人口康复服务利用现状及其影响因素。方法：使用第二次全国残疾人抽样调查数据。应用卡方检验分析老年群体间康复服务利用差异。应用多因素logistic回归模型分析老年残疾人口康复服务利用的影响因素。结果：老年残疾人口康复服务利用率(45.82%)远低于需求率(96.89%),各项康复服务均存在较大需求与利用缺口。罹患听力残疾、中轻度残疾(三、四级)、高龄(≥80)、离婚或丧偶对老年残疾人口利用康复服务有抑制作用;残疾类型为肢体残疾或精神残疾、男性、未婚、居住在城镇、有残疾人证、有社会保险、较高的受教育水平和户人均年收入对其服务利用有促进作用。不同因素在城乡间作用方向一致,作用程度存在差异。结论：中国老年残疾人口康复服务需求尚未得到较好满足。基本人口特征、家庭特征、社会环境支持、残疾状态均影响其康复服务利用。应落实残疾报告制度;统筹康复服务资源配置;开展老年群体的健康评估与跟踪;加快完善康复服务项目的医疗保障范畴,建立以功能恢复为导向的支付原则。     

对地震伤员康复治疗工作中存在问题的思考

通过对北京等8省市30家收治汶川地震伤员医院的康复治疗工作进行调研,总结分析了地震伤员康复治疗工作中存在的问题和面临的困难,提出目前要尽快制定康复评定原则、尽快出台伤员返川政策、明确政府各相关部门在此次伤员后期康复治疗工作中的职责、加强临床与康复治疗多专业和多部门协作的建议,以促进我国康复医学学科的建设和发展.     

Change in quality of life in the year following cardiac rehabilitation

The aim of the present study was to assess change in health-related quality of life (HRQoL) after cardiac rehabilitation in the usual care setting, and to determine predictors for change. In the Post Infarction Care Study, 2441 patients were consecutively included at admission to 18 inpatient cardiac rehabilitation centres following coronary events. HRQoL was assessed with the SF-36 questionnaire at baseline as well as 6 and 12 months after discharge. HRQoL improved significantly in patients after coronary artery bypass grafting (CABG) but not in patients after myocardial infarction. Significant baseline predictors for change of the SF-36 physical component summary (PCS) score were the exercise ECG result at admission (0.59 absolute change/10-watt increase; 95% CI: 0.39, 0.79), an income > or = 1750 euros (1.64; 95% CI: 0.35, 2.93), baseline PCS score (-0.63; 95% CI: -0.69, -0.57), and CABG as indication for admission (3.65; 95% CI: 2.27, 5.04). Significant predictors for change of the mental component summary (MCS) score were age (1.28/10-year increase; 95% CI: 0.62, 1.94), East Germany as area of residence (2.62; 95% CI: 1.32, 3.91), baseline MCS score (-0.58; 95% CI: -0.63, -0.52), and CABG as indication for admission (1.68; 95% CI: 0.36, 3.01). The identification of predictors of HRQoL in the present study may aid in the further development and evaluation of cardiac rehabilitation programmes.     

Seroprevalence of Neospora caninum Infection in Dairy Cattle in Tabriz,Northwest Iran

Background

The aim of this study was to determine the seroprevalence of antibody to Neospora caninum in healthy and aborted dairy cattle in Tabriz, capital of East-Azarbaijan in northwest of Iran.

Methods

In this cross-sectional study serum samples were collected from 266 healthy and aborted Holestein-Feriesisnc cows from September 2008 to August 2009. The sera were analyzed to detect of antibody against N. caninum using the commercially ELISA kit.

Results

Seroprevalence of antibody to N. caninum was 10.5% in Tabriz dairy cattle. Also the abortion rate in all cattle sampled was 33.6% but percentage of seropositive aborted cattle was 18.4%.

Conclusion

Neosporosis could be one of the possible causes of abortion in dairy cattle in Tabriz and regarding the distribution in dogs as definitive host for the parasite, further studies in dog and cattle are recommended.     

Mental health problems and disability pensions: trends and measures in a cross-national perspective

The article reports on a cross-border investigation into disability pension receipt due to mental health problems. The quantitative part comprised an analysis in how far disability benefit receipt due to mental health problems is similar with regard to size, trends, diagnostic patterns and risk groups across six countries (Belgium, Canada, Germany, the Netherlands, Sweden and Switzerland). The second part included a cross-border inventory of measures aiming at prevention, rehabilitation and “return to work measures” (RTW), focusing on sickness absence and disability due to mental health problems. Despite the generally rising trend in all countries (as to disability pension receipt due to mental health problems), there are considerable differences in the scope of the phenomenon. But in most countries the need is felt to act. The inventory of (new) policies that aim to affect this trend showed three categories of policies: early identification of vulnerable groups, work resumption measures and specific tools for social insurance administrators. For each category some examples of instruments developed or under consideration are given. It is concluded that good practices for dealing with work incapacity due to mental health problems are in the stage of development, whereas in some countries new work resumption approaches have been implemented, some giving greater responsibility to the employer and employee instead of medical authorities.     

Health education using microcomputers II: One year in the clinic

A personal computer system dedicated to health education was placed in the waiting area of a general medical clinic serving a low-income urban community in south-central Minneapolis. The five health lessons available on this system discuss smoking, weight control, exercise, alcohol consumption, and other health behaviors. The system was evaluated through two questions asked at the end of every lesson, a survey of clinic staff after 6 and 12 months of operation, and a survey of a sample of clinic patients at the end of the year trial. Over 1,600 uses were recorded during the first year of operation. The computer has proved to be a cost-effective method of health education acceptable to both patients and staff.     

Disability Management Practices in Ontario Health Care Workplaces

Background: Workplace disability management programs are important in managing injury and disability. Methods: A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces. Results: A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence. Conclusion: Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.     

5.12地震一周内都江堰市农村分散式供水的影响分析

目的通过分析5.12地震前后都江堰市农村分散供水饮水状况,了解地震对水质的影响,为建立地震等应急状况下饮用水安全评估提供一定依据。方法采取随机抽样的方法,对5.12地震都江堰市农村分散式供水饮用水进行现场调查、检测部分应急指标,检测结果与地震前进行比较。结果不纳入消毒剂余量指标评价地震前后农村分散式供水的总体水质合格率没有变化(χ2=3.62,P0.05),单项指标浑浊度地震前合格率均高于地震后(χ2值=16.61,P0.05)。结论 5.12地震对农村分散式供水的影响主要是浑浊度、臭和味、肉眼可见物等指标,地震等应急状况下首先应通过水质的色、浊、臭和味进行现场初筛,然后根据实际情况有针对性地进行现场水质卫生检测或实验室检测。     

The attitude of farmers to the New Rural Cooperative Medical Scheme in Northwest China one year after its introduction: a cross-sectional study

Aim

The implementation of the Chinese New Rural Cooperative Medical Scheme (NRCMS) spread fast since a county pilot trial in 2003. The purpose of this survey is to guide policy-makers on how to improve the current national NRCMS policy.

Subject and methods

Cross-sectional survey of 1,978 farmers in 50 villages in Huxian Shaanxi Province on their attitudes towards the NRCMS administered door-to-door in 2005.

Results

Most farmers hold a positive attitude towards the NRCMS. However, they do not trust the scheme management. Farmers place more trust in village doctors rather than village cadres for fund collection. More than two thirds of farmers seek care in county hospitals directly, bypassing village clinics and township hospitals. Not all hospitals and doctors fully comply with the NRCMS rules, and supplier-induced demand is still widespread. More than half of farmers worry that the NRCMS is not sustainable. Importantly, the survey showed a high enrolment rate of 92% (95% CI, 91; 93) in a voluntary insurance scheme.

Conclusion

A number of remedial actions in health financing, planning and management to counteract the identified issues are proposed.     

控烟条例实施1年对北京市15岁及以上人群烟草使用的影响

目的 监测北京市≥15岁人群吸烟及戒烟状况,评价《北京市控制吸烟条例》实施效果。方法 2014年和2016年参照全球成年人烟草调查的原则和方法,采用多阶段整群概率抽样法从北京市324个街道/乡镇中抽取50个,再从每个街道/乡镇抽取2个居/村委会,共计100个监测点;以简单随机抽样法在每个监测点抽取100个家庭户;用掌上电脑从所有满足条件的家庭成员中以简单随机抽样法自动抽取1名≥15岁的家庭成员作为调查对象。以入户调查形式获得数据。用SPSS 20.0软件的复杂抽样数据分析模块,以基本权重、未应答权重和后分层校正调整权重的乘积进行加权,计算现在吸烟率、每日吸烟率、戒烟率等指标,并估算可信区间。结果 2014年和2016年分别获得有效个人问卷8 484份和9 372份,总体应答率分别为86.5%和96.5%。2014年北京市≥15岁人群现在吸烟率为23.4%,2016年为22.3%,按照北京市第六次人口普查数据,现在吸烟者的数量减少了19.9万人。每日吸烟者比例由2014年的20.7%下降到2016年的19.2%。现在吸烟者的日平均吸烟量由2014年的14.6支上升为2016年的15.4支。戒烟率由14.9%上升为16.8%。现在吸烟者在过去12个月中至少尝试一次戒烟的比例由2014年的22.3%上升为2016年的23.2%。现在吸烟者有戒烟意愿的比例由2014年的11.6%上升为2016年的15.5%。过去12个月看过医生的吸烟者中,收到医生戒烟建议的比例2014年和2016年分别为58.9%和59.2%。2016年人群中过去12个月内尝试过戒烟的现在吸烟者中戒烟门诊和戒烟热线的知晓率分别为36.8%和29.5%,7.7%的知晓者去过戒烟门诊,5.5%的知晓者使用过戒烟热线。结论 《北京市控制吸烟条例》实施1年≥15岁人群现在吸烟率下降。下一步应加大戒烟服务宣传,提高现在吸烟者对戒烟服务的知晓,促进其寻求戒烟服务。     

Sleeve gastrectomy vs gastric bypass in improvement of depressive symptoms following one year from bariatric surgery,Tehran Obesity Treatment Study (TOTS)

BackgroundThe Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain.MethodThe study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery.ResultsMean age of the patients was 38.7 ± 10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ± 6.0 kg/m². One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0–9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10–18), moderate (19–29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ± 10.5 vs 11.1 ± 9.6, and for the SG group 16.1 ± 10.2 vs 9.6 ± 8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (−6.04 ± 10.6 vs −6.4 ± 9.5, P = 0.149).ConclusionBariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.     

2008年汶川大地震后双流县饮用水卫生状况调查

[目的]了解2008年汶川大地震后双流县饮用水的卫生状况,以便提出相应的应对措施,为今后处理类似突发事件提供参考。[方法]对双流县集中式供水、农村分散式供水和灾民安置点的饮用水进行卫生学调查,采集集中式供水的出厂水、管网水,部分农村分散式供水的井水进行水质检测,并与地震前和地震恢复期的水质检测结果比较。[结果]地震后,双流县集中式供水系统受到不同程度的损坏,分散式供水设施被破坏,部分水质恶化。集中式供水的管网水、出厂水与农村分散式供水的井水合格率,震后初期分别为91.30%、81.16%、44.56%,地震前分别为95.12%、75.00%、49.18%(P0.05);震后恢复期分别为92.44%、81.82%、51.06%,与地震前无明显变化(P0.05)。水质不合格项目主要是总大肠菌群、菌落总数、耐热大肠菌群、色度、浑浊度、铁、锰、余氯,合格率分别为87.37%、90.78%、93.40%、98.86%、96.36%、93.75%、98.61%、96.93%。[结论]汶川大地震后双流县饮用水水质变化不大。     

地震后在帐篷内救治脾破裂患者的临床方法分析

目的探讨在地震后的紧急情况下，在简易的帐篷内，救治外伤性脾破裂患者的治疗方法。方法迅速采取措施，加强组织领导，严格遵守医疗规范和常规，严格手术指征，及时地对患者进行心理辅导，因地制宜地进行病房内消毒和医疗废物管理。结果57例患者中有2例在2年随访期间发生并发症，且该并发症仅有术后发热，其余患者均痊愈出院。结论在地震后的紧急情况下，在简易的帐篷内，严格遵守医疗规范和常规，能够显著降低外伤性脾破裂术后的并发症。     

汶川"5·12"大地震后受灾人群急性应激障碍的调查

应激障碍是一组主要由心理、社会因素引起的异常心理反应而导致的精神障碍,主要包括急性应激障碍(acute stressdisorder)和创伤后应激障碍(posttraumatic stress disorder).     

青川县部分地震灾区群体性预防接种工作评估

目的评价四川省青川县部分地震灾区灾后群体性预防接种工作情况。方法通过对接种现场的督导,对接种率进行调查。结果接种现场基本符合要求,乙脑疫苗调查接种率为81.3%,甲肝疫苗调查接种率为89.2%。结论乙脑疫苗及甲肝疫苗接种率均>80%,可形成有效的免疫屏障;受地震灾害的影响,两种疫苗群体性预防接种率均低于有常规免疫接种史的比例。