德尔菲专家咨询法在社区婴儿母乳喂养支持项目中的应用研究

目的 应用德尔菲专家咨询法制定社区0～1岁婴儿母乳喂养支持的内容。方法 根据研究内容初步制定社区母乳喂养干预内容109条，采用德尔菲专家咨询法对15位相关领域的专家进行两轮专家咨询，采用专家积极性、权威系数、专家意见的集中程度进行评价。结果 两轮专家咨询问卷的权威系数分别为0.87和0.89,经过两轮专家咨询，最终确定了社区母乳喂养干预核心条目21条，重要条目28条，包括母乳喂养知识和理念、喂养技能、辅食与营养、婴儿及母亲相关问题4个维度。结论 本研究确定的条目满足社区母婴保健服务的需要，可作为后续社区母乳喂养干预方案的基础。     

中学生学校心理环境评价指标体系的建立及问卷初步编制

建立适合我国国情的中学生学校心理环境指标体系并编制相应问卷,为评价学生心理健康状况并提出有效措施提供依据.方法 对有关学校心理环境的文献进行较全面的检索和分析,确定量表的理论框架,建立条目池;经专家论证、小样本的预调查,对条目进行修改,形成正式调查版本(64个条目)并对3 776名中学生进行调查;通过专家咨询、条目分析、因子分析法筛选条目,形成正式量表并进行信、效度检验.结果 通过德尔菲法专家咨询法,得到2轮专家咨询的各项系数均在0.75以上,表明该评价体系具有较高的可靠性和代表性.条目分析没有删除条目,因子分析删除4个条目,最终形成由60个条目组成的问卷;全量表的克伦巴赫系数为0.883,分半系数为0.765;各维度的克伦巴赫系数在0.748~0.883之间,分半信度在0.60~0.812之间,说明量表具有比较可靠的信度.结论 中学生学校心理环境量表的条目质量及信、效度符合心理测量学的基本要求.     

上海市长宁区社区卫生服务中心品牌建设评价指标体系研究

目的:构建适用于评价上海市长宁区社区卫生服务中心品牌建设的指标体系,促进社区卫生服务中心的品牌建设。方法:结合已有研究和国内相关政策文件,应用德尔菲法邀请28位专家开展两轮咨询。利用层次分析法和平均权重法分析专家评分,并筛选指标。结果:两轮专家咨询表有效回收率为100%,专家的权威程度为0.90,第2轮专家咨询结果的协调系数为0.205。建立的社区卫生服务中心品牌建设评价指标体系包括8个维度、19个一级指标和32个二级指标。结论:基于德尔菲法构建的社区卫生服务中心品牌建设评价指标体系具有一定科学性,但是在精简性和推广性方面还有待进一步完善。     

基于德尔菲法的医院感染防控能力评估体系初探

目的 用德尔菲法建立医院感染防控能力评估体系,并评估其在宜宾市6所不同等级医院的应用.方法 采用德尔菲专家咨询法经过2轮咨询筛选出13个评价指标,建立线性回归模型,并通过问卷调查和实地考察2种方式获取宜宾市6所医院的指标值,导入评估模型评价医院感染防控能力.结果 ①28名咨询专家完成2轮咨询,应答率93.3％,专家自评...     

重大活动食品安全风险量化评价指标的研究

目的构建快速评价重大活动接待单位食品安全风险量化评价指标体系。方法采用德尔菲专家咨询法进行咨询,确定评价指标、关键项目、权重等。结果建立了重大活动食品安全风险量化评价指标体系,确定了关键项目12个,建立了评价模型。结论专家意见的协调性可信度高,用德尔菲法确定的重大活动食品安全风险量化评价指标体系结果可靠。     

眼外伤检伤分类评价指标体系的构建

构建眼外伤检伤分类评价指标体系,为眼部创伤急救的快速评估提供标准、量化的依据。方法 本研究在文献研究、临床病历资料查阅及半结构访谈的基础上,建立眼外伤检伤分类指标体系框架。采用德尔菲专家咨询法于2022年4—5月对来自北京、四川、重庆、河南、新疆等地23名眼外伤领域的医疗、护理专家进行2轮德尔菲专家咨询,确定眼外伤检伤分类指标的内容及各指标权重。结果 2轮专家咨询问卷回收率均为100%,专家权威系数分别为0.91和0.94,Cronbach′s α系数分别为0.90和0.86,肯德尔和谐系数分别为0.42和0.46。最终形成包括眼视力、开放性外伤、闭合性外伤、化学烧伤及热烧伤5个一级指标,36个二级指标,共41个条目的眼外伤检伤分类指标。结论 眼外伤检伤分类指标科学合理、专科性强,可为眼部创伤初期快速评估、分检及创伤分级提供参考依据。     

基于三维结构医疗机构主导的“互联网+护理服务”质量评价体系的构建

目的：基于三维结构医疗机构主导，构建“互联网+护理服务”质量评价体系。方法：以Donabedian提出的“结构-过程-结果”为理论框架，基于文献检索、半结构式访谈、田野研究初步构建质量评价指标条目池，通过两轮德尔菲专家咨询法确定评价指标体系。结果：两轮专家积极系数100%，权威系数为0.90，两轮专家咨询的肯德尔系数分别为0.283、0.266(P<0.05)，具有较高一致性，最终形成包含3个一级条目，11个二级条目，57个三级条目的“互联网+护理服务”质量评价体系。结论：基于三维结构医疗机构主导的“互联网+护理服务”质量评价体系内容合理，构建过程科学，可为我国医疗机构“互联网+护理服务”质量评价提供参考。     

育龄期妇女生殖健康素养评价指标体系的构建

目的构建我国育龄期妇女生殖健康素养评价指标体系。方法通过文献研究与专家会议得到三级体系框架,采用德尔菲专家咨询法筛选育龄期妇女生殖健康素养三级指标条目。结果 3轮德尔菲专家咨询有效回表率为100%,专家权威系数为0.85,专家协调系数达0.308、0.275、0.359。指标涉及卫生服务利用、疾病预防、健康促进3方面,以获取、理解、评价、应用4个维度来评价健康素养,最终得到48个三级指标。结论此次研究初步构建了育龄期妇女生殖健康素养评价指标体系,可用于个体妇女生殖健康素养水平的测量及妇女生殖健康干预项目的评估。     

护理人员工作量影响因素现状调查问卷的编制及信效度检验

目的编制护理人员工作量影响因素现状调查问卷,并进行信效度检验。方法采用文献回顾法、头脑风暴法、辩证分析法及半结构式访谈法拟定量表条目池。选取18名专家进行2轮德尔菲专家咨询形成初量表。选取335名护理人员对初量表进行预调查。专家咨询阶段条目筛选采用"界值法";预调查阶段采用项目分析、探索性因素分析、内容效度、相关性分析、内部一致性检验、分半信度、重测信度等对量表进行评价。结果初步形成的条目池包括57个条目,经德尔菲专家咨询形成50个条目,经项目分析、探索性因素分析后最终剩余30个条目。2轮函询专家权威系数分别为0.869、0.853,专家协调系数分别为0.218、0.570(P均0.01)。预调查阶段,探索性因子分析提取5个公因子,累积贡献率为60.389%,内容效度为0.855,Cronbach’sα系数为0.879,分半信度为0.924,重测信度为0.821。结论编制的问卷具有较高的权威性,信效度良好,可作为护理工作量影响因素的测量工具。     

基于德尔菲法和层次分析法构建部队官兵心理健康教育核心内容体系

目的利用德尔菲法和层次分析法构建武警部队官兵心理健康教育的核心内容体系。方法通过理论分析、文献回顾和专家访谈等方法构建部队心理健康教育内容初稿。运用2轮德尔菲专家咨询明确部队官兵心理健康教育核心内容的维度和条目,应用层次分析法统计分析核心内容维度层及条目层的权重。结果经历2轮德尔菲专家咨询,选入专家48名,2轮问卷有效回收率分别为100%与95.83%,专家权威系数0.90,专家协调系数检验P0.01,表明入选专家积极程度、权威程度及协调程度较高。2轮德尔菲专家咨询中专家共提出81条建议,研究小组采纳了72条。最终确定武警部队基层官兵的心理健康教育核心内容体系,包括3个维度9个条目33个专题。结论通过系统研究方法,初步研究构建较完备的、适用于武警部队官兵的心理健康教育核心内容体系。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.