医院改革——医改的关键环节

新医改方案要求政府财政增加投入,但是政府增加财政投入并不一定能完全解决"看病难、看病贵"问题。医院作为医疗服务主体,其自身还存在很多弊端,例如,医疗资源的布局问题,行业管理的规范问题,医疗服务效率和服务质量问题,社会资本的介入问题等,这些弊端将成为医改政策的瓶颈。针对这些问题提出个人的见解。     

实施企业医院社会化的实践与探讨

企业卫生机构是卫生资源的重要组成部分,在深化企业改革过程中,减轻企业办医院负担,逐步实现企业卫生机构社会化,已成为各级政府卫生行政部门必须认真研究和切实解决的问题。在充分调查我市企业医疗机构卫生资源现状的基础上,我们进行了企业医院社会化的实践,并取得初步成效。本文就分离企办医疗机构应遵循的基本原则、具体操作和存在的问题进行了总结和探讨。     

关于加强医院信息管理的思考

医院信息管理是现代化医院管理的重要组成部分。随着医院改革不断深入及医院现代化管理的发展,许多医院相继成立了信息科,但在信息管理的建设和发展中,仍存在着许多差距和问题,值得我们去认真地思考。     

医院信息系统实施中应注意的问题

分析了医院在实施HIS时必须注意的几个问题，正确认识和处理好这些问题，对于HIS的成功实施具有重要意义。     

中小医院信息化建设现状和发展趋势

本文在对重庆市周边中小型医院调研的基础上,阐述了当前中小医院信息化建设的现状和发展趋势,指出了中小医院信息化建设过程中存在的问题,并提出一些解决办法和措施。     

民营医院发展瓶颈与对策探讨

随着改革开放的深入,一批专科特色明显的民营医院在医疗市场上应运而生,经过近20多年的发展取得了一定的成绩,但仍有许多问题制约其长远发展,如人才队伍问题、内部管理问题、医院文化问题、社会信任度问题。笔者这对以上问题进行了剖析;并对民营医院的可持续发展提出了对策和建议。     

关于改善医院经营管理的几点思考

我国各级国有医院由于长期在计划经济体制下运作 ,经济上靠国家拨款 ,分配上搞平均主义、吃大锅饭 ,一旦被推向市场 ,其经营管理中存在的各种问题便暴露无遗。当前 ,国有医院的经营管理与市场经济的深入发展和我国入世后的形势不相适应 ,极需改进和完善。1　医院经营管理中存在的问题以我市各级国有医院及我院近几年经营管理的实际分析 ,突出的问题是经营管理中普遍存在的“三高三低”现象 ,即高支出、低收入 ,高分配、低积累 ,高耗费、低效益。1 .1　高支出 ,低收入医院的各项支出 ,如仪器设备、卫生材料、药品、试剂、清洁用品、劳保用品…     

城市医院改革成效浅谈

城市医院推行技术经济责任制是在农村实行联产计酬承包制和城市工矿企业经济项目管理责任制的基础上开展的。5年的改革实践,成效如何,下一步如何兴利除弊,进一步深化改革,是公众关心的问题。     

谈新形势下军队医院管理突出问题及对策

1医院管理中存在的主要问题 1．1医院管理人才、制度、设备现状等问题一是目前医院管理人员现状问题。目前医院管理者大多是从临床和其他专业改行而产生的,管理专业知识掌握十分有限,办事效率低下,整天忙于主观随意性管理,不按医院的发展规律和内在管理要素去发现问题、分析问题、解决问题。学历也参差不齐,不会作市场调查,没有形成一个完整的、科学的管理思路和模式,这样严重地制约医院的科学性发展,并给决策者带来了一些苦恼和麻烦,甚至失误及决策质量的下降。二是建章立制现状问题。依法治院,从严治院得到了共识。目前医院的管理制度不少,但真正认识到用制度管人的意义还不够清楚,并在结合医院实际抓落实的工夫还不够,大     

医院信息化建设存在的问题与对策

简述了我国医院信息化建设的发展和现状,对医院信息化建设中存在的问题进行了分析,并对有关问题提出相应建议。     

The contribution of lone parenthood and economic difficulties to smoking

Smoking is more prevalent among lower socioeconomic status groups, among those who perceive economic difficulties and among lone mothers. Less is known of how these factors contribute to smoking independently. The aim of this study was first to examine the association between smoking and both economic difficulties and lone parenthood. We then also studied to what extent smoking among people experiencing economic difficulties and lone parenthood is due to other factors such as socioeconomic status and social relations. The data derive from surveys conducted among the employees of the City of Helsinki, Finland, in 2000 and 2001 including 6243 respondents aged 40-60 yr (response rate 68%). The measures were daily smoking, economic difficulties and family type, as well as socioeconomic status (education, occupational social class, household income, housing tenure) and social relations. The more had respondents experienced economic difficulties, the more prevalent was their smoking. Smoking among lone parents was more common than among parents living together; this was true for both men and women. After controlling for socioeconomic status and housing tenure, the association between smoking and economic difficulties, as well as that between smoking and lone parenthood, attenuated but remained statistically significant. However, after controlling for social relations the associations became stronger. Both economic difficulties and lone parenthood were associated with smoking independent of education, occupational social class, household disposable income, housing tenure or social relations for both men and women.     

Dyspraxia series: part one. At sixes and sevens

Developmental Co-ordination Disorder (DCD), also known as Dyspraxia in the UK, is a common disorder affecting motor co-ordination in children and for many continues into adulthood. This condition is formally recognised by international organisations including the World Health Organisation. DCD is distinct from other motor disorders such as cerebral palsy and stroke. The range of intellectual ability is in line with the general population. Individuals may vary in how their difficulties present. The co-ordination difficulties may affect participation and functioning of everyday life skills in education, work and employment. Children may present with difficulties in writing, typing, riding a bike, self care tasks, and recreational activities. In adulthood many of these difficulties will continue, as well as learning new skills at home and work such as planning, organisation, driving a car and DIY.     

The impact of children's emotional and behavioural difficulties on their lives and their use of mental health services

This paper examines the relationship between the impact of children's emotional and behavioural difficulties and the use of mental health services, using 3 years of nationally representative data from the National Health Interview Survey. Data for the years 2001, 2003 and 2004 were combined ( n  = 29 265) to identify a sample of 1423 children aged 4–17 years with emotional/behavioural difficulties. Multivariable logistic regression analysis was used.
About 5% of U.S. children had emotional or behavioural difficulties. Children whose difficulty was a burden on their family were almost twice as likely to have contact with a mental health professional. Younger children (aged 4–7 years), Hispanic children and non-Hispanic black children with emotional or behavioural difficulties were less likely to use mental health services. These findings indicate that children's emotional and behavioural difficulties influence their lives and those of their families, leading parents to seek help. Racial disparities in mental health service use exist when controlling for the severity and the burden of these difficulties.     

大型医疗设备售后维修管理中的难点及对策

本文针对大型医疗设备在售后维修管理中存在保修服务流程复杂、设备管理部门对设备故障不知情、厂方工程师保养工作不彻底以及院方自行维修力量不足等难点展开分析，同时阐述了解决的方法。     

Internationally adopted children in Finland: parental evaluations of symptoms of reactive attachment disorder and learning difficulties - FINADO study

Objective This study investigated the association between psychological symptoms, such as features of reactive attachment disorder (RAD), and learning difficulties among international adoptees in Finland. Methods The data for this study came from the FINnish ADOption (FINADO) study covering all internationally adopted children in Finland (n= 1450), with a response rate of 55.7%. The subsample consisted of 395 adopted children aged 9–15 (51.6% girls, 48.4% boys). Learning difficulties were evaluated by a screening questionnaire ‘Five To Fifteen’ and symptoms of RAD by FINADO RAD scale. Results The parents estimated that one‐third (33.4%) of the internationally adopted children had some, and 12.7% had severe learning difficulties, i.e. three and six times more than in normal population, respectively. RAD symptoms at the time of adoption were associated with learning difficulties at school age (OR 4.57, 95% CI 2.57–8.13). Conclusions Learning difficulties are common among internationally adopted children in Finland and symptoms of RAD are associated with a child's learning difficulties.     

Medical students and congenital colour vision deficiency: unnoticed problems and the case for screening.

The results are given of a questionnaire study to determine the range of difficulties that doctors notice in their work due to congenital colour vision deficiency (CCVD). The study is primarily qualitative. A questionnaire was sent to 40 self-selected doctors, 35 of whom were general practitioners (GPs). All were administered a number of colour vision tests to assess the type and severity of their deficiency. Many difficulties and some ways of overcoming them were reported. Those with a mild deficiency reported fewer difficulties and this relationship was significant. Twenty-three of the doctors also reported difficulties as medical students and their answers are given verbatim. The results are discussed in relation to other studies and data on colour vision. The reasons for and against screening medical students for this deficiency are considered and it is concluded that there is a strong case for screening.     

Associations between changes in physical fitness and psychological difficulties status among Norwegian adolescents

ObjectivesTo investigate the associations for one-year changes in cardiorespiratory fitness, muscular strength and body mass index, with psychological difficulties status in adolescents.MethodsNorwegian 14-15-year-olds (n = 925) participated in data collection at two time points separated by one year. Psychological difficulties were assessed via the Strengths and Difficulties questionnaire and data from follow-up serve as the dependent variable. Cardiorespiratory fitness (the Andersen-test), muscular strength (Eurofit) and body mass index were measured. Change scores were calculated from the physical fitness variables and serve as independent variables in linear mixed effects models.ResultsThere was no association between change in body mass index and psychological difficulties. Sex and socioeconomic status moderated the association between cardiorespiratory fitness and psychological difficulties. Immigrant status moderated the association between muscular strength and psychological difficulties. Subgroup results indicated inverse associations between change in cardiorespiratory fitness and psychological difficulties among boys (b = −0.009; 95% CI = −0.015 to −0.003; p = .006); change in muscular strength and psychological difficulties among immigrants (b = −1.97; 95% CI = −4.03 to 0.09; p = .061). Subgroup results also indicated an association between change in cardiorespiratory fitness and psychological difficulties among girls in the highest socioeconomic group (b = 0.014; 95% CI = 0.003 to 0.025; p = .014).ConclusionsThe associations for different fitness components were dependent on different moderators. Possibly, this indicates that associations in different subgroups are mediated by different mechanisms. Moderated associations should be addressed in future investigations.     

Hearing difficulties, ear-related diagnoses and sickness absence or disability pension - a systematic literature review

ABSTRACT: BACKGROUND: Hearing difficulties is a large public health problem, prognosticated to be the ninth leading burden of disease in 2030, and may also involve large consequences for work capacity. However, research regarding sickness absence and disability pension in relation to hearing difficulties is scarce. The aim was to gain knowledge about hearing difficulties or other ear-related diagnoses and sickness absence and disability pension through conducting a systematic literature review of published studies. METHODS: Studies presenting empirical data on hearing difficulties or ear-related diagnoses and sick leave or disability pension, published in scientific peer-reviewed journals, were included. Studies were sought for in three ways: in literature databases (Pub-Med, Embase, PsycInfo, SSCI, and Cochrane) through March 2011, through scrutinising lists of references, and through contacts. Identified publications were assessed for relevance and data was extracted from the studies deemed relevant. RESULTS: A total of 18 studies were assessed as relevant and included in this review, regardless of scientific quality. Fourteen studies presented empirical data on hearing difficulties/ear diagnoses and sick leave and six on these conditions and disability pension. Only two studies presented rate ratios or odds ratios regarding associations between hearing difficulties and sick-leave, and only two on hearing difficulties and risk of disability pension. Both measures of hearing difficulties and of sick leave varied considerable between the studies. CONCLUSIONS: Remarkably few studies on hearing difficulties in relation to sickness absence or disability pension were identified. The results presented in them cannot provide evidence for direction or magnitude of potential associations.     

Social competence and learning difficulties: Teacher perceptions

Background/aim: Social competence has been linked to children's classroom performance with three out of four children with learning difficulties reported to have problems with social skills. Social participation remains a predominant childhood occupation and a key indicator of school performance. Occupational therapists work with teachers to accurately assess the social performance of children in context and to provide targeted intervention. There is limited research about what teachers perceive are the specific nature of social difficulties experienced by children with learning difficulties in the classroom. This study investigated teacher perceptions of the social competence of a small sample of Australian boys with learning difficulties within the classroom context. Methods: The Teacher Skillstreaming Checklist was used to investigate teacher perceptions of the social abilities of 21 primary school aged boys with learning difficulties compared to a control group. A correlational analysis was used to examine the relationship. Results and conclusions: The study identified that the boys with learning difficulties were perceived by their teachers as having poorer social performance across multiple domains when compared to their typically developing peers. Implications of these findings are that children's social performance may negatively impact learning and classroom participation and that for some children, social competence should be a focus of occupational therapy assessment and treatment.