金华市社区糖尿病综合防治管理模式探讨

目的：评价糖尿病社区综合防治管理效果。方法：通过设立试点社区和对照社区开展综合防治管理一年半以后，对病人的发现率，对病人和病人家属知信行情况改变以及病人家属对病人的督导率的改变和社区糖尿病管理率的变化进行考评。结果：社区糖尿病的发现病人数（率），社区卫生服务站的糖尿病建档人数和病人管理率，病人和家属的糖尿病防治知识的知晓率，家庭成员对病人督导率均提高，病人生活方式有所变化，病人的规范服药率明显提高。在试点社区和对照社区之间的差异显著。结论：“以卫生行政部门为领导，疾病预防控制机构为中心，医疗机构为诊疗支撑，社区卫生为服务平台，患者家庭为辅助”的社区糖尿病综合防治管理模式有一定效果。     

山东省基层糖尿病防治工作现状及探讨

目的了解山东省基层糖尿病防治工作现状，探讨今后工作模式。方法采用现场问卷调查的方式，对全省17地市20个县市区的基层医生和糖尿病患者进行糖尿病防治知识培训与询问，用统一问卷进行了调查。结果基层医生糖尿病综合防治水平较低，应加强培训。糖尿病患者出现了不同程度的并发症；85．7％的患者使用过广告宣传能治好糖尿病的保健品、秘方等；65．7％的患者认为当前治疗费用过高；48．9％的患者认为控制饮食很苦恼；14．3％的患者有心理压力。结论加强基层医生糖尿病综合防治水平，规范糖尿病治疗和加强糖尿病患者的管理，是山东省糖尿病防治工作的重点。     

社区糖尿病综合防治模式探究

为探索社区糖尿病综合防治的模式和有效方法,提高社区糖尿病综合防治效果,本社区卫生服务中心于2006年6月至2008年12月,开展了《社区糖尿病分层干预效果评价研究》（上海市宝山区医学重点社区项目）。研究显示：在社区建立社区糖尿病防治组织、网络、实施社区户籍医生责任制、团队式管理、建立糖尿病俱乐部、社区健康促进志愿者队伍、建立社区糖尿病防治长效管理机制、考核激励机制,可有效提高社区糖尿病综合防治效果,社区一般人群、高危人群、糖尿病患者糖尿病知识知晓率有较大提高;糖尿病高危人群不健康生活方式有所改善,糖尿病高危因素中的可控因素得到一定的控制;糖尿病患者自我管理、饮食、运动、自我监测能力、血糖控制达标率均有所提高。提示在社区开展糖尿病综合防治是一项全民防治经济有效的糖尿病防治措施。     

社区农民糖尿病防治干预效果分析

为了制定符合本县特点的农村糖尿病综合防治策略，2006—2008年，永嘉县疾控中心与中塘社区卫生服务中心对糖尿病患者进行综合防治干预，2008年12月对干预效果进行评估，结果报告如下。     

宁波城区2型糖尿病患者知识、态度、行为调查

目的：了解宁波城区2型糖尿病患者知识、态度、行为情况。方法：随机选择3个社区内200名糖尿病患者进行问卷调查。结果：患者糖尿病知识得分优秀率为40．10％，不及格率27．08％；对糖尿病防治持积极态度者占65．28％，持消极态度者占12．95％；糖尿病防治相关行为得分优秀率42．39％，不及格率2．72％。结论：我区大部分2型糖尿病患者掌握了糖尿病基本知识，有正确的态度和行为。     

糖尿病防治六要诀

在糖尿病患者甚至医务人员中，不科学的认知观念，不合理的用药和饮食习惯会让患者的血糖居高不下或者大起大落：因而需要医务人员科学的防治以及糖尿病患者良好的自我管理，掌握糖尿病防治中的要诀，才能使糖尿病不至成为脱缰野马。     

卫生部办公厅关于印发《防治糖尿病宣传知识要点》的通知

各省、自治区、直辖市卫生厅局，新疆生产建设兵团卫生局： 目前，我国约有糖尿病患者2000多万人，另有近2000万人糖耐量低减，我国成为全球糖尿病患病率增长最快的国家之一。为指导防治糖尿病的宣传教育工作，为公众和媒体提供正确的防治糖尿病相关知识和信息，我部组织编写了《防治糖尿病宣传知识要点》。现印发你们，为各地开展防治糖尿病宣传工作，普及糖尿病预防知识，降低糖尿病危害提供参考。     

2型糖尿病患者降糖药物治疗方式及疗效比较

目的：探讨2型糖尿病(DM)患者的药物治疗方式变化情况，为临床医生提供较好的治疗方案。方法：回顾性分析我院1997年1月至2001年12月5年问在内分泌科住院治疗的921例2型糖尿病患者的治疗及血糖控制情况。结果：随着病程的增加，2型糖尿患者胰岛素治疗比例越来越大，随着糖尿病教育的开展，患者血糖控制有显著改善，接受胰岛素治疗的比例逐年增加，寻找实验依据以帮助调整治疗方案的患者也越来越多。结论：2型糖尿病的药物治疗方式在我院仍以日服药物为主，但接受胰岛素治疗的患者有逐步增多趋势，加强糖尿病防治教育，更加合理的使用药物治疗方式。使患者得到良好血糖控制，将会有利于患者急慢性并发症的防治。     

东林镇社区慢性病综合防治的实践与体会

目的：探索社区慢性病综合防治模式,探寻切实有效的社区慢性病综合防治方法。方法：选择吴兴区东林镇作为试点,利用社区网络,成立慢性病患者俱乐部开展＂同伴教育＂,并在慢性病病人管理中进行质量控制,实施以防治高血压、糖尿病为主的社区慢性病综合防治。结果：高血压患者规范管理率、治疗率、规范化治疗率、血压控制良好率分别由33.33%、65.81%、4.07%、7.24%上升到53.03%、96.38%、17.35%、19.26%;社区医生慢性病随访质量明显提高。结论：社区综合防治是我国当前慢性病防治的有效模式;成立慢性病患者俱乐部开展＂同伴教育＂,并在慢性病病人管理中进行质量控制是社区慢性病综合防治的有效方法。     

糖尿病慢性并发症临床诊疗分析

目的：探讨糖尿病慢性并发症的诊疗方法与措施,观察临床疗效。方法：回顾性分析124例糖尿病患者的慢性并发症发生情况,并对具体的诊疗措施进行系统地分析与评价。结果：大部分患者并发症情况控制满意,致残率为4.8%,死亡率为4.0%。结论：糖尿病慢性并发症的发生与多因素有关,早期、科学、合理地综合防治是降低患者死亡率、致残率,提高患者生活质量的有效途径。     

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.     

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.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.