民营社区卫生服务机构就诊患者的情况分析

目的:通过对武汉市民营社区卫生服务机构的调查,针对就诊患者就医情况、服务态度进行分析。结果:“服务便利性”是患者选择民营社区卫生服务的主要目的;民营社区卫生服务机构重视服务质量,讲究服务理念,以良好的服务、较低的价格赢得市场竞争,但其还不太重视公共卫生服务,居民对此满意度较低。结论:纳入区域卫生规划、注重服务态度、提供简捷便利的医疗服务是民营社区卫生服务机构赖以生存和发展的基础。提高医疗技术水平、降低医疗药品价格、改变服务方式、完善公共服务的功能是民营社区卫生服务尚需努力的方向。     

武汉市民营社区卫生的服务情况分析和对策

通过问卷调查和访谈,了解民营社区卫生服务的服务项目、服务模式和服务功能等情况,对武汉市3家民营社区卫生服务机构进行了分析,发现民营社区卫生的服务项目:重视基本医疗项目,忽视公共卫生项目;民营社区卫生的服务模式:沿用“坐堂行医”的模式;民营社区卫生的服务功能:功能缺失或空档。针对民营社区卫生服务中的不足,我们提出了相关的对策,以供民营社区卫生服务机构采取措施来完善和发展。     

石河子市居民社区卫生服务满意度调查结果分析

目的分析社区就诊居民对社区卫生服务的满意度及其相关因素,推动社区卫生服务发展。方法在石河子市5个街道,选取了2个社区卫生服务中心和2个社区卫生服务站,随机抽取200名年满18岁的社区就诊居民进行现场问卷调查。结果被调查的200名居民对社区卫生服务的总满意率为77.38%,其中对“就诊的方便性”的满意率最高为98.50%,而对“机构的设施、设备”和“技术水平”满意率较低,为39.50%、52.00%。结论社区卫生服务机构的设施、设备和技术水平是影响石河子市社区卫生服务满意度的重要关联因素。     

2012年乌鲁木齐市社区卫生服务利用者满意度调查

目的 了解乌鲁木齐市社区卫生服务的利用者对社区卫生服务的利用情况及满意度,为制定社区卫生服务相关政策及措施提供依据.方法 采用分层随机抽样的方式对700名在社区卫生服务中心(站)就诊的居民进行社区卫生服务机构利用情况及满意度调查.结果 ①社区居民享受各种形式医保比例较高,选择社区卫生服务机构的主要原因是“方便快捷”、“服务态度好”、“是医保定点单位”.病伤诊治及购药是主要接受服务的类型,占总服务类型的70.0％以上;36.5％的利用者一年内就诊次数在2次以下,经常来社区卫生服务机构就诊(6次以上)的患者比例为27.3％;②居民对社区卫生服务机构就诊等候时间、服务态度、受尊重程度的满意度较高,对就医环境、设备设施、服务价格、药品价格的满意度较低.结论 乌鲁木齐市社区卫生服务利用者满意度情况总体较好,个别服务类型有进一步改进的空间.有关部门应加大社区卫生服务机构的支持和宣传引导力度,不断完善“六位一体”功能.     

郑州市社区卫生服务居民利用和满意度调查

目的：了解郑州市居民对社区卫生服务的利用和满意度情况。方法于2013年对207名社区卫生服务利用者进行问卷调查。结果居民自感病轻时选择社区卫生服务机构为首诊意向的比例最高,为54?55％,促使其选择的最主要原因是方便到达;居民到社区卫生服务机构多为看病、拿药、打针输液,对其他服务利用较少;居民对社区卫生服务总体满意度为30?11％,其中居民对就诊路程的满意度最高(53?98％),而满意度最低的是设备技术(18?19％)。结论政府应加强宣传,发挥社区卫生服务机构“六位一体”功能;优化医疗资源,提高社区卫生服务机构的软硬件水平;加大投入,落实和完善相关政策法规。     

北京市海淀区社区居民卫生服务利用及满意度调查

目的：了解北京市海淀区社区居民卫生服务利用及满意度情况,并分析其影响因素。方法采用典型抽样的方法,对海淀区15岁及以上的2103名社区居民进行面对面、一对一的问卷调查,通过现场调查收集相关资料,应用单因素方差分析进行统计学分析。结果居民对社区卫生服务机构的知晓率为82．00％（1724人）,近1年内有1033人（49．12％）利用过社区卫生服务。居民对社区卫生服务就诊方便性、候诊时间和服务态度的满意度较高,其中对就诊方便性的满意度最高。相对而言,居民对社区卫生服务机构的技术水平、医疗设备、服务项目方面的满意度较低。结论尽管海淀区居民对社区卫生服务的知晓率较高,但由于社区卫生服务机构技术水平、服务条件的限制,利用率还相对较低。因此,社区卫生服务机构应根据居民的需求,在提升医疗卫生服务水平的同时,不断发挥社区卫生服务“六位一体”的功能。     

大型企业所办社区卫生服务机构存在的问题和对策

社区卫生服务是保证广大城镇居民享受基本卫生保健和缓解“看病难,看病贵”的根本保证和有效途径,大型企业所办社区卫生服务机构是城市社区卫生服务体系建设中的重要组成部分。通过对东风汽车公司在十堰所办的社区卫生服务机构进行调研,发现在管理体制、政府投入和管理及社区卫生服务机构自身业务发展上均存在一定的问题,提出了政府部门要提高认识、完善相应政策以及加强企业所办社区卫生服务机构业务发展等对策建议。     

医联体模式下城市居民选择社区卫生服务的影响因素研究△

目的：探讨城市居民在社区卫生机构利用的卫生服务量占居民卫生服务利用总量的比例（以下简称“社区卫生服务利用比重”）变化及其影响因素。方法：采用整群随机抽样调查的方式于2017年初对我市A社区的家庭成员实行调查,问卷内容包括个人基本情况、健康状况、知晓度和满意度、信任度以及2015和2016年卫生服务利用情况。调查数据采用Excel2007、SPSS20.0进行描述性分析和回归分析。结果：共对62户家庭进行了问卷调查,有效问卷158份,2016年居民社区卫生服务利用比重比2015年有所增加。通过回归分析,城市居民选择社区卫生服务中心的影响因素有：家庭人均收入差、就医方便程度感受的变化、两年参加健康宣教的次数差、对社区卫生服务中心两年的比较得分。结论：居民的就医流向在向社区卫生服务机构转移。根据影响因素的结果分析,通过针对居民自身、社区卫生服务机构和卫生行政部门3个方面提出措施,引导居民在社区卫生服务机构就诊。     

岳阳市岳阳楼区居民社区卫生服务资源利用及影响因素分析

目的 了解岳阳市岳阳楼区居民对社区卫生服务中心知晓和利用情况,为促进和发展社区卫生服务建设提供依据. 方法 采用横断面研究,自拟调查问卷,对岳阳楼区3 274名居民进行问卷调查. 结果 居民对社区卫生中心知晓率为77.3％;50.9％的居民去就过医.近两周患病就诊地点和住院机构的选择上看,社区卫生服务利用率分别为26.9％和19.8％.多因素分析发现：“距离近”和“对卫生服务中心了解”是居民易于接受社区卫生服务的主要因素.结论 岳阳楼区居民对社区卫生服务知晓率和利用率不高,需通过各种途径提高居民对其的知晓率和信任度.     

中山市三乡镇社区居民双向转诊服务影响因素分析

目的：研究和分析中山市三乡镇实行双向转诊服务现状及其影响因素。方法：采用分层抽样法,抽取中山市三乡镇6间社区卫生服务站内就诊的居民进行匿名问卷调查。结果：高达90.2%的居民选择社区卫生服务机构作为首诊机构;居民双向转诊知晓率较低,高达76.9%的居民“没听说过”双向转诊制度;84.9%的居民不知道本地区社区卫生服务机构已与上级医院（二级及以上医院）间建立了双向转诊制度,但同时64.5%的居民赞成实行双向转诊制度,分别有69.2%和42.3%的居民对目前社区卫生服务机构实行的双向转诊制度和双向转诊流程感到满意。居民的年龄、职业、月收入、医疗费用支付方式和首诊机构选择是影响双向转诊服务满意的主要因素。结论：中山市三乡镇社区卫生服务机构与上级医院之间的双向转诊服务还有待进一步优化和完善,应加强其宣传力度。     

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.