医保应唱“主角”

国内外研究证明，对慢性病人实施综合管理，能够以较低的成本达到比单纯的医疗服务更好的结果，即延缓疾病进程、减少并发症、降低伤残率、提高生活质量并降低医药费用。建立这种以对各种危险因素进行干预为核心，全方位、多角度对慢病患者普及医药卫生知识，提供科学合理的健康促进、用药指导及人文关怀的新型管理模式，是社区卫生工作的重要内容。随着医疗保险制度在卫生筹资中的地位日益提高，医疗保险应该在社区慢病管理体系建设中扮演重要的“角色”。     

关于促进医疗保险参保人员充分利用社区卫生服务的指导意见

各省、自治区、直辖市劳动和社会保障厅（局）： 促进医疗保险参保人员充分利用社区卫生服务，对保障参保人员基本医疗，提高医疗保险基金使用效率具有重要意义。医疗保险制度改革以来，各地在大力推进医疗保险制度建设的同时，按照党中央、国务院的统一部署，结合本地实际，通过扩大社区卫生服务机构及基层医疗机构定点范围、将社区卫生服务中的基本医疗服务项目纳入医疗保险支付范围、以及适当降低参保人员医疗费用自付比例等措施，引导参保人员利用社区及基层医疗服务，既方便了参保人员就医购药，减轻了参保人员费用负担，又促进了医疗机构的公平竞争和社区卫生服务事业的发展。根据《国务院关于发展城市社区卫生服务的指导意见》（国发[2006]10号），为进一步发挥社区卫生服务在医疗保障中的作用，促进医疗保险参保人员充分利用社区卫生服务，现提出如下意见：     

劳动和社会保障部关于促进医疗保险参保人员充分利用社区卫生服务的指导意见

劳社部发〔2006〕23号各省、自治区、直辖市劳动和社会保障厅(局):促进医疗保险参保人员充分利用社区卫生服务,对保障参保人员基本医疗,提高医疗保险基金使用效率具有重要意义。医疗保险制度改革以来,各地在大力推进医疗保险制度建设的同时,按照党中央、国务院的统一部署,结合本地实际,通过扩大社区卫生服务机构及基层医疗机构定点范围、将社区卫生服务中的基本医疗服务项目纳入医疗保险支付范围、以及适当降低参保人员医疗费用自付比例等措施,引导参保人员利用社区及基层医疗服务,既方便了参保人员就医购药,减轻了参保人员费用负担,又促进…     

社区卫生服务与医疗保险的经济良性循环研究

随着医学模式，疾病谱和人口年龄结构的改变，为了保证城镇职工的基本医疗和有效控制卫生费用，必须使社区卫生服务与医疗保险协调发展，优势互补，形成两者的良性循环。在保证社会效益的前提下，应制定和完善相关政策，探讨解决影响社区卫生服务和医疗保险衔接的办法。     

社区卫生服务机构所有权和服务私有化探讨

在国家卫生政策和高医疗保险覆盖的情况下,社区卫生服务所有权和服务私有化可以实现,并有利于医疗资源的合理分配,同时也促进国家对社区卫生服务的规范化管理。目前大部分社区卫生服务机构运行效率低下,没能提供高效社区卫生服务,控制医疗费用上涨。本文从社区卫生服务功能及与其他组织之间关系及社区卫生服务运行情况、目前我国卫生政策、医疗保险政策等方面探讨社区卫生服务所有权和服务私有化的可能性。     

我国社区卫生服务亟待解决的几个问题

随着我国人均期望寿命的延长、老龄化程度的加大,社区服务站已成为老年人群生活、娱乐、家庭照顾及卫生保健的重要依托,社区服务站的功能不仅成为居民小区管理工作的重要标识,同时也是政府为老年人群提供社会保障的重要体现。在综合性的社区服务中,卫生保健服务显得尤为突出,由于老年人群年龄和疾病特征,使其对卫生服务的需求距离弹性很大,社区卫生服务的出现恰恰从某种程度上满足了这部分人群的医疗需求,同时,另一方面又减轻了大医院门诊负担。国内有研究表明,社区卫生服务站的医疗服务费用平均低于大医院4倍左右,说明组建和发展社区卫生服务站是控制医疗费用过快、不合理增长的一个有效途径。在我国要构建经济、有效的卫生服务体系,社区卫生服务站无疑是这个体系中重要的基底。     

我国老年人健康档案建立现状及存在的问题探讨

居民健康档案是社区医生掌握居民健康状况的基本工具,是进行社区卫生服务管理的重要前提,是实现人人享有基本医疗服务和医疗服务机构提供高质量服务的基础。随着人口老龄化的进程,对老年人进行健康管理,及时了解老年人群的健康状况,建立高质量的健康档案,成为缓解老年人医疗费用的不断增长、保障老年人晚年幸福生活的重要途径。老年人健康档案包括心理健康、生活方式调查、自理能力评估、慢性病诊疗档案和常规体检材料。目前我国老年人健康档案存在档案质量不高、数据虚假、档案使用率低、慢性病管理效果不明显等问题,需要不断完善以促进老年人健康。     

深圳和上海两市医疗机构服务数据分析

医疗保险与城市社区卫生服务是医疗卫生领域改革两项重要工作 ,由于各地经济、居民卫生问题、医疗服务机构现状不同 ,医疗保险的政策取向 ,直接影响各地参保人群对医疗卫生服务的利用。社会人群如何对医疗服务机构进行选择 ,医疗保险政策对城市社区卫生服务的影响怎样 ,针对这些问题 ,我们开展了调查。资料来源及方法(一 )资料来源 :选择深圳市、上海市 1997～ 1999年卫生服务利用资料做历史纵向分析 ,以及卫生行政部门日常收集的各类统计报表所产生的各种医疗卫生信息及对某一区域内各级医疗机构的服务量 ,特别是社区卫生服务机构的调查获…     

社区卫生服务机构收支两条线管理实施效果分析

文章以现场调研所收集的定性、定量数据为基础,对经济状况基本相当,但实行和未实行社区卫生服务机构收支两条线管理的两个地区其社区卫生服务机构的筹资结构、服务提供、次均门诊费用、社区人群满意度及社区医务人员满意度情况进行对比分析.得出的结论是:实行收支两条线管理地区社区卫生服务机构较好地落实了基本医疗和公共卫生服务、就诊人群医疗费用负担减轻、社区人群及社区医务人员满意度较高,此外,社区卫生服务机构并没有出现效率降低的情况,而政府也完全有能力负担社区卫生服务机构实行收支两条线管理.     

杭州市终末期肾病血液透析患者疾病经济负担研究

通过杭州市7所综合性医院终末期肾病血液透析的直接、间接医疗费用的测算,患者家庭疾病经济负担的调查,比较了享有不同医疗保险患者肾透析的利用及医疗费用。结果表明,城镇职工医疗保险制度在减轻疾病经济负担方面发挥了重要作用。尽管如此,血液透析患者的家庭经济负担仍显过重。因此需要进一步完善杭州市现行的对肾透析服务的医疗保险支付和补偿制度,减轻患者疾病经济负担。     

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.     

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.     

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.