上海市医务人员劳务报酬现况及影响因素分析

通过对上海市6家医院医务人员劳务报酬现况的抽样调查发现，医务人员平均月收入为2416元，国家规定部分占总收入的52.4%，而其中由工资制度所决定的部分仅占总收入的22.4%；月收入多元分析表明，职称是决定收入及收入差别的最主要因素，但最高与最低职称平均收入之比为1.6-2.8倍，相邻职称收入比为1.2-1.4，分配上平均主义仍旧存在，建议加强对医院劳务报酬总量的宏观调控，加快分配制度改革。     

医疗机构人事与分配制度改革可行性研究

该文主要从医院运营效率和医务人员劳务报酬两方面进行分析.研究发现政府对卫生的投入不足,医疗服务收费价格不尽合理,劳务补偿不充分,医务人员工资收入没有合理反映其劳务价值,绩效考核不完善.因而提出人事分配制度的改革,以提高医疗卫生服务质量和效率,理顺医院和医务人员的补偿机制,体现医务人员的劳务价值.     

医务人员劳务价值补偿调查

通过对上海市某二级综合征医院十年的业务收支、补偿状况和医务人员劳务补偿意向调查发现，现行的医疗服务项目收费标准主体部分沿袭多年价格偏低，特别含人力成本的技术劳务收费价格严重偏离价值。医院床日费严重亏损，预算拨款和医疗收入比重逐年下降，造成医院在提供卫生服务中创造的技术性劳务价值无法完全补偿，妨碍了医院的再生产和发展规模。调查结果提示，目前医技人员的月基本收入只补偿了其实际收入的４６．６％，包括估计     

医务人员分配制度的概况

1　国外医务人员收入分配制度概况商品经济社会里 ,劳动者劳务价值的补偿是通过收入报酬来体现的。在西方的一些发达国家 ,例如 :美国、加拿大 ,医疗制度实行的是多元型医疗保险 ,医疗机构绝大多数为私人企业经营型 ,医生大多属于私人开业 ,独立于医院之外 ,因而对医疗卫生服务费用偿付方法相应地也分为对医师和对医院的偿付方法。1 .1　对医务人员劳务价值补偿的支付方式主要有三种[1]1 .1 .1　按服务项目支付 (Feeforservice)。医务人员每提供一个服务 ,从病人或第三方 (保险公司或政府 )处直接得到偿付 ,一个服务一个价格 ,根据种类及数…     

北京市公立医院综合改革对医疗机构技术劳务收入的影响分析

目的:分析北京市医药分开和医耗联动综合改革对不同级别医疗机构体现医务人员技术劳务价值收入部分的影响。方法:利用参与北京市医药分开和医耗联动综合改革363家公立医疗机构2016年1月—2019年12月的监测数据,采用描述性分析结合多重间断时间序列模型,对改革前后不同级别医疗机构技术劳务收入及其占比的变化情况进行分析。结果:医药分开综合改革实施后,三级医院、二级医院、一级医院及社区的技术劳务收入较改革前分别增长了105.4%、119.7%和318.3%,其占比分别增长了5.91、6.44和5.87个百分点;医耗联动综合改革实施后,三级医院、二级医院、一级医院及社区技术劳务收入较改革前分别增长了26.2%、18.3%和11.6%,其占比分别增长了2.31、2.03和0.84个百分点。结论:北京市两项公立医院综合改革的实施有效促进了各级别医疗机构技术劳务收入的增长,医疗费用结构得到优化。建议进一步建立科学合理的医疗服务价格定价及动态调整机制,加强对基层医疗机构的重视,健全医疗服务行为监管体系。     

我国基层医务人员离职意向状况与分析

目的调查了解我国基层医务人员的离职意向状况,分析可能的影响因素,为改善我国基层医务人员状况和构建一支稳定的基层医务人员队伍提供政策参考依据。方法利用2013年国家卫生服务调查基层医务人员调查的数据,采用描述性分析、单因素分析、多因素分析、比较的方法进行分析。结果基层医务人员的离职意向有所降低,不同地区、机构、年龄段、性别、学历、工作年数、平均月收入的基层医务人员的离职意向程度有所差别,工作满意度、工作投入、工作压力是主要影响因素,月收入、自感受尊重程度是次要影响因素。结论提高基层医务人员的工作满意度,降低工作压力;提高基层医务人员的工作收入,改善基层医务人员的执业环境;完善基层医务人员相关制度,提高工作积极性,造就一支稳定的基层卫生人力队伍。     

医院卫生技术人员收入结构和意愿分析

我国公立医院医疗卫生技术人员收入结构和意愿研究，是目前医院管理领域的热门话题，文献综述结果表明，有关这方面的资料或文献，无论是政策研究还是实际研究尚不多见。本研究通过对医务人员的收入与结构及其收入意向等信息的搜集与分析，探讨收入意愿的影响因素，评价当前医疗机构分配制度中存在的问题，为医院分配制度改革提供参考依据。     

利益传导视角下医疗服务价格改革对医务人员薪酬水平的影响*

目的：医疗服务价格改革对完善医疗服务合理定价,合理体现医务人员劳务价值,提高医务人员薪酬水平具有重要意义。方法：基于利益传导的视角,以医务人员劳务价值的体现为中介,采用定量研究方法,实证检验医疗服务价格对医务人员薪酬水平的影响。结果：医疗费用规模对医务人员薪酬水平有着显著的正向影响,但在门诊医疗和住院医疗二者间存在异质性,主要体现在劳务价值在医疗费用中的差异方面。结论：应持续深化医疗服务价格改革,提高医务人员薪酬水平。     

菏泽市县级公立医院改革后医务人员满意度调查

目的了解菏泽市县级公立医院改革一年后医务人员满意度现状,分析影响因素并了解医务人员的个人期望。方法利用调查问卷,对菏泽市进行改革的15家医院的医务人员进行调查,利用SPSS 20.0进行统计分析,综合医院和中医院的比较利用χ~2检验,利用logistic回归分析影响满意度的因素。结果综合医院医务人员的工作满意度高于中医院;满意度最高的是医院管理状况,最低的是收入满意度;工作时间、年龄和职业是影响医务人员满意度的因素;医务人员最期望改善的前三项是个人收入、职业环境秩序和个人工作能力。结论医务人员的满意度整体不高,应该加强医院管理,提高医务人员特别是中医院医务人员的满意度。     

薪酬制度到底怎么改？

有人对我国医务人员薪酬现状作过分析评论，认为我国医务人员平均劳务成本低，即使和发展中国家同行的收入相比都要少得多。这与医务人员的职业特点相悖。新医改以来，各地纷纷提出取消双休日，实行无假日门诊，行业特点更加彰显。完善医务人员薪酬制度已成为深化医改的迫切要求。     

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.