精神病医院与综合医院工作场所暴力比较研究

目的了解精神病医院和综合医院工作场所暴力发生状况并比较其特点。方法采用问卷调查方法，同期调查广州市1所精神病医院和1所综合医院在职工作人员工作场所暴力发生率及影响因素。依据世界卫生组织关于工作场所暴力的定义。纳入标准为：工作人员在被调查前的12个月内遭受过暴力，且事件发生在工作中或当班时。结果医院工作场所暴力发生率较高，精神病医院为70．52％，综合医院为69．73％。精神病医院中90．82％的受害者曾反复遭受暴力伤害，多次暴力发生率达64．06％；49．45％的应答者1年中遭受过身体暴力；综合医院较少发生身体暴力，发生率仅为7．57％。精神病医院以患者本人肇事为主，综合医院则以患者亲属为主。肇事者精神障碍，患者(或陪护、探视者)要求未能得到满足，患者自认病情无好转，是精神病医院发生工作场所暴力的主要危险因素；综合医院前3位原因依次为患者(或陪护、探视者)要求未能得到满足，患者自认病情无好转及诊疗费用太高。医院工作人员对工作场所暴力认知程度很低，精神病医院尤为突出。结论精神病医院比综合医院工作场所暴力问题更为严重，应针对各类医院特点，开展综合性的工作场所暴力防控工作。     

广州市两所医院工作场所暴力现象调查

目的 了解医院工作场所暴力的发生现况并分析其原因,为维护医院正常工作秩序提供依据。方法 调查广州市2所三级甲等医院的卫生工作人员2001年10月至2002年10月中遭受工作场所暴力的情况。工作场所暴力事件的判断标准是,卫生工作人员本人在上述调查时间的1年中,在医院场所遭遇到心理暴力和(或)身体暴力。结果 1043名被调查者在1年中有678人遭受过工作场所暴力,以个人为单位,发生率为65．0％,以心理暴力为主。医生比护士更容易受到暴力威胁,发生率分别为70．3％和67．7％。30～39岁年龄段、工龄为11～20年的医院工作人员发生率最高。男性(11．7％)比女性(5．3％)更容易遭受身体暴力,但心理暴力和性暴力在性别上均差异无显著性。护士和护士助理最容易遭受性暴力。患者家属(64．2％)与患者本人(50．0％)是主要的肇事者,以患者家属为主。没有满足肇事者要求、患者病情无好转或患者自认无好转是发生工作场所暴力的主要原因。结论广州市医院工作场所暴力多发,必须引起重视,实施以法律与教育为主导的综合干预措施,以维护医院的正常工作秩序。     

医院工作场所暴力的流行病学特征及危险因素分析

目的 探讨医院工作场所暴力的流行病学特征及危险因素。方法 抽样调查医院工作人员工作场所暴力发生情况,根据2002年5月10日世界卫生组织在题为《新的研究表明工作场所暴力威胁卫生服务》的公报中关于工作场所暴力的定义,采用频数分析和logistic回归等统计学方法对资料进行处理。结果 调查的4062名医院工作人员中1年内有2619人遭受过工作场所暴力,暴力的发生率为64.48％,其中心理暴力为49.12％,身体暴力为15.36％。男性更容易遭受多次暴力,且更容易遭受身体暴力;30～39岁年龄组医院工作人员是工作场所暴力的主要受害者,医生、护士。(含助理护士)是工作场所暴力的高危职业人群;白班是发生工作场所暴力事件的高峰时问,病房是多发地点。患者(或探视者)的要求未能得到满足、患者自认病情无好转和诊疗费用太高是工作场所暴力发生的主要危险因素。患者亲属和患者本人是主要的肇事者。结论 医院工作场所暴力问题严重,实施以医院为主导和改善医患关系的综合干预措施,尽量减少和避免工作场所暴力发生。     

唐山市医院工作场所暴力现象调查

目的：了解医院工作场所暴力的发生情况并分析其原因，为预防暴力事件的发生提供依据。方法：采用统一问卷，调查唐山市2所三甲医院工作人员2004年4月至2005年4月遭受工作场所暴力的情况。结果：747名被调查者在1年中有430人遭受过工作场所暴力，发生率为57．56％，以心理暴力为主（发生率56．89％）。医生比护士更容易受到暴力威胁，发生率分别为65．16％和55．58％，30～39岁年龄段的医院工作人员发生率最高（62．91％）。男性（29．95％）比女性（15．82％）更容易遭受身体暴力。“媒体负面导向”（56．25％）、“肇事者酗酒”（38．46％）、“患者病情无好转或自认为无好转”（36．36％）是发生工作场所暴力的主要原因。多数被调查者认为“工作场所暴力可以预防”（85．89％），“媒体正确宣传导向”（81．32％）、“加快立法”（79．75％）、“加强保安”（73．63％）是预防暴力的有效措施。结论：唐山市医院工作场所暴力多发，须实施以法律与教育为主导的综合干预措施，以维护医院的正常工作秩序。     

伤害

精神病专科医院工作场所暴力流行病学调查；某石化企业1966—2003年伤害事故的调查；炼钢工人安全认知和安全行为与职业伤害相关性的调查研究；广州市中学校园暴力发生情况及原因分析；我国20个地区农村青年女性与男性自杀死亡者特征的比较。[编者按]     

儿科护士遭受工作场所暴力流行病学特征分析

[目的]了解儿科护士遭受工作场所暴力的流行病学特征及危险因素,为减少儿科护士遭受工作场所暴力的发生提供科学依据。[方法]调查广州市10所综合医院的儿科护士,依据世界卫生组织关于工作场所暴力的定义调查在调查前12个月中遭受工作场所暴力情况。[结果]调查的304名儿科护士中,有215名(70.7)在12个月内曾遭受工作场所暴力,其中心理暴力为68.8,身体暴力为16.1。暴力的类型多样,且多发于诊治护理病人时(53.1)或患者病情恶化时(20.7)。Logistic回归分析结果显示较低学历和职称的护士更容易遭受工作场所暴力侵犯。[结论]儿科护士遭受工作场所暴力问题较为严重,应采取多种措施减少儿科护士遭受工作场所暴力的机会。     

深圳市罗湖区某医院暴力调查

[目的]了解医院暴力发生现状,分析其原因及影响因素,为医疗卫生人员在工作场所预防暴力事件提供依据.[方法]采取整群抽样的方法,对深圳市某所医院工作人员在1年内遭受工作场所暴力的情况进行调查.[结果]该医院301名医务工作人员中,有193人曾经遭受暴力,发生率为64.1%,以心理暴力最为常见.男女的暴力发生率差异无统计学意义;不同工作性质的医务人员暴力发生率不同.暴力发生的主要原因为患者粗暴无理,其次为媒体对医患关系的负面导向.[结论]深圳市某所综合医院中暴力多发,有关部门应当引起重视并采取综合干预措施,以维护医院正常的工作秩序.     

护士工作场所暴力流行病学研究

目的探讨护士工作场所暴力的流行病学特征,为有效预防与控制工作场所暴力提供科学依据。方法整群与分层抽样相结合,调查广东省所属广州、揭阳、深圳和东莞4市医院在职护士工作场所暴力发生情况,采用频数分析和Logistic回归等统计方法对资料进行处理。结果被调查到的3319名护士在过去的一年中有2085人遭受过工作场所暴力,个别护士甚至因暴力伤害而致残或遭受强奸（含未遂）,暴力的年发生率为62．82％,其中心理暴力为62．07％,身体暴力为15．06％。暴力多发生在急诊科或住院部各科室,科室内部以病房和护士站最常见,近1／3的暴力事件发生在晚依班。男性护士比女性护士更容易遭受暴力伤害,小于40岁年龄段护士是工作场所暴力的高危人群。受访者认为传媒在暴力防治过程中起重要作用。结论护士工作场所暴力问题严重,正逐渐成为一种职业伤害。护士个人、医院、政府以及社会传媒应共同努力,消除暴力隐患,尽量减少和避免护士工作场所暴力发生。     

江西省院前急救工作场所暴力现况调查及危险因素分析

目的探讨院前急救工作场所暴力的特征及危险因素,为有效防控院前急救工作场所暴力提供科学依据。方法调查本省4个地市及所属县医疗急救中心在职工作人员近12月内工作场所暴力发生情况,采用频数分析和logistic回归等统计方法对资料进行处理。结果被调查的261名工作人员在过去的12月中有149人遭受过工作场所暴力,暴力的年发生率为57.1%,心理暴力、身体暴力发生率分别为56.3%(147/261)、37.6%(98/261)。男性更易遭受暴力;26~35岁年龄组人员是主要受害者;医生、护士遭受工作场所暴力较其他岗位多;患者亲属是主要的肇事者;职业类别、职称、本岗位工作时间、性别、学历、单位级别等因素与院前急救工作场所暴力发生显著相关。结论院前急救工作场所暴力问题日益严重,社会各界应共同努力,消除暴力隐患,避免和减少工作场所暴力的发生。     

急诊护士工作场所心理暴力问题调查报告

目的 调查急诊护士工作场所遭受心理暴力的特征.方法 按世界卫生组织关于工作场所暴力的定义设计调查表,对医院100名急诊科护士工作场所心理暴力发生情况进行调查.结果 100名急诊科在职护士心理暴力发生率为88%,其中78%的受害者多次遭受暴力.辱骂与威胁是心理暴力的主要表现形式.护士站是急诊科发生心理暴力的常见工作场所;60%的急诊心理暴力事件发生在晚/夜班.急诊科护士处理心理暴力的主要方式是耐心解释(64.58%)和忍让回避(45.42%);27.50%的受害者未将暴力遭遇告诉别人.心理暴力的主要危险因素依次为病人(或其陪同者、探视者)的要求未能得到满足、肇事者酗酒或药物滥用、候诊时间过长等.病人亲属和病人本人是主要肇事者.结论 心理暴力以极高发生率存在于急诊科护士人群.需针对医院特点开展工作场所暴力防范与应对措施教育,提高急诊科护士防范心理暴力能力.     

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.