武汉市各级医院门诊工作的调查与思考

根据1996年武汉市各级医院门诊工作调查资料，分析了就诊病人职业分布、文化程度、经济收入、医疗费用负担形式、就诊科别、交费形式及挂号类型、不同等级医院等方面分布构成及门诊人均费用情况。此次调查武汉市门诊人均费用为81.64元，并就与医疗保险体制改革中有关政策性的问题进行了探讨。     

武汉市各级医院门诊医疗服务的调查与思考

本文根据1996年武汉市各级医院门诊医疗服务调查资料，分析了就诊病人在职业分布，文化程度，经济收入，医疗费用负担形式，就诊科别、交费形式及挂号类型，不同等级医院等方面分布构成及门诊人均费用情况。此次调查武汉市门诊人均费用为：81．64元。并就与医疗保险体制改革中有关政策性的问题进行了探讨。     

河南农村医疗费用分析

文章对河南农村居民医疗费用进行了深入的研究分析,结果表明：河南农村居民人均两周门诊医药费用５９５ 元,年人均住院费用 ３２４５ 元, 年人 均总医药费用１８７１５ 元,占人均收入的 １１２７％ ,且经济收入越低的人群,医疗费用支出占人均收入的比例越高。医药费用的影响因素有性别、年龄、文化程度、医疗保健制度和是否患有慢性病等。结论：河南农村居民医药费用负担相对较重。不同特征人群的医药费用支出不均衡,农村医疗保障形式应福利与风险并举,兼顾门诊和住院。     

医院医疗收入增长影响因素分析

目的分析影响医院医疗收入增长的主要因素。方法运用统计指数因素分析法分析影响医院医疗收入各因素的变动方向和影响程度。结果以2014年为基期,2015年为报告期,某院医疗收入同比增长11.07%,医疗收入增加6 509.5万元,因人均费用增加而增加的医疗收入5 189.72万元,增长8.63%。因工作量增加的医疗收入1 319.78万元,增长2.24%。结论某院医疗收入增长的主要因素是因人均费用增长,工作量增加而增长的医疗收入贡献率较低。提示,门诊收入人均费用的增长,住院收入人均费用的增长需要加以控制,努力提高门急诊就诊人次、出院人数,医院管理层应给予高度重视。     

上海市老年护理医院出院患者费用分析

目的 了解上海市老年护理医院老年患者住院费用，旨在为政府和行政管理部门完善医疗保险制度，加强老年护理医院宏观管理提出有益的政策建议。方法 以调查表形式调查收集经上海市卫生局审批注册的67所老年护理医院出院患者费用，收到有效调查表57份，采用SPSS软件进行统计分析。结果 调查显示，57所老年护理医院出院患者的平均费用为11449．72元，日均费用98．12元，人均药费3842．86元，占出院费用的33．56％。比较3年出院费用的变化趋势，显示人均费用、日均费用及人均药费有不同程度增长，年递增率分别为7．1％、5．1％和8．8％。结论，针对老年护理医院住院费用和药费比例的逐年增长，有必要加强对老年护理医院的管理，既要控制费用的不合理增长，也要区分不同地区、不同疾病及住院时间对日均费用的影响。对老年住院患者提出统一的医保支付费用总控指标，与现实情况不符，改进医保费用管理方法迫在眉睫。     

2013年呼伦贝尔市医疗机构就诊居民循环系统疾病患病状况及直接经济负担

目的了解呼伦贝尔市循环系统疾病的患病状况及直接经济负担,为进一步开展疾病防治工作及制定相应的防治策略提供科学依据。方法系统收集呼伦贝尔市医保局、呼伦贝尔市新农合2013年度全市农村、城镇居民医疗保险患病资料,疾病分类依据国际疾病分类(ICD-10)进行,剔除同一人患同一疾病、无明确诊断、无出生日期、无性别等无效数据后,实际对141 645人的就诊病例资料进行分析。结果 2013年,呼伦贝尔市医疗机构就诊居民循环系统疾病患病构成顺位第1。循环系统疾病中高血压就诊病例占47.12%,居第1位;慢性缺血性心脏病占19.06%,居第2位;脑梗死占15.42%,居第3位。随年龄增长,就诊居民循环系疾病患病率呈逐渐上升趋势,进入80岁后呈下降趋势。主要患病年龄段为50岁以上人群。2013年,全市医疗机构就诊居民循环系统疾病人均医疗费用为4 525.29元,人均报销2 883.85元,总体报销比例为63.73%,医保人均费用是新农合人均费用的1.97倍,医保人均补偿费用是新农合人均补偿费用的2.44倍,医疗保险人均补偿比例比新农合保险人均补偿比例高了12.86个百分点。2013年,呼伦贝尔市居民循环系统疾病市外人均医疗费用是市内人均医疗费用的3.26倍。市外人均补偿费用是市内人均补偿费用的2.83倍。市外人均补偿比例比市内人均补偿比例低8.57个百分点。结论 2013年呼伦贝尔市医疗机构就诊居民循环系统疾病患病率较高,高血压、慢性缺血性心脏病、脑出血、脑梗死4种疾病为循环系统重点发病疾病,个人承担医疗费用仍然较高。     

对医保病人住院费用控制管理的探索

济南市中心医院于2003年被济南市社会劳动保障局确定为首批基本医疗保险定点医疗机构．在医疗保险中负担着提供基本医疗服务和控制医疗费用的双重任务。2007年．济南市医保参保职工总数突破100万人．参保职工住院费用自付比例为30．3％．参保职工的人均次住院费用比社会人员低千余元。医院面临激烈的市场竞争．要以优良的服务、低廉的价格吸引患者；患者入院治疗，也应尽量寻求治疗费用与治疗结果的最优组合。因此．加强医保病人住院费用控制管理是非常重要的．     

武汉市医院门诊检查影响因素分析

病人到医院就诊需进行一些必要的诊断检查，而检查的项目多少又必须经医生根据病人的病情需要做出判断，因此检查单据受那些因素影响？而由检查单据产生的检查费用又如何呢？为此我们在对武汉市医院门诊医疗检查费用调查分析的基础上，又进行多元回归分析，并求得多元回归方程，试为今后医疗保险制度改革提供一点参考。一、资料来源与方法调查对象，武汉市各级各类医院门诊就诊的病人。包括部属、省属、市属、区属、工矿企业及其他、街道、郊县、中医近27所医院门诊就诊的病人调查资料。调查时间：1996年7月一吕月调查内容：基本情况，经济…     

1996年全国中医医院资源效益分析

笔者就１９９６年全国中医医院资源进行了分析，当年中医院已达２５７２所，病床为２４７２７５张，每院平均９３张。医院中４３％分布在城市。中医院特点是起步晚、发展难。每院平均职工１３９人，卫技人员占８０５％，中医医师占医师的７０９６％。固定资产每院均值４２７２万元，其中设备仅占１／３。资源利用：门急诊人次增长缓慢，呈下降趋势，床位使用率持续下降，但医院功能有所扩展。门急诊和住院病人费用涨幅明显回落，总体看，医院平均收入增长１０４８％，但业务收入增长为３６２０％，业务支出比１９９５年增长１６５２％。今后应控制医院发展规模，提高制剂能力和药品质量，促进疗效和效益的新增长     

用因素分析法分析医院业务收入

目的：分析和探讨影响医院业务收入的主要因素,为管理层提供科学决策的参考依据,促进医院的良性发展。方法将医院收入分解为门诊收入和住院收入,利用综合指数因素分析法对各变动因素进行因素分析。结果某院2011年业务收入比2010年增加19992万元,因工作量的增加使业务收入增加13195．8万元,因人均费用增加使业务收入增加6796．2万元。其中：门诊收入增加1504万元,因门诊量增加使门诊收入增加1163．1万元,因人均费用增加使门诊收入增加340．9万元;住院收入增加18488万元,因出院病人增加使住院收入增加12032．7万元,因平均住院日增加使住院收入增加5658．5万元,因每床日均费用增加使住院收入增加796．8万元。结论2011年该院业务收入增长是工作量增加和人均费用提高共同作用的结果,工作量的增加是业务收入增长的主要因素。     

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.     

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.