我国农村贫困地区乡镇卫生院补偿状况及公共卫生服务效果评价

对贫困地区乡镇卫生院补偿状况和公共卫生开展状况进行分析，并分析了两者之间的关系，发现贫困地区乡镇卫生院政府补偿不足且投入方式缺乏科学性、自身补偿能力有限。公共卫生存在严重的危机。政府投入只是影响公共卫生服务开展的其中一个因素，并在此基础上提出了相关建议。     

贫困地区乡镇卫生院补偿渠道研究

通过了解卫生 项目实施后对乡镇卫生院的影响和促进 ,从而系统地研究贫困地区乡镇卫生院补偿渠道。目前乡镇卫生院的经费都由县级政府按人头计算纳入财政拨款 ,这种补偿方式产生了很多负面作用 ,而且通常贫困县财政紧张 ,很多县又对卫生的重视程度不够 ,投入不足 ,不能足额补偿乡镇卫生院的费用。所以单一的政府补偿渠道已经不能维持乡镇卫生院的生存     

健康扶贫视域下的贫困地区乡镇卫生院服务能力调查研究

目的调查分析贫困地区乡镇卫生院的服务能力状况,为其服务能力提升提供实证依据和决策参考。方法采用分层随机抽样的方式,随机选取河南省新蔡县12家乡镇卫生院开展调查,采取问卷与访谈相结合的方式收集数据。结果新蔡县乡镇卫生院存在人力资源配备不足、基础设施以及诊疗条件亟需改进、药物短缺、基本卫生资源利用效率低效果差等问题。结论改进人才引进与培养机制,优化卫生人力资源配备;稳步加大财政保障力度,提升卫生院基本诊疗能力;落实基本药物补偿制度、进一步完善基本药物目录;积极融入医联体建设,引导优质医疗资源下沉。     

内蒙古自治区乡镇卫生院卫生资源配置现状调查

进一步了解医改后内蒙古自治区乡镇卫生院卫生资源配置的现状,为加快我区乡镇卫生院卫生资源合理配置提供决策依据.通过对乡镇卫生院的物力资源、人力资源和财力资源等与全国同期平均水平进行比较分析发现,自治区乡镇卫生院基础设施建设和设备水平还不容乐观;乡镇卫生院卫生人力数量少、缺口大、结构不完整、比例不合理和人员素质低;乡镇卫生院自身补偿能力不足,卫生发展财力资源有限.     

合作医疗干预前后中国农村贫困地区乡镇卫生院服务效率比较

中国农村贫困地区的乡镇卫生院卫生资源不足，同时现有卫生资源利用效率低下，这种低效率对于乡镇卫生院的生存发展具有重要影响。使用回顾性调查研究对中国10个贫困县的乡镇卫生院在合作医疗开展前后的效率进行综合评价研究。数据包络分析结果显示，乡镇卫生院的卫生服务效率仍在下降。建议扩大合作医疗覆盖范围，提高医疗卫生费用的补偿比例，以保障农村居民公平地利用卫生服务，提高卫生机构的资源利用效率。     

四川省贫困农村地区乡镇卫生院运行效率调查

[目的]通过对四川省贫困农村地区乡镇卫生院运行效率的分析,为该地区卫生资源配置提供科学依据。[方法]按不同经济水平抽取四川省东西部贫困地区的36所乡镇卫生院,对其所在乡镇的经济状况和卫生院基本情况进行调查。[结果]被调查地区乡镇卫生院财政投入不足、现有卫生资源缺乏且分布不均、住院服务利用效率低下。[结论]在政府提供优惠政策和加大财政投入的同时,卫生院自身要因地制宜,积极探索管理体制上的改革,提高卫生服务的效率。     

四川省贫困地区乡镇卫生院设备拥有情况研究

[目的]通过调查巴中市乡镇卫生院主要设备拥有情况,为西部贫困地区乡镇卫生院的发展提出建议.[方法]采用问卷调查、小组深入访谈等方法进行现状调查,并结合第2次全国卫生服务调查的资料进行分析.[结果]巴中所辖乡镇卫生院院均拥有千元以上设备13件,其中普通卫生院5件;普通卫生院设备缺乏情况严重,100%的普通卫生院无多参数监护仪、救护车和胃镜,而洗胃机、心电图机的院均拥有数不足0.1件.[结论]巴中市卫生院主要设备拥有率低,普通卫生院尤为突出,政府应采取有效措施来提升乡镇卫生院的服务能力.     

在“新农合”下乡镇卫生院医疗模式的转变

<正>1“新农合”给乡镇卫生院带来的影响合作医疗的减免和补偿,使农民在经济上得到实惠,实际提高了农民的有支付能力的医疗卫生服务需求的水平,激励和促进农民有病早治,该就诊的及时就诊,从而规范了病人的就医行为,使乡镇卫生院的就诊病人有了稳定的增长[1]。从而改善了卫生服务利用的合理性,使卫生院的资源得到充分、有效的利用,提高了经济效益,给乡镇卫生院带来经济活力。     

四川省部分贫困地区乡(镇)卫生院基本卫生服务能力现况调查

[目的]了解四川省部分贫困地区在接受卫生项目资助之后乡(镇)卫生院基本卫生服务开展情况,总结经验与不足,为改善贫困地区乡(镇)卫生院提供基本卫生服务的能力,提高居民健康水平提供科学参考.[方法]在某贫困县分层随机抽取3个乡(镇),利用自行设计的问卷对其乡(镇)卫生院进行机构调查;并分层随机抽取87名普通村民进行问卷调查.[结果]各乡镇卫生院的基本设施齐全,开展的基本卫生服务基本能满足居民的需要,但还存在一定的问题.[结论]为改善贫困地区居民健康水平,建议增加对乡镇卫生院的投入,保障基本设施的建设;加强乡镇卫生院卫生技术队伍的建设,保证卫生服务的质量;加强对卫生服务各领域的重视,提高卫生服务能力.     

我国乡镇卫生院发展现状及其影响因素分析

目前，我国乡镇卫生院存在的主要问题是卫生资源效率低、预防保健工作滑坡、对村级卫生机构监管弱化。乡镇卫生院困境产生的主要原因是服务能力不高、卫生服务缺乏活力、基本工作经费得不到保证、农民基本卫生需要与有效需求相差甚大。制约乡镇卫生院发展的主要因素为政府财政对农村卫生的投入总量不足、资源配置不合理、管理体制不适应，没有形成稳定可持续的补偿机制和有活力的运行机制。因此，乡镇卫生院要健康、快速发展，必须明确政府责任，加大改革与投入力度，重视人才培养，加强监管和规范医疗行为。     

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.