加强经济管理促进医院发展

在社会主义市场经济体制下，医院只有加强经济管理，才能促进医院发展。一、转变观念，增强经济管理意识．１９８４年，我院只有３０８名职工，１６１．８７万元固定资产，１６８．２１万元业务收入。医院建设可谓是“稳扎、稳打慢步发展”；到１９９５年底，我院已有９０６名职工，近１亿元固定资产，年业务收入近１亿元，这１１个年头医院建设称得上“大干快上，快步发展”。要总结我院这１１年的发展历程。我最有体会的是“两个转变”；即把医院管理从几十年一贯制的管理模式向经营管理转变；从等、靠、要向自力更生转变．我院在树立管理…     

医院制度创新的探讨

文章探讨了医院制度创新的涵义与意义，同制度创新是医院其它所有创新的基础和前提，我国医院制度创新更为迫切和重要。文章还分析了我国医院制度创新存在的主要问题：各自为政的行业管理；政府对医院的管理职能不清；医院内部改革不足。针对上述问题，提出了我国医院制度创新的对策：实行医疗服务全行业统一管理；转变卫生行政管理职能，逐步实行“管”、“办”分离；重庆抓好医院内部改革。     

领导与管理在医院改革中的关系

目前医院一般不区分领导与管理、领导者与管理者的状况，其实领导与管理应是不同的概念。领导的职能应是：明确办院宗旨，确立医院发展方向与目标；激发职工的工作热情，给职工以战胜困难的信心；掌握对医院能造成影响的重大因素的发展趋势，推动医院改革进程。管理的职能是：制订医院的各项规章制度以及执行程序，组织相关部门落实各项职责，明确部门之间的相互关系，做好人力资源的分配，运用有效手段发现与解决问题，使整体朝着高效地完成既定目标的方向前进。     

医院经济管理的展望与实践

在新世纪之初，回顾近些年医院经济管理的实践，分析其变化及发展趋势，明晰今后发展的对策与方法，将有利于医院顺应社会潮流，抓住发展机遇，拓展优势，提高医院的管理效益。纵观医院经济管理的变化及发展，主要表现为经营管理观念的转变、战略地位的提高、管理职能的拓展、组织结构的变迁、技术手段的科学化和人员素质的提高。在新世纪之初，加强医院经济管理应当注重不断更新经营管理观念，才能适应改革政策下的卫生服务市场；只有拓展经济管理职能，结合医院改革不断创新，才能充分发挥经济管理的效应；需要重组经济管理机构，才能形成合力；必须培养经营管理人才，才能提高管理效益，适应新世纪医院发展的需要。     

在深化改革中加强医院管理的体会

根据军队医院的根本职能和在市场经济条件下，加快医院建设与发展的客观需要。从三个方面总结了加强医院管理的体会。提出管理的核心是做人的工作；管理的基本思路是坚持从严管理、依法管理和综合治理；管理改革的关键是：要处理好履行根本职能和适应新形势加快医院建设的关系，使军队医院既能立足现有条件做好当前的保障工作，又能较快发展适应未来保障任务的需要。     

论公有制医院的产权管理与改革

对产权的概念和医院产权问题的客观性进行了阐述。认为在社会主义市场经济条件下存在的，以公有制为主体，多种所有制结构并存的格局是讨论医院产权问题的前提；政府转变管理职能是明晰医院产权的必然；确立医院市场行为是明晰产权的核心。当前，医院的产权管理存在两方面的问题。而医院改革的当务之急是明晰产权，以加强国资管理，提高卫生资源的利用率，并推进医院的产权改革。     

当前护理工作面临的形势及对策

文章概述了当前军队医院护理工作所面临的主要问题是：护理人员数量不足，难以适应新的护理模式的发展；护理队伍知识结构不合理，难以适应科学技术的发展；护理队伍不稳定，难以适应护理专业建设的需要；护理经费不足，难以适应市场经济发展的需要；护理管理职能不完善，难以适应现代医院管理的需要。针对这些问题，需要采取的对策是：强化护理职能作用；注重培养人才和知识更新；重视对聘用护士的管理和使用；对于非护理岗位占用护理人员应予以控制，提供优质服务，满足不同层次的病人需求。     

推行双向转诊制度合理利用卫生资源

在实际工作中，双向转诊未得到贯彻实施的原因是：三级医院对双向转诊不重视，没有落实转诊患者的查房、随访制度；社区医院在医疗技术、服务水平上难以满足患者的医疗需求；现行医疗保险制度无法解决患者报销问题；双向转诊制度的公众知晓度低。文章提出应通过转变社区医院的管理理念，明确各级医院的职能，制定统一的工作标准和相应的规章制度，完善基本医疗保险政策，加大双向转诊的宣传，将双向转诊工作纳入医院考核等措施，保证双向转诊制度顺利推行。     

新形势下的医院质量保证

医院质量保证面临新的挑战：医学模式和质量观的转变给医院质量保证提出了新要求；高新技术的发展和应用给医院质量保证增加了新内容；社会主义市场经济给医院质量保证带来了新问题。新形势下医院质量保证应具有系统性、中心性、科学性和主动性特点。医院需在原有医院质量保证体系的基础上，对质量观念、质量标准、质量教育内容和质量管理方法加以完善和扩充。     

试论医疗保险对医院发展的推动作用

随着我国社会主义市场经济体制和社会保障体系的逐步建立和完善，医院面临着前所未有的发展机遇。适应医疗保险制度的改革，抓住机遇．转变管理意识和观念，加强内涵建设，提高医疗服务质量，规范医疗行为，降低医疗成本，医院呈现出了稳定、协调、健康的发展势态。     

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.