我国突发公共卫生事件后勤保障、公众教育和人员培训能力现状评价

目的:评价当前我国突发公共卫生事件后勤保障、公众教育和人员培训能力的现状.方法:采用分层抽样随机抽取4个省(市)作为调查样本,采用卫生部统计信息中心编制的<省/地级市突发公共卫生事件应对能力问卷>进行调查.结果:共发放问卷66份,问卷回收率为90.91%.80%的地市(州)有专门机构负责应急物资储备、管理和调配工作,65%的地市(州)制定了应急物资储备清单和标准,35%的地市(州)制定了应急物资储备点的标准,25%的地市(州)制定了突发公共卫生事件应急储备物资定期检测、维护和更新管理办法,45%的地市(州)制定了日常工作财政预算,27%的地市(州)建立了应急资金的储备标准,28%的地市(州)制定了应急储备资金紧急调用程序,4省(市)后勤保障子问卷平均标准得分为43.33,总体均数的95%置信区间为(35.65～51.01).25%的地市(州)在近2年中开展培训需求调查,53%的地市(州)制定了应急人员培训规划,20%的地市(州)制定了应急人员培训效果评价办法,80%的地市(州)指定了专门机构负责公众教育工作,23%的地市(州)制定了公众教育管理办法.4省(市)公众教育和人员培训子问卷标准得分均数为47.43,总体均数的95%置信区间为(40.69～54.17).结论:当前我国突发公共卫生事件后勤保障、公众教育和人员培训能力方面尚存在不少问题,各级政府应迅速采取措施加强这几方面的能力.     

Health technology assessment in Canada: diversity and evolution

Canada has health technology assessment programs at national, provincial and local levels. The programs have been complementary in providing advice to decision makers in health care. A national strategy for the management of health technologies is expected to strengthen communication with policy areas.     

Alberta''s Rural Physician Action Plan: an integrated approach to education, recruitment and retention

This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.     

Cost of primary health care services in the emergency department and the family physician's office.

An attempt has been made to determine the true cost of providing primary health care for nontraumatic conditions in the emergency departments of two hospitals in Ontario and in the offices of family physicians. A total of 1117 patients presenting with 1 of 10 common symptom/sign complexes at the emergency departments or the offices of 15 participating family physicians were studies with regard to number of visits made, type of assessment by the physician, investigations undertaken, management, therapy and outcome of the illness. Costs were calculated from the charges that would be made against the provincial health services insurance plan and from the system of hospital financing in effect in the province. The average true cost per illness episode of this type of care was $14.63 in hospital A, $14.20 in hospital B and $15.90 in the family physician's office.     

Forging local level partnerships to make health programs possible

The quintessential difference between most successful rural health programs and unsuccessful ones is local leadership. The ways in which a community invites, values, develops, nurtures, and supports the involvement of diverse stakeholder groups form an important part of the base for local rural health program success. Successful programs are initiated by local stakeholder groups who are committed to collaboration, have a working governance structure, a good understanding of their health and healthcare challenges, and a plan for sustainability. A key first step for rural community health planning is to contact one's local state Office of Rural Health. Most ORHs will provide information, guidance, and technical assistance. There are many challenges in rural health, but there are also great successes. North Carolina communities fare better than many because the North Carolina Office of Rural Health has demonstrated how effective state and local leadership work together to directly benefit rural communities and rural people.     

浅谈实验动物饲养管理和使用计划中 “灾难计划”的制定与实施

作为一个健全的实验动物饲养管理和使用计划的必须组成部分,"灾难计划(disaster plan)"的制定对任何研究机构均是非常重要的。目前,国内多数实验动物饲养和使用机构均会制定一份突发事件下的紧急预案(emergency operation plan,EOP),但多数机构均没有制定完善的运营连续性计划(business continuity plan,BCP)。本文将就"灾难计划"中"灾难"的定义、如何制定和实施完善的"紧急预案"、如何制定和实施完善的"运营连续性计划"等内容分别进行浅述,以期呈现一个完整并专业的实验动物饲养管理和使用计划中的"灾难计划"。     

Civil Emergency Planning in Canada

The national objectives of civilian emergency planning are: (1) protection and preservation of life and property; (2) maintenance of governmental structure; and (3) conservation of resources. The Canada Emergency Measures Organization (E.M.O.) has been developed to accomplish these objectives. E.M.O. co-ordinates other departments and agencies of federal government and its organization is reflected within provincial and municipal governments.

Present E.M.O. accomplishments include: an attack warning system; an emergency broadcasting system; emergency government facilities; 400 emergency measure organizations across Canada; plans to implement general readiness; a medical stockpile; and “shadow agencies” for control of housing, food and manpower.

Present undertakings include: a national survey of fallout shelters; the equipping of the radiation defence (RADEF); the pre-positioning of the items of the medical stockpile; and the training at the Canadian Emergency Measures College at Arnprior.

     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

我国突发公共卫生事件风险识别、评价和缓解能力的现状

目的了解我国突发公共卫生事件风险识别、评价和缓解能力的现状。方法采用分层抽样随机抽取4个省(市)作为调查样本,采用卫生部统计信息中心编制的《省/地市级突发公共卫生事件应对能力评价问卷》进行调查。结果共发放问卷66份,问卷回收率为90.91%。58%的地市(州)识别了当地可能发生的突发公共卫生事件,28%的地市(州)对所识别的突发公共卫生事件进行了风险评价,8%的地市(州)对当地易发生事故的厂矿企业及大型设施进行了风险评价,10%的地市(州)根据风险评价结果确定了当地突发公共卫生事件工作重点,10%的地市(州)针对主要突发公共卫生事件制定了专门预防策略,5%的地市(州)对当地居民的脆弱性进行了评估,57%的地市(州)开展过或正在开展应对能力评价工作,4省(市)突发公共卫生事件风险识别、评价和缓解能力的平均标准分为24.05,总体均数的95%置信区间为(18.32,29.77)。结论风险识别、评价和缓解工作在我国的突发公共卫生事件管理中重视程度不够,政府应采取措施提高此方面的应对能力。     

上海市消除疟疾行动计划中期评估报告

疟疾曾是上海市的主要传染病之一,建国后曾发生过两次流行,经过大力防治疟疾疫情得到有效控制,1983年疟疾各县年发病率降至1/万以下,1986年通过卫生部基本消灭疟疾的考核验收,此后,全市进入全面监测和流动人员管理阶段。20世纪90年代以后,受其他疟疾流行省份的影响,全市疟疾疫情略有波动,但基本控制在1/10万以下。2009年上海作为全国6个试点省（市）之一,率先启动了消除疟疾试点工作,2010年按全国统一行动全面实施消除疟疾行动计划,并确定到2015年全市实现消除疟疾的目标。2012年原闸北区和松江区两个消除疟疾国家试点县通过了原卫生部组织的现场考核,率先达到消除疟疾标准,2015年黄浦等其他15个区（县）在完成自评的基础上,通过市级考核评估,同年上海市完成全市消除疟疾自评,并向国家卫生计生委提交自评报告和验收评估的请示。2017年国家卫生计生委组织专家对上海市的消除疟疾工作进行评估,认为上海市达到省级消除疟疾目标。至此,上海市成为全国第一个通过省级消除疟疾评估的地区。面临输入性疟疾的再传播风险和维持消除疟疾状态的挑战,上海市已然开始探索维持消除疟疾状态的工作模式。     

Emergency Health Supplies: Present Status of Procurement and Control

Until recently there was no substantial reserve of health supplies in Canada capable of supporting major peacetime or wartime disasters. In 1952, an $18,000,000 stockpile was authorized by the Federal Government of Canada. Purchases were made to a total of $15,500,000 with deliveries to exceed $13,000,000. Over $6,000000 worth of supplies was distributed to eight regional depots across Canada in safe and strategic locations. Plans were made for release and control of supplies to provincial governments for use at all levels of control, and a Resources Planning Unit has been organized. In Canada, undergraduate students in pharmacy receive special civil defence instruction in emergency health supplies service.     

高等医学院校医学生灾难医学教育课程的设计开发

目的 为本教研室的医学生提供结构化的教育指导和资源,开发和设计灾难医学课程。方法 采用医学教育课程开发六步法作为组织流程,急诊及灾难医学专家的专业知识、文献检索灾害医师培训计划、科学证据,作为内容开发的基础。结果 最后课程由14个模块组成,每个模块教学事件2 小时。介绍灾难医学概念,包括灾难的响应、医疗救助、法律条款、指挥、协调、沟通和大规模灾难的管理。综述全球灾难援助的医院预案和经验。讨论灾难发生条件下挽救生命的急诊治疗与有限的个人治疗。介绍爆炸、战争、辐射/核事件、化学和生物事件尤其是传染病和恐怖袭击初始处理的特殊性。灾难疏散的演习,大规模灾难分诊分流与当地救灾机构合作的模拟。当地消防部门合作演练个人去污与净化。人体模型复苏练习,个人防护设备应用练习。职业道德、应激疾病、社会心理干预措施和质量改进的培训。结论 该课程设计提供了合理的时间框架、多学科、多实践的灾难医学教育模式,可以作为医学生灾难医学教育的基本模板。因其具有全面灵活的组织结构,其进一步深化,也有利于急救或灾难专业医疗学生的灾难医学教育课程     

Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?

The committee of inquiry into the outbreak of food poisoning at Stanley Royd Hospital identified serious deficiencies in the management of the outbreak and urged all health authorities to learn from the incident and prepare adequate plans for dealing with any future outbreaks. A survey of district health authorities in England showed that most authorities do not yet have a written plan or that their plans are incomplete and inadequate. The appreciable resistance to such planning suggests that most health authorities would be unable to deal with outbreaks of food poisoning effectively and efficiently.     

Mitigating the health impacts of a natural disaster--the June 2007 long-weekend storm in the Hunter region of New South Wales

A severe storm that began on Thursday, 7 June 2007 brought heavy rains and gale-force winds to Newcastle, Gosford, Wyong, Sydney, and the Hunter Valley region of New South Wales. The storm caused widespread flooding and damage to houses, businesses, schools and health care facilities, and damaged critical infrastructure. Ten people died as a result of the storm, and approximately 6000 residents were evacuated. A natural disaster was declared in 19 local government areas, with damage expected to reach $1.5 billion. Additional demands were made on clinical health services, and interruption of the electricity supply to over 200,000 homes and businesses, interruption of water and gas supplies, and sewerage system pump failures presented substantial public health threats. A public health emergency operations centre was established by the Hunter New England Area Health Service to coordinate surveillance activities, respond to acute public health issues and prevent disease outbreaks. Public health activities focused on providing advice, cooperating with emergency service agencies, monitoring water quality and availability, preventing illness from sewage-contaminated flood water, assessing environmental health risks, coordinating the local government public health response, and surveillance for storm-related illness and disease outbreaks, including gastroenteritis. The local ABC (Australian Broadcasting Corporation) radio station played a key role in disseminating public health advice. A household survey conducted within a fortnight of the storm established that household preparedness and storm warning systems could be improved.     

Screening Mammography Program of British Columbia: pattern of use and health care system costs

BACKGROUND: The use of mammography for screening asymptomatic women has increased dramatically in the past decade. This report describes the changes that have occurred in the use of bilateral mammography in British Columbia since the provincial breast cancer screening program began in 1988. METHODS: Using province-wide databases from both the breast cancer screening program and the provincial health insurance plan in BC, the authors determined the number and costs of bilateral mammography services for women aged 40 years or older between Apr. 1, 1986, and Mar. 31, 1997. Unilateral mammography was excluded because it is used for investigating symptomatic disease and screening abnormalities, and for follow-up of women who have undergone mastectomy for cancer. RESULTS: As the provincial breast cancer screening program expanded from 1 site in 1988 to 23 in 1997, it provided an increasing proportion of the bilateral mammographic examinations carried out each year in BC. In fiscal year 1996/97, 65% of bilateral mammographic examinations were performed through the screening program. The cost per examination within the screening program dropped as volume increased. Thirty percent more bilateral mammography examinations were done in 1996/97 than in 1991/92, but health care system expenditures for these services increased by only 4% during the same period. In calendar year 1996, 21% of new breast cancers were diagnosed as a result of a screening program visit. INTERPRETATION: Substantial increases in health care expenditures have been avoided by shifting bilateral mammography services to the provincial screening program, which has a lower cost per screening visit.     

Impact of government regulations on two management and clinical information systems in a medical school environment

Administrative and legal requirements and, in particular, federal and state government health care assistance and social services program regulations all combine to add complexity to the management and operation of ambulatory and inpatient health programs. This paper describes how constantly changing government regulations and differences in interpretations and definitions have been expensive, time-consuming and sometimes detrimental to health care delivery for two large management and clinical computer-based information systems.     

Cost containment education efforts in United States medical schools.

Noting the increasing nationwide concern with factors relating to rising health care costs, the Association of American Medical Colleges surveyed 119 U.S. medical schools in the summer of 1978 to ascertain the degree of program activity in the area of cost containment education. A 100 percent response was achieved. An analysis of this data indicates that considerable activity is underway. Forty-one institutions (34 percent) have programs underway or planned specifically to teach health care cost containment to undergraduate medical students or residents or both. The majority of such programs were introduced during the past two years. The costs of such programs are fairly modest, averaging $22,680 per year. Respondents indicated that further activities might be enhanced by development of a primer for faculty and students on elements of cost containment education and the organization of a series of regional workshops related to this subject.     

India increases spending on health

The government of India announced that the fifth Five-Year Plan (1974-1979) will provide a total of $2,316,000 for health, family planning and nutrition programs. During the next five years emphasis will be placed on increasing the accessibility of health services to rural areas, correcting the uneven distribution of medical manpower, intensifying control of communicable diseases, and improving educational training of health personnel at all levels. The family planning program will continue to receive the highest priority. The main goal will be to achieve a reduction of the birth rate to approximately 30/1000 population. Methods of family planning in India include IUD insertion, sterilization, oral contraception and the presently very popular vasectomy.     

Cost analysis of a provincial drug program to guide the treatment of upper gastrointestinal disorders

BACKGROUND: Concerned with the rising costs of its drug programs for seniors and social-assistance recipients, the government of Newfoundland and Labrador requested physicians and pharmacists at the Memorial University of Newfoundland, and members of the Newfoundland and Labrador Medical Association and the Newfoundland Pharmaceutical Association to provide guidance to the health care community for the use of drugs to treat upper gastrointestinal disorders. METHODS: Algorithms for the management of dyspepsia and gastrointestinal reflux disease were created and distributed to all physicians and pharmacists in the province in June 1996. On July 1, 1996, the provincial government implemented a program to restrict payment for proton-pump inhibitors through its drug programs to situations defined by the algorithms. Restrictions were not applied to the prescribing of cimetidine, ranitidine and prokinetic agents. The status of famotidine and nizatidine was changed from "open benefit" to "special consideration," which requires prescribers to request authorization of their use on a case-by-case basis. RESULTS: Between July 1 and Dec. 31, 1996, 973 of 1078 requests for a proton-pump inhibitor were approved (679 for gastroesophageal reflux, 186 for Helicobacter pylori eradication, 55 for ulcer treatment and 53 for other reasons). The program resulted in a sustained reduction in drug expenditures. Total drug expenditures, which had risen from $39.0 million in 1992/93 to $50.8 million in 1995/96, fell after implementation of the program to $46.4 million in 1996/97 because of a decrease of more than 80% in the use of proton-pump inhibitors. Expenditures on proton-pump inhibitors, which had increased from $0.7 million for the 6 months ending March 1993 to $1.6 million for the 6 months ending March 1996, decreased to $0.3 million for the 6 months ending March 1997. The use of H2-antagonists, but not prokinetic agents, increased concomitantly with the decline in proton-pump inhibitor use. Compared with the year preceding implementation of the program, annual combined expenditures in the subsequent 3 years for H2-antagonists, prokinetic drugs and proton-pump inhibitors were reduced by $1.6 million, $1.7 million and $1.0 million, respectively. Feedback from physicians and pharmacists was supportive for the clinical information and prescribing guidelines. Concerns were mostly limited to process issues. INTERPRETATION: The program, designed by health care professionals, approved by health care associations and implemented by the province of Newfoundland and Labrador to guide the treatment of upper gastrointestinal disorders, has achieved a substantial reduction in drug expenditures.     

Emergency Blood Services

The prime and essential function of any emergency blood service is to provide ample supplies of blood and blood derivatives to the medical services operating in the post-nuclear disaster period with as much despatch and precision as possible. To meet these needs, a plan has been devised in Canada whereby 600,000 units of whole blood may become available for the treatment of an estimated 200,000 living casualties in the two- to three-week period immediately following a national disaster. The disaster organization is based upon the existing Canadian Red Cross Blood Transfusion Service which is currently providing blood and blood fractions to all hospitals, coast to coast, through its 16 depots.

The key to the emergency operation is the establishment of shadow depots in preselected sites 50 to 75 miles from the existing depots and in places free of fallout.

Stockpiling of essential blood transfusion supplies and equipment, along with a peace-time training program of essential personnel, is a prerequisite for the success of the plan.