急诊检验应与等级医院相适应

急诊检验应与等级医院相适应陈虹作者单位：２２３３００江苏省淮阴市第一医院检验科依江苏省县级以上医院《检验科建设管理规范》（简称规范），目前，县级以上医院检验科急诊检验临检类有：血液检验；大、小便及脑脊液检验；临床生化类：二氧化碳结合力、尿素氮、淀粉酶...     

医院检验科日常标本在科研中的应用与管理

医学科研是医院工作的重要内容，没有科研就没有医学技术的创新和发展。检验医学科研包括：①检验技术的创新和应用；②立足检验技术（实验室技术），研究新的检测指标在疾病诊断、预防和观察疗效等方面的临床价值（实验诊断）；③为新的治疗措施提供疗效方面的循证依据等方面。检验医学科研是临床科研的重要组成部分。     

血常规检验项目与LOINC术语的对照

目的通过试验性地进行白求恩国际和平医院检验科血常规检验项目与观测指标标识符逻辑命名与编码系统（logical observation identifier names and codes，LOINC）标准术语的对照，探索中文本地临床观测指标与LOINC标准术语对照的原则与方法。方法检验科血常规检验项目来自本院实验室信息系统（LIS）的检验项目字典；中文LOINC数据库依据2．14版英文LOINC数据库编制；基于Visual Basic的自编辅助对照程序用来搜索相关LOINC术语，并将合适的LOINC代码对照至本地检验项目。结果完成了检验科血常规检验项目与LOINC数据库的计算机辅助对照，并且获得检验科血常规检验项目本地术语与LOINC术语的对照关系表。结论结果表明，采用中文LOINC数据库作为英文LOINC数据库的语言接口，借助计算机辅助对照程序，能够有效地将检验项目字典中的本地术语与LOINC术语关联对照起来。该研究不失为一次有益的尝试，其实践经验、指导原则和实现方法，在一定程度上将为今后实现我国医院、疾病预防与控制中心等医疗卫生机构信息系统中实验室及临床观测指标命名与编码的标准化奠定工作基础。     

我院检验科质量管理体系岗位设置探讨

检验科主要是为临床医生和患者及时提供可靠有效个体健康和疾病状况的检验数据,并有效转化为更高层次的诊断信息.随着ISO15189标准化认证的逐步深入及美国病理学家学会(CAP)标准在国内的较为广泛的应用,检验科的软件和硬件设施都得到了大幅度的提升.但是,对检验科如何进行合理的岗位设置,并针对不同教育背景和不同级别的工作人员进行岗位培训,如何合理地利用目前的人力资源等问题,尚未达成共识[1-4].为此,我院在不断完善检验科标准化、规范化管理制度的基础上,建立了一整套教学质量管理体系,将检验科的岗位从不同系统工作的角度进行了合理的规划和分配,明确了各体系运行的具体规则和岗位职责分布,每一级岗位目的明确,职责分工清晰,使各级人员的管理更加有序规范.     

淮安市二、三级医院检验科人力资源现状调查分析

目的：调查分析淮安市二级以上医院检验科人力资源现状。方法：采用横断面调查方法于2018年4月对淮安市19所二、三级医院检验科人员的年龄、学历、职称构成、检验科各实验室人力资源分配等现况进行调查分析。结果：医院实际床位数与检验人员比例为20-71∶1，平均33∶1；检验科血液体液实验室及急诊实验室初级职称人员比率显著高于其它实验室（P < 0.001），分子生物实验室研究生学历人员比率最高，达33%；各层级医院<30岁人员比率均高于其它年龄段，三级医院≥50岁人员比率显著高于二级医院（P < 0.05），各层级医院职称构成无显著差异。结论：淮安市二级以上医院检验科人力资源配置需要进一步规范，各实验室人力资源配置有待进一步优化。     

丽水市学生艾滋病相关因素调查分析

[目的]分析丽水市学生艾滋病知识掌握程度，为健康干预提供依据。[方法]分为大学生、高中生、初中生3个层次整群抽样，确定调查对象，制定调查表进行匿名问卷调查。[结果]共调查学生258人，男女比1：1；其中大学生51人，高中生104人，初中生103人；被调查者中听说过艾滋病的占97．7％；艾滋病知识知晓率约74．8％，男女生类似（M-W检验，Z＝－0．755，P＝0．450）；不同的问题知晓率不同，大学生与高中生艾滋病知识知晓情况类似（Z＝－0．218，P＝0．827），但高于初中生（Z＝－4．41，P＜0．05）；没有发现有吸毒行为的学生；有过性交行为的学生占6．6％，男女生类似，而大学生要高于高中生与初中生，性交过程中安全套的使用率不高，且使用安全套的目的主要是为了避孕。[结论]应就不同学校、不同知识有针对性地加强学生艾滋病知识的宣传教育。     

检验科人员手微生物监测及消毒方法探讨

目的：为了解医院检验科人员手的污染状况，寻找简单、有效的消毒方法。方法：对我院检验 科3种岗位的工作人员的手进行了98人次的微生物监测；并采用3种不同的手消毒方法消毒后进行比较。结果：98只手均有不同程度的污染，采用1：500“消佳净”消毒液洗手后，微生物数量明显减少，与其他方法呈差异显著。结论：提示检验科人员手污染严重，采用1：500“消佳净”消毒液浸泡后自然干燥，消毒方便、有效。     

汕头市社区女性居民登革热防治知识态度行为调查

目的了解汕头市18-60岁社区女性居民登革热防治知识、态度、行为，为登革热防治制定相应的健康教育模式提供科学依据。方法采用多阶段随机抽样方法，抽取汕头市18-60岁社区女性居民，由经专门培训的调查员采用面对面访谈的方式进行问卷调查，对调查资料进行描述性统计和x^2检验分析。结果共调查791名女性居民，对登革热防治知识3个基本问题均答对率68．65％（543人）。答对率中，本地人口高于流动人口（x^2=5．78，P=0．016）；各年龄组不同（x^2=12．14，P=0．007），各年龄组答对率在59．43％～78．75％之间，答文化层次不同（x^2=111．27，P=0．000），随着文化层次的提高，答对率从16．67％（文盲）上升到87．50％（大专或以上）；各职业人群答对率均不同，教师最高，离退体人员最低（x^2=77．28，P=0．000）。结论社区女性居民登革热防治知识、态度和行为水平不高，存在相关知识与行为不一致的现象，改变种养水生植物的不良社会习性，干预的重点可放在文化层次较低的人群、老年人群。     

80株伤寒沙门氏菌耐药性分析

８０株伤寒沙门氏菌耐药性分析大连石油化工公司职工医院检验科（１１６０３１）邵本令大连市第六人民医院检验科（１１６００１）张淑荣我院１９９２年从患者不同标本中获得伤寒杆菌８０株，其血培养５８株，便培养２２株，对８０株伤寒沙门氏菌以Ｋ－Ｂ法选择１３种药物...     

作者投稿须知——层次标题的设计

层次标题应与文章题名有相同的要求，即应用简明得体的词语表达文章、条的特定内容。具体要求：（1）同一层次的标题，应表达同一层次的内容；（2）同一级标题应尽量讲究排比，即结构相似、意义相关、语气一致；（3）不同层次的标题，有上下关系者，在内容上应互相联系。（4）层次标题前要有层次序号，层次序号以1、1．1、1．1．1．．．…表示，但注意分层不要超过4层；（5）只要有层次序号，其后即应有小标题；（6）层次标题应该是短语结构，不要出现动宾结构；（7）注意层次标题不要过长，一般为15个字左右。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.