新冠疫情背景下社区医护人员公共卫生应急能力自我认知调查

目的 通过对新冠疫情背景下社区医护人员公共卫生应急能力的调查分析,并分析其主要影响因素,以期为政府卫生决策、医院管理决策等提供参考。方法 对广州市越秀区所有社区卫生服务中心的838名医护人员开展匿名问卷调查,被调查者根据自身实际情况进行公共卫生应急能力自评;对数据采用单因素方差分析和多元线性回归分析识别主要影响因素。结果 问卷有效回收率99.16%;全区医护人员平均得分为193.23±30.56,公共卫生应急能力整体较好,各维度中“预防能力”得分最低;多元回归分析结果显示“是否具有应急救援经历”是其最大影响因素(F=14.617, P＜0.001),其次是“应急培训经历”和“综合性医院工作经验”(F=14.617, P＜0.001)。结论 后疫情时代应重点提升公共卫生应急预防能力,定期组织医护人员开展应急救援培训演习、经验交流;优化基层社区资源配置,落实医护人员人文关怀;多方配合共建防御壁垒,提高居民应急救援能力与意识。     

Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers

Objectives

Numerous interventions seeking to increase preparedness for pandemic influenza have been implemented, but low compliance of healthcare providers has been reported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital managers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time.

Study design

A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' perceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters.

Methods

Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sciences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza.

Results

All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R² = 0.346, P = 0.002). Inclusion of preparedness evaluations explained an additional 15% of the variance (R² change = 0.146, P = 0.026). An increase in mean total score for emergency preparedness was found in the second evaluation compared with the first evaluation.

Conclusions

Familiarity with guidelines and preparedness evaluations affect the perceptions of healthcare managers regarding preparedness and capability to manage pandemic influenza.     

提高县级疾病控制中心分析决策能力培训效果评价

目的评价提高县级疾病控制中心专业人员应对突发公共卫生事件分析决策能力培训效果。方法通过培训前后的测试和问卷调查,比较培训前后的专业技能水平及培训满意度,从教与学两个方面进行评价。结果通过培训,学员的专业技能水平有了明显提高,及格率从40.79%提高到100.00%,平均分从55.06分提高到81.63分,统计分析显示,培训前后的专业技能得分有统计学差异(P<0.001);培训前不同性别、年龄、文化程度、所学专业、从事业务人员的专业技能水平均无统计学差异(P>0.05),而培训后学历高、所学专业为预防医学、从事业务为流行病学人员的专业技能提高程度显著高于其他人群(P<0.05);80%以上的学员对培训的效果感到满意,提示教与学都达到了预期设想的目标和要求。结论提高县级疾病控制中心专业人员应对突发公共卫生事件分析决策能力培训的模式和方法是有效的,该模式值得推广。     

哈尔滨市疾病预防控制机构突发公共卫生事件应对能力现况与评价

目的了解哈尔滨市基层疾病预防控制体系中突发公共卫生事件应对能力的现况,并评估其机构和人员应对能力的强弱,找出应急体系建设的相关问题,针对问题提出改善措施。方法采用统一的调查问卷对哈尔滨市18所区（县）疾控机构及相关应急管理人员进行调查,并对每项调查结果赋分,最终汇总计算的分值,作为每个疾控中心的最终结果。结果各疾控机构学历、职称分布不均衡;应急准备和响应能力整体情况较好;各辖区疾控部门协作较少;各疾控部门检验能力、演练频次、业务培训内容有待提高。结论通过对区（县）级疾控机构应对突发公共卫生事件能力进行全面评价,找出其特点和薄弱环节,进而采取有针对性的改进措施,以提高突发公共卫生事件应对能力,完善基层疾控机构完善应急体系。     

突发公共卫生事件卫生监督应急能力现况分析

目的通过对上海市某区突发公共卫生事件卫生监督应急能力的现况调查,分析在突发事件中区县卫生监督存在的主要问题,有针对性的提出相应对策。方法运用已建立的突发公共卫生事件应急能力评价指标体系,结合应急处置人员调查问卷及能力测试卷,以某区卫生局卫生监督所为个案进行应急能力现况评价。结果某区突发公共卫生事件卫生监督应急处置评价指标的总得分为80.2分,能力评价为良好。一级指标中过程的得分率最高为82.11%,结果次之为81.29%,结构的得分率最低为76.77%。二级指标中的经费保障、设置现场检测实验室、检测仪器设备数量种类、人员业务技能水平、职能行使以及制度建设的得分率相对较低。结论某区卫生局卫生监督所的应急能力基本满足实际工作需要,但在人员能力和仪器设备等方面还需要加强建设。     

因子分析法的公众应急准备情况影响因素研究

摘要：目的　用因子分析方法探讨公众应急准备状态的影响因素。方法　随机选取４６８名黑龙江省哈尔滨
市居民为调查对象,调查可能影响公众应急准备状态的２３项因素,对２３项影响因素进行了初始因子分析
和方差最大旋转。结果　２３项影响因素间存在６个主要公因子,其中第１公因子主要反映的是公众学习应
急知识、参与应急培训演练、思考及探讨应急逃生计划等应急准备行为情况;第２公因子主要反映的是公
众对于突发事件、应急准备的认知情况;第３公因子主要反映的是公众对于生活工作学习的场所发生自然
灾害、事故灾难、公共卫生、社会安全类事件的可能性大小的判断情况;第４公因子主要反映的是公众对
增强风险意识、保持警惕、做好应急准备的重要性认识情况;第５公因子主要反映的是公众对应急内容、
掌握应急知识、技能以及探讨应急类话题的态度情况;第６公因子主要反映的是公众对于探讨应急类话题
的凶吉认识、应对突发事件责任认识等的应急心理情况。结论　加强公众的应急准备能力,需要从公众的
应急准备行为、应急认知、风险判断、风险意识、应急态度、应急心理等多个方面来进行干预。
关键词：因子分析;公众;应急准备情况;影响因素
中图分类号：Ｒ１９７　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０３ ０１６６ ０４     

浅谈医院在应对突发公共卫生事件中的能力建设

医院作为医疗卫生系统的重要机构,是突发公共卫生事件应急体系的关键组织,面对危及公众健康的突发性公共卫生事件,医院应对公共卫生突发事件的监测能力、预防能力、应急能力、救治能力和保障能力水平的高低,直接决定着公共卫生事件应急体系效能的发挥。为此,医院必须加强应对突发公共卫生事件的能力建设。     

Public Health Emergency Preparedness at the Local Level: Results of a National Survey

Objective. To study the relationship between elements of public health infrastructure and local public health emergency preparedness (PHEP).
Data Sources/Study Setting. National Association of County and City Health Officials 2005 National Profile of Local Health Departments (LHDs).
Study Design. Cross-sectional.
Principal Findings. LHDs serving larger populations are more likely to have staff, capacities, and activities in place for an emergency. Adjusting for population size, the presence of a local board of health and the LHDs' experience in organizing PHEP coalitions were associated with better outcomes.
Conclusions. The results of this study suggest that more research should be conducted to investigate the benefit of merging small health departments into coalitions to overcome the inverse relationship between preparedness and population size of the jurisdiction served by the LHD.     

突发公共卫生事件应急防控体系建设刍议

本组资料介绍了突发公共卫生事件的含义和种类,分析了我国应对突发公共卫生事件存在的主要问题①公共卫生投入不足,应急储备薄弱;②突发公共卫生事件应急组织机构不健全,初期应急指挥不力;③公共卫生信息网络不健全,突发事件监测预警不力。就建立健全突发公共卫生事件的应急防控体系提出了几点建议①加强突发公共卫生事件的社会防控体系;②加强医院突发公共卫生事件的专业队伍建设。     

社区公共卫生应急能力指标体系构成要素研究

目的 探索社区公共卫生应急能力指标体系构成要素,为构建社区公共卫生应急能力评价指标体系提供参考依据。方法 研究利用系统文献检索和文本分析方法,对2003年“非典”以来突发公共卫生事件社区应急能力评价指标的中英文文献和相关政策文件进行分析,对科学性、相关性均较高文献中提出的要素进行了归纳整理,形成社区公共卫生应急能力指标体系构成要素框架。结果 本研究形成了社区公共卫生应急能力评价指标体系构成要素框架,包括6类一级要素和47项二级要素,可为进一步构建社区公共卫生事件应急能力指标体系提供参考。     

张家港市突发公共卫生事件应对能力调查

目的 调查张家港市突发公共卫生事件应对能力,为完善应急预警体系提供依据.方法 设计调查问卷内容,抽取10家医疗卫生单位共49名工作人员进行访问调查.结果 疾病预防控制人员突发公共卫生事件相关知识的知晓率达100%,医务人员对<中华人民共和国传染病防治法>、<突发公共卫生事件应急条例>规定的报告病种、甲类传染病报告病种知晓率达93.3%～100%,其他知识知晓率相对较低,为53.3%～73.3%.调查对象所在单位能应对的优势病种是肝炎、霍乱、流行性感冒、食源性疾病,而鼠疫、炭疽、不明原因疾病、职业中毒、射线危害、自然灾害等疾病或事件不能很好独立应对,对生物恐怖事件不能应对.结论 张家港市突发公共卫生事件相关知识的总体知晓率高,一般事件或疫情应对能力强,医务人员知晓率需进一步提高.     

Community Health Centers and Emergency Preparedness: An Assessment of Competencies and Training Needs

Community health centers (CHCs) provide care to a large number of medically underserved Americans. As primary care providers and trusted members of their communities, CHCs need to be prepared to respond to emergency and disaster situations, as they may be relied upon for medical care and other support services. Focus groups were conducted with CHC medical directors and administrators from New York City. Participants discussed previous emergency preparedness training, future training needs, applicability of competencies, and usefulness of two training programs. Participants indicated that they had more experience with preparedness training than many of their colleagues, although participants still reported further training needs. In particular, emergency roles and responsibilities, decontamination and containment, and personal preparedness were given as needed training topics for staff. The training resources were reported to be useful and beneficial. Participants also reported that most of the competencies were appropriate for CHC clinicians. During an emergency, people want to receive care from their normal provider, and for many, that provider is a CHC. This and other research suggests that the emergency preparedness needs facing CHCs are significant and should be addressed.     

2015年北京市职业人群应急准备现状及影响因素分析

目的 了解北京市职业人群应急准备现状及其影响因素,为制定干预策略提供依据。 方法 采用多阶段分层整群抽样方法,选取北京市18岁以上职业人群800人于2015年进行问卷调查, 调查内容包括基本情况、应急准备量表、应急经历与判断、应急知识与技能、能力建设相关活动参与情况等内容。运用χ²检验进行单因素分析,应用logistic 回归进行多因素分析。 结果 北京市18岁以上职业人群仅有2.6%的职业人群表示已经做好了各种应急准备行动,22.3%的人不计划采取任何准备行动。应急准备测评总体平均分(3.28±0.47)分,应急意识、应急态度、应急心理与文化、应急准备行为倾向、应急知识与技能各维度平均分分别为(2.91±0.79)、(3.45±0.67)、(3.36±0.55)、(3.09±0.88)、(3.63±0.81)分。职业人群不做应急准备的原因主要为不知道应该做什么(55.2%)。女性、卫生相关技术人员、居住房屋类型为高层有电梯人群、购买商业保险人群、接受过应急教育/培训、演练以及应急意识、应急态度、应急心理和文化、应急准备行为和应急知识与技能5个方面平均分≥4 分者应急准备率较高,分别为29.5%、45.9%、32.6%、31.3%、39.9%、40.5%、44.3%、36.7%、39.4%、43.7%和33.3%。logistic回归分析显示:购买商业保险[P=0.15,OR=1.582, 95%CI(1.092～2.292)]、接受宣传/培训[P=0.006,OR=2.348,95%CI(1.279～4.311)]、应急准备行为倾向[P=0.003,OR=2.026,95%CI(1.280～3.207)]是职业人群应急准备水平的影响因素。 结论 北京市职业人群的应急准备情况有待提高。需要加强对职业人群的应急教育/培训,培养风险意识,提高应急知识与技能水平,提升应急准备水平。     

基于岗位胜任力的培训模式在突发公共事件卫生应急救援培训中的应用

目的分析岗位胜任力培训模式在突发公共事件卫生应急救援培训中的应用价值。 方法以2016年3月至2018年3月某医院内部46名医护人员作为研究对象,其中男性18例,女性28例;年龄24～45岁,平均(35.28±2.31)岁。采用随机数字表法,将其分为试验组和常规组,每组医护人员23人。试验组采用的培训模式是岗位胜任力培训模式,常规组采用的培训模式是常规性培训模式。比较两组医护人员岗位胜任能力以及患者的反馈分值和患者满意度。 结果培训后,试验组医护人员的响应时间、院内分诊时间、输液通道开通时间、抢救措施落实时间、完成分流时间、患者停留时间均优于常规组,差异有统计学意义(P<0.05)。培训后,两组医护人员的理论成绩和操作成绩均高于培训前(P<0.05),但试验组优于常规组,差异有统计学意义(P<0.05)。培训后,试验组患者标准化反馈分值高于培训前,(P<0.05),且优于常规组,差异有统计学意义(P<0.05)。培训后,试验组和常规组对应的患者满意度分别为95.00%、77.50%,常规组低于试验组,差异有统计学意义(P<0.05)。 结论在面临突发公共事件卫生时,对医护人员在应急救援培训中采用岗位胜任力的培训模式,具有较好的效果,值得广泛应用于应急救援培训中。     

我国公共卫生危机管理应对机制研究

公共卫生危机事件具有突发性、公共性、多样性、复杂性、高频化、社会危害严重性、全球流动性等特征,可能对公众健康和生命安全、社会经济发展、生态环境等造成不同程度的危害,严重影响着社会经济发展.而我国的危机管理工作起步较晚,公共卫生危机管理应对机制和体系建设方面存在着诸多不足.本文以危机管理理论的视角,分析了我国公共卫生危机管理的现状,提出从法制体系、协调机制、信息管理、人力资源保障、社会动员五个方面建构我国可持续发展的公共卫生危机管理体系,旨在建立健全公共卫生危机管理机制,提高政府公共卫生危机处理能力.     

Vaccine-related standard of care and willingness to respond to public health emergencies: A cross-sectional survey of California vaccine providers

Introduction

Responding to a vaccine-related public health emergency involves a broad spectrum of provider types, some of whom may not routinely administer vaccines including obstetricians, pharmacists and other specialists. These providers may have less experience administering vaccines and thus less confidence or self-efficacy in doing so. Self-efficacy is known to have a significant impact on provider willingness to respond in emergency situations.

Methods

We conducted a survey of 800 California vaccine providers to investigate standard of care, willingness to respond, and how vaccine-related standard of care impacts willingness to respond among these providers. We used linear regression to examine how willingness to respond was impacted by vaccine-related standard of care.

Results

Forty percent of respondents indicated that they had participated in emergency preparedness training, actual disaster response, or surge capacity initiatives with significant differences among provider types for all measures (p = 0.007). When asked to identify barriers to responding to a public health emergency, respondents indicated that staff size or capacity, training and resources were the top concerns. Respondents in practices with a higher vaccine-related standard of care had a higher willing to respond index (β = 0.190, p = 0.001). Respondents who had participated in emergency training or actual emergency response had a higher willing to respond index (β = 1.323, p < 0.0001).

Conclusion

Our study suggests that concerns about staff size and surge capacity need to be more explicitly addressed in current emergency preparedness training efforts. In the context of boosting response willingness, larger practice environments stand to benefit from self-efficacy focused training and exercise efforts that also incorporate standard of care.     

A preliminary framework to measure public health emergency response capacity

To provide a scientific guide for most countries in the world to build a complete public health emergency management system. Capacity assessment theory and emergency management theory were reviewed respectively and linked together to construct a preliminary, two-dimensional public health emergency response capacity framework. A preliminary framework for public health emergency response capacity was obtained, which consists of three levels: the systems level, the organizational level, and the individual level. A two-dimensional matrix or a set of two-dimensional matrixes that comprise capacity, dimension, and emergency function dimension formed the preliminary framework in three levels, respectively. This preliminary framework can act as a theoretical guide for a country or a region to set up their own public health emergency response systems.     

四川省疾病预防控制机构专业人员突发公共卫生事件应急能力现况研究

目的 了解四川省疾病预防控制机构专业人员突发公共卫生事件应急能力现状及影响因素,为提高专业人员应对能力提供参考。 方法 抽取该省9家疾病预防控制中心(centers for disease control and prevention,CDC)的319名专业人员,对其突发公共卫生事件应急能力现况进行问卷调查; 在对其应对能力现况进行描述的基础上,采用秩和检验和秩相关分析影响专业人员应急能力的主要因素。结果 319名CDC专业人员8个方面的应急能力平均得分在2.55～3.08分之间,有7个方面的平均得分低于3分(满分为5分)。不同级别CDC专业人员的8个方面应急能力(包括分析评价能力、政策制定和发展规划技能、交流沟通技能、文化知识技能、社区实践技能、公共卫生基础科学技能、财政预算和管理技能、领导和系统思考技能)得分具有统计学差异(依次为:H=12.159,P=0.002; H=22.784,P<0.001; H=26.253,P<0.001; H=24.694,P<0.001; H=34.816,P<0.001; H=23.661,P<0.001; H=12.144,P=0.002; H=21.509,P<0.001)。省级CDC专业人员8个方面应急能力得分均高于区县级CDC专业人员,且有6个方面的应急能力得分高于巿级CDC专业人员,巿级CDC专业人员有2个方面的应急能力得分高于区县级CDC。专业人员的年龄、工作年限及近一年参加应急处置培训的级别与其8个方面的应急能力得分呈正相关。 结论 该省疾病预防控制机构专业人员的突发公共卫生事件应急能力一般,市级、区县级CDC专业人员的应急能力相对较差; 今后应加强专业人员的应急处置培训,尤其是高级别的应急处置培训,提升其突发公共卫生事件应对能力。     

南通地区县级公共卫生应急反应能力的评价

目的探讨评价县级公共卫生应急能力的指标体系模型,对南通市各县公共卫生应急反应能力进行综合评价。方法通过专家咨询和现场调查筛选指标,按指标框架加以整理,确定决定诸因素的权重,然后综合判断,确定各县公共卫生应急反应能力的顺序。结果建立了县级公共卫生应急能力的评价指标体系并通过了现场实地检验,南通市各县公共卫生应急反应能力顺序;启东>通州>海门>海安>如皋>如东。结论县级公共卫生应急能力评价方法科学,可行性好,有较大的应用潜力,可为公共卫生应急管理提供参考。     

保定市县级疾病预防控制机构应对突发公共卫生事件的能力

目的了解保定市县级疾病预防控制(疾控)机构应对突发公共卫生事件的能力建设现状。方法以该市25个县(市、区)疾病预防控制中心作为调查对象,通过制定统一的调查问卷进行调查,综合评价县级疾控机构应急能力。结果目前保定市县级疾控机构实际在编人员为730人,占应具备人员编制数的62.45%;另有796人属无编制长期职工或临时人员,共计1 496人。其中防病人员923人,检验人员163人。总体人员学历以专科(36.89%)和中专(37.17%)为主;高级职称23人(1.50%),中级322人(21.52%),初级690人(46.12%),无职称461人(30.82%);年龄40岁以下有875人(58.49%)。还存在业务经费投入不足、仪器设备落后、开展检测项目少、应急反应能力弱等问题。结论保定市县级疾控机构人员的应急能力不能满足实际工作需求,应进一步增加疾控专业人员编制,加大经费投入力度,加强专业技术培训,提高应急队员应对突发事件的能力。