社区卫生服务中心后勤社会化管理的实践与思考

后勤工作是医院管理的重要组成部分,后勤工作水平的高低直接影响医疗服务质量的优劣。2000年,上海市卫生局下发了《关于深化本市公立医疗卫生机构后勤服务社会化改革的意见》,2002年,卫生部下发了《关于医疗卫生机构后勤服务社会化改革的指导意见（试行）》,对医疗机构实行后勤社会化管理提出了明确要求。     

医院后勤服务社会化的可行性探讨

实现医院后勤服务社会化是医院后勤工作适应市场经济的一种形式。阐述了医院后勤服务社会化内涵；分析了北京地区医院后勤服务工作现状；提出了实现医院后勤服务社会化的４个阶段，即实行单项工程承包和班组工作计量承包，后勤实施总金额承包，建立卫生系统后勤工作联网，实现以医疗卫生系统为服务主体的双向社会服务。     

浅谈医院后勤经营管理模式

医院后勤由供给福利型管理转向经营管理,是医院适应市场经济、保证改革发展方向的必由之路。计划经济体制下滞后的医院后勤封闭式供给福利服务模式,已经严重制约了医院的改革与发展。在后勤服务社会化的市场竞争中,医院后勤经营管理模式可根据我国目前的基本国情、生产力发展水平、全社会生产社会化的程度和医院后勤工作状况,采取社会化经营、企业化管理的多种实现形式。①院内社会化：实行全面经济承包;成立经济实体;成立经营（企业）实体。②过渡社会化：社会逐步接办后勤部分服务项目;实施“准社会化工程”;创建涉医的集约化、集团化公司;建立生产经营联合体。③社会化：让社会服务行业基本承办医院后勤服务项目。     

老医院后勤服务社会化的探索

医院后勤服务社会化随着卫生事业改革的不断深入发展而显得十分必要和迫切。四年多来我院部分后勤服务实行社会化，但远远未能适应改革发展要求。由于老医院老职工多的原因而难以全面实行社会化。基于老医院的实际情况，我院尝试全院后勤工作实行社会化形式管理，不搞一刀切，避免一阵风，切实持久坚持走后勤服务社会化之路。     

医院后勤社会化模式的探讨

随着医院后勤化的逐步开展,在实行过程中出现很多问题,文章就当前医院后勤工作存在的主要问题,医院后勤服务社会化的具体措施和医院后勤社会化的步骤,进行了探讨.     

我看医院后勤改革

<正>后勤社会化不再陌生诸葛立荣(复旦医院后勤管理研究院院长):计划经济时期的传统医院后勤管理体制和运行机制已不能适应现代化医院的改革发展。医院后勤"小而全"的模式,机构臃肿,效率低下,资源得不到充分利用,保障质量不高。经过10多年的医院后勤服务社会化改革,后勤服务外包,实行后勤服务专业化,降低了运行成本,提高了质量效率,发挥了市场资源效率,促进了医院后勤改革发展。当然,要完全实行医院后勤服务社     

医院后勤社会化改革的探索与思考

根据卫生部和省市卫生厅、局关于深化医院后勤改革的文件精神 ,深圳市沙井人民医院结合自身实际 ,对传统医院后勤管理运作模式实行大胆改革和创新 ,力求建立后勤服务的管理科学化、服务社会化、经营市场化的运作模式 ,为医院业务工作的顺利开展提供最佳的后勤保障。1　后勤社会化具体做法1.1　确定医院后勤社会化改革的服务内容　在保证不影响医院正常业务开展的前提下 ,根据后勤工作的岗位特点、工作量大小和人员要求等因素 ,将清洁卫生、保安、消防、水电和车辆维修管理等工作纳入到社会化改革内容中 ,并在社会化改革的探索中 ,从广度和深…     

医院后勤改革的思考与展望

通过医院后勤改革10年的分析与思考,结合后勤工作的管理实践和规律,将医院后勤分为后勤管理、后勤保障、后勤服务,并提出后勤管理规范化、后勤保障要强化、后勤服务社会化的改革理念与思路.     

再论医院后勤服务社会化的可行性

目前，经济高速发展，服务体系和水准相对滞后，加上管理者素质的提高，现代管理技术的应用，以及后勤管理体制的改革，为医院后勤工作向社会分离提供了条件，也为推进医院后勤服务社会化提供了机遇。但规范卫生服务市场体系是后勤服务社会化的保障，故要建立：卫生物质流通、后勤人才流动、经济信息市场及卫生建设筹资机构。在推进后勤服务社会化时尚需解决：①支持条件；②实施集团联盟；③注意经营定位等问题。     

对医院后勤服务社会化的探讨

上海市金山区卫生局结合本区区域较大 ,下属医疗卫生机构较多 ,规模、性质不同等特点 ,以局直属单位为范围 ,将在后勤工作的约６００人整体从医疗卫生单位中分离 ,建立“金山区卫生后勤服务中心”。目前服务中心工作运行稳定 ,服务质量有所提高。一、具体做法金山区卫生后勤服务中心为卫生局下属事业单位 ,成立餐饮、保洁等公司或部室 ,下设医院服务、社会服务两个组。中心实行企业化管理 ,三年内逐步转制为服务公司或专业化服务机构。在服务中心成立的过程中 ,适宜可行的人事政策在解决后勤职工后顾之忧 ,稳定情绪 ,为后勤社会化工作顺利推…     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.