The Impact of Government Regulations on Early Childhood Services: Perceptions of Early Childhood Professionals in the South West of England

This study investigated the impact of government regulations pertaining to the operation of a range of early childhood services on day to day practice within such services. A non random sample of twenty four early childhood service managers in the south west of England participated in structured interviews in order to assess their awareness of existing government regulations and to what extent existing regulations were used to guide day to day practice. Qualitative content analyses of the interview data revealed that the majority of managers were aware of a range of documents pertaining to regulations but considerable confusion existed about which regulations were considered to be imperative. The majority of respondents considered government regulations to be related more to meeting minimum standards rather than to quality assurance. Quality was perceived to be related to the commitment to good practice. The data indicate that government regulations have a minimal impact upon the day to day practice of early childhood professionals, pointing to the need for in-service opportunities to assist early childhood professionals to make greater connections between regulations, practice and quality.     

Dependency, social factors, and the smoking cessation process: the doctors helping smokers study

We analyzed data obtained from a representative sample of the smoking patients (n = 1,338) of 66 family physicians to determine predictors of attempts to stop smoking, desire to quit smoking, and successful smoking cessation. Compared to subjects who made no attempt to quit smoking, subjects who tried to quit smoking tended to be younger, had tried to quit smoking in the year prior to the study, waited longer before smoking their first cigarette of the day, had more desire to quit smoking, and had more social support for quitting. Education and cigarettes smoked per day were not independently related to the subject making a quit attempt. Desire to quit smoking was associated with an attempt to quit in the year prior to the study and social support for smoking cessation (support of spouse, second most important social contact, and physician). Desire to quit smoking was not independently related to age, education, or dependency on cigarettes (measured by the number of cigarettes smoked per day and the length of time a subject waited before smoking the first cigarette of the day). Compared to subjects who tried to quit and failed, subjects who succeeded were older, smoked fewer cigarettes per day, and waited longer to smoke their first cigarette of the day. Spouse support, support of the second most important social contact, and advice of a doctor to quit smoking were not independently related to whether or not a cessation attempt would be successful. These data suggest that successful smoking cessation requires two components: social support to make an attempt to quit and the ability to overcome dependency on cigarettes to make the attempt successful.     

Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients

This research highlights the importance of expanding examinations of service accessibility for hard to engage client populations to include assessments of individuals’ ability to gain entrance to services and the system’s ability to meet the service needs of particular client populations. The results of this research provide a framework to support these examinations. The increasing levels of selectivity and targeting of mental health services to particular client populations found in this study raise fundamental questions about the goals of service accessibility in 21st century public mental health services generally, and for hard-to-engage clients particularly. These findings also point to the need for examinations of the eligibility criteria and gatekeeping mechanism that are used to target services to particular client populations to determine if they are working as intended and to assess what impact these mechanisms have on hard to engage clients’ ability to gain entrance to needed services.     

5年革兰阴性杆菌耐药性变迁分析

目的分析近5年主要革兰阴性杆菌对常用抗菌药物耐药性的变迁。方法对医院1999-2003年1464株革兰阴性杆菌的药敏试验进行回顾性分析,药敏试验采用K-B纸片扩散法。结果铜绿假单胞菌、大肠埃希菌对哌拉西林的耐药率分别由1999年的17.6%、42.9%增至2003年的79.2%、68.9%;对环丙沙星的耐药率分别由1999年的4.3%、40.0%增至2003年的36.0%、73.5%;大肠埃希菌对喹诺酮类抗菌药物耐药率>50.0%,对三代头孢菌素的耐药率多在30.0%~40.0%;不动杆菌属对哌拉西林、头孢曲松的耐药率由1999年的31.2%、36.0%增至2003年的67.5%、74.1%;沙雷菌属对头孢他啶、头孢曲松、庆大霉素、阿米卡星和哌拉西林的耐药率增长迅速;亚胺培南对革兰阴性杆菌依然保持强大抗菌活性,头孢哌酮/舒巴坦和哌拉西林/他唑巴坦也显示较强的抗菌活性。结论近5年革兰阴性杆菌对常用抗菌药物的耐药率增长迅速,如何抑制细菌耐药率的过快增长已成为全球性的难题。     

Factors related to outcome following a work hardening program

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.     

Health professions education for adapting to change and for participating in managing change

This paper outlines a case for a new approach to the education of future professionals. The magnitude and potential seriousness of changes to be anticipated in the first half of the new century challenge institutions of higher education to prepare their students to become able to adapt themselves to change and to participate in the management of change--not only in relation to their own profession, but more widely for the benefit of society at large. The Network of Community-Oriented Educational Institutions for Health Sciences is planning three major programs which are designed to help meet this challenge in the 21st century. The first of these programs will set out to identify generic competencies that are needed for adapting to change and for participating in managing change. This is to include not only profession-specific changes, but also changes that affect the well-being of society as a whole. The second program will address the related need to develop educational interventions that are designed to foster competencies for interprofessional and intersectoral collaboration. The third of these programs accepts that serious attention to effective education for the professions will require institutionalization of recognition and reward of creativity and commitment in education.     

Prosecutor seeks new law to shield HIV exposure victims

Chautauqua County (NY) prosecutor James P. Subjack is asking State legislators to enact legislation to make it easier to prosecute people who recklessly transmit HIV to others. Subjack's office prosecuted the case of Nushawn Williams, who is linked to 11 cases of HIV in women and girls. Dozens more said they were exposed to HIV via sex with Williams, but only five would cooperate in prosecuting Williams. Most were unwilling to be part of a "media frenzy," and wanted to protect their own privacy. Subjack asked for laws to protect identities of victims of crimes involving HIV exposure, to make it a felony for people to engage in sex with a partner who is not informed of HIV-positive status, and to give law enforcers easier access to public health records of people with HIV. Six bills pertaining to cases like Williams' have been proposed, but none include provisions to protect the victims' identities or to grant greater access to health records. Contact information is included.     

A 4-year study of Pseudomonas aeruginosa susceptibility to antibiotics (1998-2001) in northern Lebanon

Four hundred and sixty-four Pseudomonas aeruginosa strains were isolated in northern Lebanon at the Islami Hospital Microbiology department, in Tripoli. The purpose of this study was to evaluate the susceptibility of these strains to antibiotics, to compare this susceptibility according to the nature of the sample and the year of sampling. The results show that urinary samples were the most frequent (39.3%), followed by wound samples (21.2%), and ear samples (16.5%). The average rate of susceptible strains was 39.8% to ticarcillin, 56.9% to piperacillin, 58.2% to piperacillin + tazobactam, 74.1% to imipenem, 63.3% to ceftazidime, 60.4% to cefepime, 62.1% to aztreonam, 60.3% to netilmicin, 57.5% to gentamicin, 62.2% to tobramycin, 69% to amikacin, 100% to colistin, 45.4% to pefloxacin and ofloxacin, 57.7% to ciprofloxacin and 1.3% to rifampicin. The study showed that the strains isolated from pulmonary secretions were the most resistant to antibiotics.     

医疗质量考评体系改革的方法和策略

介绍了在医院等级评审全面展开的背景下,参照医院评审标准要义,进行医院医疗质量考评体系改革,即以建立健全2个体系、全面加强2项管理、持续改进4项质量、保障患者安全为目标,设置关键指标考评模块,构建医疗质量考评三级网络,设置关键指标考评模块,突出质量,兼顾效率,向服务倾斜,注重消费和成本控制,成立医疗质量与安全管理基金,实行奖惩两条线等.     

Science and social responsibility in public health

Epidemiologists and environmental health researchers have a joint responsibility to acquire scientific knowledge that matters to public health and to apply the knowledge gained in public health practice. We examine the nature and source of these social responsibilities, discuss a debate in the epidemiological literature on roles and responsibilities, and cite approaches to environmental justice as reflective of them. At one level, responsibility refers to accountability, as in being responsible for actions taken. A deeper meaning of responsibility corresponds to commitment to the pursuit and achievement of a valued end. Epidemiologists are committed to the scientific study of health and disease in human populations and to the application of scientific knowledge to improve the public's health. Responsibility is also closely linked to reliability. Responsible professionals reliably perform the tasks they set for themselves as well as the tasks society expects them to undertake. The defining axiom for our approach is that the health of the public is a social good we commit ourselves to pursue, thus assuming an obligation to contribute to its achievement. Epidemiologists cannot claim to be committed to public health as a social good and not accept the responsibility of ensuring that the knowledge gained in their roles as scientists is used to achieve that good. The social responsibilities of environmental health researchers are conspicuous in the environmental justice movement, for example, in community-based participatory research. Responsibility is an ethical concept particularly well suited to frame many key aspects of the ethics of our profession.     

脱细胞-核DNA模型检测烟气氧化损伤的研究

目的探索烟气的损伤特征,并建立烟气生物效应的快速检测新模型。方法采用脱细胞-核DNA作为实验模型,用烟气染毒,实验分烟气直接染毒(按照染毒时间分为:60、30、15和0min 4个组)和烟气水过滤后染毒(水过滤烟气、水过滤空气、烟的水溶液、空气的水溶液和水对照5个组),用彗星试验检测DNA损伤情况。结果烟气直接染毒的DNA损伤顺序为:60min组>30min组>15min组>0min组,呈现时间-反应关系;处理后烟气对DNA的损伤顺序为:烟气水溶液组>水过滤烟气>水过滤空气=空气水溶液=水溶液;直接染毒60min对DNA的损伤大于水过滤后烟气。结论烟气可直接损伤脱细胞DNA,水过滤后烟气对DNA的损伤降低;脱细胞-核DNA对烟气的损伤比较敏感,可用于烟气生物效应的评价。     

综合医院产前诊断系统管理模式及效果评价

产前诊断工作是一个涉及面广的系统工程。为有效地实施产前诊断管理 ,深圳市人民医院建立了完善的管理模式 :经过严格的科学管理 ,本院系统管理对象围产儿死亡率由 1993～ 1995年的 9.0 8‰下降为 1999～ 2 0 0 1年的 1.32‰ ;新生儿死亡率由 1993～ 1995年的 3.77‰下降为 1999～ 2 0 0 1年的 0 .2 6‰ ;出生缺陷率由 1993～ 1995年的7.0 0‰下降为 1999～ 2 0 0 1年的 3.19‰。     

On the stability of stigmatization: The case of ex-homosexual males

We undertook to empirically identify variables that influence the stigmatization of ex-homosexuals by analyzing the relationship between stigmatization and seven variables held to influence negative attitudes toward members of other ex-deviant groups: the stimatizer's age, highest achieved educational level, amount of interaction the stigmatizer has had with an ex-homosexual, degree of effectiveness attributed to treatment in changing the homosexual to a heterosexual orientation, degree of responsibility that the stigmatizer attributes to ex-homosexuals for their prior homosexual behavior, degree of dangerousness attributed to ex-homosexuals, and degree of seriousness attributed to homosexuality. Analysis of data obtained by questionnaire from 281 respondents showed that the variable most strongly related to stigmatization of ex-homosexuals was the degree of dangerousness attributed to them. There was a profound direct relationship between these variables. Further, educational level, belief in the effectiveness of treatment, and amount of interaction with ex-homosexuals were inversely related to stigmatization, while degree of seriousness attributed to homosexuality was directly related to stigmatization. Respondents' tendency to stigmatize was not found to be related to age or to their attribution of responsibility to the ex-homosexual for his previous sexual orientation.Paper presented at the 1979 Annual Meeting of the Southern Sociological Society, Atlanta, Georgia.     

昏迷患者应用口咽通气管吸痰的护理体会

目的经口咽通气管建立起来的人工气道吸痰法,克服影响经鼻吸痰效果的因素,解决经鼻吸痰中存在的问题,有效清除昏迷病人气道分泌物。方法对13例昏迷患者采用了经口咽通气管辅助吸痰护理。结果13例昏迷患者均未因痰液堵塞而发生窒息,呼吸道梗阻症状明显改善、血氧饱和度由原来的90%以下上升到95%以上。结论昏迷患者口腔放置口咽通气管辅助吸痰,操作方法简便、易于掌握,它是一种能够在数秒钟内迅速获得通气的方法,不仅可以保持呼吸道通畅,纠正缺氧,降低脑损害,还可以避免舌后坠,减轻脑水肿,避免脑损害的发生。此方法是清除痰液潴留,改善通气功能,控制肺部感染的一项积极、有效的护理措施。     

加强医院药学管理 创新医院药学服务

随着科学技术的进步,医院药学发展的总趋势是进行医院药事管理,药学技术工作和药学服务要向临床靠拢。这就要求医院药学部门应掌握国内外药学发展动态,根据实际情况不断引进、吸收和应用现代药学新知识、新技术和新方法,创新医院药学管理。文章对此进行了分析,并就创新医院药学管理提出了建议。     

以人为本科学发展推动医院工作全面进步

推进医院工作全面进步,必须以“三个代表”重要思想统揽医院工作的全局;必须用科学发展观指导医院的建设和发展;必须注意把握医院改革的方向和重点;必须探索和推行以服务第一为理念的经营战略。     

Commitment to change: exploring its role in changing physician behavior through continuing education

Statements of commitment to change are advocated both to promote physician change and to assess interventions designed to promote change. Although commitment to change is only one part of a complex process of change, recent progress has established a solid theoretical and research base to support this approach. Studies have demonstrated that it can be used effectively with many different types of educational activities and that statements of "plans to change " practice can predict actual changes. The importance of follow-up as part of the commitment to change model is becoming clearer, although questions remain about the most effective process to accomplish this and the optimal timing. Further research is needed to establish the effectiveness of the commitment-to-change approach itself as well as to better understand the functions (and thus the forms) of the different components of the commitment-to-change model.     

Improving the system of preventing vibration and noise-induced pathology

Due to the long-term study of various machines under industrial and test conditions it became possible to determine the specific role of each chain of the man-machine system in the intensification of vibroacoustic effect on a worker and to develop a system of medical, technical and organizational preventive measures. Introduction of a set of such measures at one of the plants helped to reduce vibration disease rates by dozens of times. In order to control noise- and vibration-caused diseases it was necessary not only to improve machines' quality and service conditions but also to pay special attention to the choice of operators and to the quality of monitoring their adaptation process.     

Balancing relevance and excellence: organizational responses to link research with decision making.

Research faces the challenge of balancing relevance to decision making and excellence in the strict adherence to the norms of scientific inquiry. This paper examines the organizational responses that can be undertaken to promote integration of these potentially conflicting goals. We posit that there seem to be structural barriers to effective communication between researchers and decision makers, such as differences in priorities, time management, language, means of communication, integration of findings and definition of the final product of research. These barriers must be overcome through solutions aimed at the organization of research. In this respect, there are three possible models to approach the tension between excellence and relevance: academic subordination, segregation and integration. Only the latter makes it possible to reconcile the advantages of proximity to decision making with the procedures to assure academic quality. In addition to organizational design and institutional development, a strategy to promote research must include a set of incentives to prevent the 'internal brain drain', that is, the tendency of researchers to move to managerial positions. There are four guiding principles to address this problem: parallel careers, academic autonomy, administrative sacrifice and inverted incentives. The complexities of health problems demand that we create new organizational formulas to finally balance relevance and excellence in research.