基于GIS的医疗设施布局及空间可达性研究 ——以北京市Z区为例

目的:借助地理信息系统,对北京市Z区医疗设施布局及居民就医空间可达性进行分析研究,旨在为促进医疗资源合理布局、提高居民医疗服务公平性提供决策参考.方法:基于ARCGIS软件,采用两步移动搜寻法模型,对北京市Z区的居民点对不同等级医疗机构的空间可达性进行测算.结果:Z区人口及医疗床位资源主要分布在中西部几条核心街道地区;...     

卫生服务空间可达性度量方法与应用领域

卫生服务空间可达性是可获得性和可接近性融合的概念.卫生服务空间可达性度量方法与模型有传统的比值比法、最短距离、平均距离、累计机会、引力模型、两步移动搜索等.其研究可用于评价卫生设施公平性、确定卫生服务短缺区、解释健康状态、疾病发生和卫生服务利用差异,是机构选址模型的重要参数.国内卫生服务空间可达性研究还存于起步阶段.     

基于高斯两步移动搜索法空间可达性模型的医院布局评价

目的 探讨高斯两步移动搜索法空间可达性模型在医院布局评价中的应用。方法 借助搜狗网络地图服务应用程序接口,使用高斯两步移动搜索法测算街道/乡镇尺度下上海市三级医院空间可达性指数,评价其空间分布。结果 距离阈值为60分钟时,“5＋3＋1”项目实施使上海市三级医院空间可达性指数均值从1.65提升至1.98,中心城区该指标均值为3.63,郊区（县）为1.03。结论 高斯两步移动搜索法空间可达性模型评价医院布局具有方法学优越性;“5＋3＋1”项目改善上海市三级医院水平与布局,但地区差异依然存在。     

基于床位数的医疗服务可达性与公平性评价研究——以贵阳市云岩区为例

目的 利用床位数开展医疗服务可达性和公平性评价研究。方法 采用两步移动搜寻法模型和聚集度,对贵阳市云岩区医疗机构的空间可达性和公平性进行分析。结果 研究区域医疗机构床位数12.29张/每千常住人口;研究区域整体床位空间可达性值为4.52（R = 7.54）,基层医疗机构可达性值0.26（R = 1.18）,一级医疗机构可达性值为2.24（R = 4.09）,二级医疗机构可达性值2.48（R = 4.23）,三级医疗机构可达性值为6.24（R = 5.79）;医疗机构床位数可满足区域人口需求的街道7个（d＞0）,占区域面积16.24%,人口密度2.14万人/km2,其中d值最高为市西河街道12.24,最低为普陀路街道- 3.37。结论 本研究区域医疗机构床位总量配置充足,但从空间可达性和公平性视角看配置仍显不均衡。     

武汉市口腔医疗资源公平性及空间可达性分析

目的 分析武汉市口腔医疗资源配置的公平性和可达性.方法 用基尼系数和泰尔指数计算公平性,通过两步移动搜索法评估可达性,采用空间自相关研究可达性的高低聚类.结果 基于人口水平的武汉市口腔医疗资源基尼系数在0.3左右,基于地理面积则>0.6,泰尔指数计算结果相似.总体可达性来看,可达性差的区域为2428 km2,达到了28...     

2011-2013年深圳市孕产妇HBsAg携带现况分析

目的了解深圳市孕产妇HBsAg携带情况,为预防控制乙肝母婴传播提供本底资料。方法孕产妇到助产机构产前检查或分娩时检测乙肝两对半,并将孕产妇基本情况及检测结果录入自主开发的专用信息管理系统,通过系统统计相关信息。结果深圳市2011-2013年孕产妇乙肝平均检测率为95.01%,孕产妇HBsAg三年平均阳性率为9.00%。〈20年龄组孕产妇阳性率最低为7.05%,35岁以上年龄组孕产妇阳性率最高达9.61%。龙岗区孕产妇HBsAg阳性率最高达9.90%,最低南山区为8.17%。结论深圳市孕产妇HBsAg携带率较高,表明深圳仍为乙肝高流行地区,母婴阻断是预防控制乙肝的重要措施。     

北京市孕产妇抢救用血情况调查

目的:了解北京市孕产妇抢救临床用血情况以及北京市各级助产机构库存血量情况,阐明制约产科出血孕产妇抢救的因素。方法:采用问卷调查收集2012年北京市16个区县的相关数据进行分析。结果:本次调查共收集到1 329份需进行输血治疗的孕产妇抢救病例的数据以及120家各级助产机构的血库及血库库存血情况。2012年北京经输血治疗的孕产妇占全年产妇数的6.0‰。三级助产机构和二级助产机构红细胞供应不足多于血浆供应不足(χ2=8.745,P=0.003;χ2=39.985,P=0.000)。北京市无红细胞或血浆库存的助产机构达17.5%。一级助产机构和二级助产机构无红细胞或血浆库存的比例远高于三级助产机构(χ2=35.315,P=0.000;χ2=8.216,P=0.004)。结论:1孕产妇临床用血需求量较大且孕产妇抢救普遍存在临床供血不足;2助产机构拥有库存血比例较低且不同级别助产机构间库存血量差异大。     

2015年贵阳市县级及以下助产机构产科出血防治建设现状

目的了解2015年贵阳市县级及以下助产机构产科出血防治现状,为今后有针对性提高产科出血综合防治水平提供依据。方法通过调查表收集并描述2015年贵阳市县级及以下助产单位孕产妇死亡率、产科出血报告率、医护人员比例、医护人员技术水平、产科出血体系建设、供血时间。结果共调查10个区县,包括25家县级综合医院,10个县级妇幼保健院,24个乡(街道)助产机构; 2015年,10个区县的孕产妇死亡总率为21. 89/10万,产科出血报告总率为2. 90%,各区县产科出血报告率相差较大;县级综合医院的医护比高于县级妇幼保健机构(1∶1. 74 vs. 1∶0. 79);县级综合医院医护人员的助产技术水平高于县级妇幼保健院和乡(街道)助产机构;云岩区、修文县、花溪区的助产机构供血时间超过60 min,仍有一半的区县尚未建立多部门防治产科出血领导小组。结论贵阳市县级及以下助产机构的产科出血防治现状不容乐观,未来亟需有针对性地开展产科出血防治干预项目,健全产科出血防治体系,提高医护人员的出血救治能力。     

国谈抗肿瘤药配备机构的空间可达性评价研究——以武汉市为例

目的：本研究旨在评估武汉市中心城区国谈抗肿瘤药配备机构的空间可达性水平,为优化药物供应与配置提供经验证据。方法：以武汉市为例,采用基于高斯衰减函数的两步移动搜索法(2-Step Floating Catchment Area, 2SFCA)评估研究区域内各个需求单元在不同交通出行方式下的国谈抗肿瘤药配备机构的可达性,同时运用空间自相关分析和K-means聚类分析识别需求单元可达性的分布态势和分类模式。结果：在驾车或公交出行的情况下,武汉市中心城区各需求单元的配药定点机构的可达性呈现出明显的空间分异特征。江汉区、汉阳区等可达性水平较高且均衡,而青山区和洪山区可达性水平较低且内部存在明显分层。此外,各需求单元呈现显著正相关空间分布,区域内高值集聚与分区内部分化现象并存。结论：武汉市中心城区配药机构可达性整体较高,但存在从核心城区向边缘城区递减的趋势;多数辖区的可达性良好且较为均衡,但少数辖区的可达性较差且存在明显的内部等级分层。     

北京市三城一区基层卫生服务空间可及性评估

目的 梳理北京市三城一区的卫生资源供给情况,评价三城一区基层卫生服务空间可及性,识别可及性较差的区域.方法 通过关键知情人访谈了解三城一区的卫生资源现状和需求,利用改进的两步移动搜寻法计算基层卫生服务空间可及性.结果 北京市基层卫生服务可及性(每千常住人口卫生技术人员数)平均值为2.34人,三城一区有5.48％(50个...     

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 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.     

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.     

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.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.