联村服务体系的探讨

随着我国医疗卫生体制改革的不断深入,全科医学处于迅速发展的阶段,发展社区医疗服务是改革与发展的必然趋势.联村服务体系由此产生,它是一个先进的,具有现代化特色的、有活力的社区医疗服务体系,属网络性社区医疗服务系统（ISSCM）。     

医学生参与社区卫生服务对社区全科医疗建设的作用

目的　了解杭州市社区全科医疗现状和居民的需求 ,探索医学生社区志愿服务在完善社区全科医疗 ,推动全科医疗服务发展中的作用。方法　通过对杭州市社区全科医疗服务提供和需求情况进行调查。结果　杭州市社区全科医疗服务存在全科医学人才缺乏 ,卫技人员学历层次低 ,医疗卫生服务单一等问题 ;杭州市居民慢性病发病率较高 ,对社区全科医疗服务需求意识不足 ,对“健康使者”社区卫生服务表示支持。结论　医学生参与社区卫生服务对社区全科医疗建设的作用在于①缓解社区全科医疗人力资源的不足。②改善当前社区全科医疗服务单一的情况。③提高居民对社区全科医疗的认识。④促进全科医学人才的培养     

城市社区全科医疗过渡模式的探索

全科医疗作为一门新的医学学科在欧美各国蓬勃发展,并进入中国,特别是近年来,随着城市人口老龄化、疾病谱的变化、社区居民对医疗卫生服务需求的日益增长,使全科医疗越来越成为社区卫生服务的主要实施形式,但目前社区卫生服务从形式到内容都还不够规范,没有现成的模式可以借鉴。我区从1996年开始对城市社区全科医疗过渡模式进行了比较系统的探索和研究,并取得了一定的成果。     

常州市调整医疗服务体系的有关政策

城市医疗服务体系调整是区域卫生规划中的重点内容。本文拟从当前城市医疗服务体系存在问题、调整的基本设想和所需前提条件 3个方面去论述调整城市医疗服务体系的政策思路。一、当前医疗服务体系存在问题建国以来 ,经长期卫生事业发展 ,在我国大中城市已基本形成了三级医院、二级医院、一级医院或医疗点为主要内容的三级医疗服务体系。其具体功能划分是 :三级医院提供高水平专科性医疗卫生服务和执行高等教学、科研任务 ;二级医院为多个社区提供综合医疗卫生服务 ,并承担一定教学、科研任务 ;一级医院或医疗点直接为一定人口的社区提供预防…     

探究全科护理在社区护理中的应用与推广

国家的卫生服务体系的完善与完备可以促进全面建成小康社会的步伐,通过建设社区卫生服务体系来实现人人享有基本医疗卫生服务,达成全科护理与社区护理相结合。但全科护理在社区护理的推广与应用的过程中存在着许多问题,本文就全科护理在社区护理中的应用与推广进行探讨与研究。     

全科护理在社区护理中的应用

当对社会的发展提出全面建设小康社会,需要逐渐的完善我国的卫生服务体系,其中社区卫生服务体系建设是实现"人人享有基本医疗卫生服务"的相关措施。在医疗体制不断改变的今天,社区卫生服务机构的健全和发展成为了对人们健康问题进行解决的有效之路,其中最重要的为医护人员的配置问题。全科护理相对于临床专科护理来说,需要与社区护理密切的配合,但是我国现今在实施全科护理过程中仍然存在着很多的问题,因而在不断的探索中对其进行完善,使其能够更好的为医疗系统服务,为患者服务。     

再造基层医疗服务体系

厦门市卫生工作在继续抓好大型重点公立医疗机构建设，加快提升全市优质医疗资源水平、医疗服务整体能力，积极服务周边地区的同时，着力推进机制创新，加快构建和完善以社区为基础的新型城市医疗卫生服务体系，力争使“就医难”问题得到明显缓解。     

威海市社区医疗卫生服务体制存在问题分析与对策探讨

社区医疗卫生服务体制建设关系着人民群众的切身利益,是构建和谐社会的重要内容.如何推进社区医疗卫生服务体制建设,使人人享有医疗卫生保障,是目前面临的理论问题和现实问题.温家宝总理在十届人大四次会议上指出:大力发展城市社区卫生服务.要通过调整城市医疗卫生资源,加大政府投入、加强人才培养、完善服务功能、推进技术创新等措施,加快构建以社区为基础的新型城市医疗卫生服务体系.因此,加强社区卫生服务体制建设,实现有效、经济、方便、综合、连续的卫生服务目标,促进社区卫生服务健康发展势在必行.     

我省社区卫生服务面临的挑战与对策

社区卫生服务是社区建设的重要组成部分．是城市卫生工作的重点．是城市公共卫生和基本医疗服务体系的基础,是城镇居民人人享有基本医疗卫生服务的基本途径．是经济社会发展和社区文明建设的必要条件和重要组成部分,是维护社会发展人力资源生产和再生产的基本保证,也是体现国家和民族兴旺发达的一个重要标志。     

我国人口变化对创新型社区卫生服务人才需求趋势分析

本文以全国人口增长和城镇老龄化增长趋势为基础资料,以贯彻新医疗改革方案要求、加快城镇社区医疗卫生服务事业的发展建立、满足社区人们对医疗卫生服务的需求为着重点,对社区医疗卫生服务创新型全科人才需求趋势进行深入分析,探讨解决社区医疗卫生服务所需的创新型全科人才的基本思路.     

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.     

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.     

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.     

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.     

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.