家用水质处理器功能性评价模拟自来水的研究

目的研究家用水质处理器功能性评价模拟自来水，以利于家用水质处理器评审工作标准化。方法分析城市自来水水质基本状况，确定水体特征指标，以纯水作为基体，加入相应化合物配制模拟自来水。结果模拟自来水基本代表中国自来水，与美国NSF试验用水比较，各指标数量与含量范围基本一致。结论模拟自来水为水质处理器卫生安全性与功能性评价方法的标准化提供了依据。     

采用德尔菲法筛选家用水质处理器的卫生管理指标

[目的]为了科学、合理地指导家用水质处理器在日常使用中的管理和维护,对家用水质处理器使用中的相关卫生状况指标进行筛选. [方法]采用改良德尔菲法,在收集文献资料的基础上,结合上海市家用水质处理器使用过程中的污染特点形成第一轮指标咨询表,以此对该市相关领域22位专家进行咨询,并根据咨询专家反馈的评分和意见加以调整,然后再次征询,待专家意见趋于一致时终止咨询,形成结果. [结果]经统计处理,两轮咨询表的积极系数均为100％,专家权威程度分别为0.80和0.81.第一轮的协调系数W=0.174(x2=6.39,P＞0.05),第二轮的协调系数W=0.835(x2=19.89,0.05＜P＜0.10),形成的14项家用水质处理器卫生指标得到专家们的基本肯定,一致性相对较好.[结论]采用德尔菲法筛选监管家用水质处理器的卫生评价指标,方法可行.结果可纳入到最终评价家用水质处理器的卫生管理要求中,并应用于家用水质处理器日常使用的指导和管理之中.     

小型水质处理器实验研究

目的：对小型水质处理器进行功能性研究。方法：对32台中空纤维加活性炭结构的小型家用水质处理器进行功能性检验。结果：32台产品中，不合格产品6台，合格产品26台。其中，不合格项目均为加标试验项目，不合格加标项目包括：耗氧量、三氯甲烷、四氯化碳。结论：功能性实验评价项目还需要进一步完善。     

上海市家用水质处理器出水细菌污染状况及影响因素

[目的]了解上海市家用水质处理器出水细菌污染状况及其影响因素. [方法]选取上海市320户居民,对其水质处理器出水细菌污染状况进行调查研究,并跟踪其季节变化.调查内容包括水质处理器的整机使用年限、部件构成、日常使用和维护情况等.检测指标包括菌落总数、大肠菌群、菌谱分析.分别采用秩和检验、x2检验和logistic回归模型对数据进行分析. [结果]受调查家用水质处理器出水水质细菌污染现象比较普遍,且污染水平随季节波动,夏季细菌污染水平高于秋、冬季.同一季节中,夏、秋两季反渗透处理装置的细菌污染水平高于一般水质处理器,冬季两种水质处理器细菌污染水平差异无统计学意义.细菌总数≥20 cfu/mL的水质处理器出水水样的菌谱分析结果显示,检出铜绿假单胞菌、金黄色葡萄球菌和蜡样芽孢杆菌等致病菌和条件致病菌.影响使用中水质处理器出水细菌污染状况的因素,主要有水质处理器是否配置紫外线处理单元、机器使用年限、滤芯使用时间和是否每天使用等. [结论]水质处理器产品质量,包括其组件设计、构成和使用说明的完善性,以及用户是否正确使用与维护是制约家用水质处理器卫生安全性的关键因素.应加强对产品质量的监管,普及家用水质处理器的正确使用和维护方法.     

广东省家用饮水处理器卫生状况分析

建设部、卫生部于１９９７年１月１日颁布了《生活饮用水卫生监督管理办法》,对饮水处理器等涉及饮用水卫生安全的产品进行法规管理。随着人们生活水平的提高,对水质处理器的需求也越来越普遍,而其卫生问题也倍受人们的关注。但对家用饮水处理器产品的卫生安全性没有进行较全面系统的调查分析,因此,于１９９７年１月至１９９８年１２月对我省２６间家用饮水处理器生产企业的卫生状况和产品的卫生安全性进行了调查。现将结果报道如下。１　内容与方法１－１　生产企业卫生学调查调查水质处理器生产企业的生产环境、原料间、成品仓、原材…     

家用净水器微生物检验方法和评价标准探讨

家用净水器用于高层楼宇二次供水终端和自来水网络用户终端对饮用水进行再净化和再消毒已越来越普遍。但由于各地水质状况及水质处理条件不同，检测评价方法各异，家用净水器也存在一些尚待解决一卫生问题。随着《生活饮用水卫生监督管理办法》的颁布，家用净水器的卫生管理已列入了监督监测的日程，但目前尚未有统一的检测规范和标准对其卫生质量进行检测和评价。     

家用净水器微生物检验方法和评价标准探讨

家用净水器用于高层楼宇二次供水终端和自来水网络用户终端对饮用水进行再净化和再消毒已越来越普遍。但由于各地水质状况及水质处理条件不同，检测评价方法各异，家用净水器也存在一些尚待解决一卫生问题。随着《生活饮用水卫生监督管理办法》的颁布，家用净水器的卫生管理已列入了监督监测的日程，但目前尚未有统一的检测规范和标准对其卫生质量进行检测和评价[1]。为保证饮用水卫生安全，对家用净水器产品卫生质量检测和评价提供有效的试验依据，受上级部门的委托，我们对几种不同类型的家用净水器按有关试验方案进行微生物冲击试验，并…     

上海市家用水质处理器出水水质卫生状况调查

[目的]了解上海市家用水质处理器出水水质的卫生状况和污染特征。[方法]选取320户住户,调查其家用水质处理器的类型,分别于2011年7月份（夏季）、10月份（秋季）和12月份（冬季）上门采样,检测经其处理的水中铁、锰、铜、锌、铅、砷、耗氧量、pH、色度、浑浊度、菌落总数和总大肠菌群等指标。采用Fisher精确概率法对超标率进行分析。[结果]各季节不同类型水质处理器的出水中重金属、pH、浑浊度的超标率较低,均小于4%;菌落总数的超标率相对较高,最大值达到71.0%;近40%的含活性炭一般水质处理器的出水耗氧量不符合要求。同一季节、不同类型水质处理器之间的出水菌落总数和耗氧量之超标率差异有统计学意义（P〈0.05）;夏季不同类型水质处理器之间出水色度超标率差异有统计学意义（P〈0.05）;含活性炭一般水质处理器的出水浑浊度和细菌总数超标率在不同季节之间的差异亦有统计学意义（P〈0.05）。[结论]家用水质处理器使用中存在一定卫生问题,主要以微生物和有机物污染为重。居民在使用中应加强水质处理器的维护与管理,尤其要重视夏季高温时的饮用水卫生。     

U型管轴流式紫外线灭菌及水质处理

紫外线灭菌及水质处理系统是应用紫线灭菌及矿化、磁化等物理方法来处理普通水,使其具有保健及治疗疾病的作用,可作为工厂、学校等单位夏令时的保健冷饮用水及医院治疗胆结石用水。该系统主要由净化器、矿化器、磁化器、灭菌器及监控装置组成,具有省时、经济、方便、卫生等优点。     

电激水质消毒装置的卫生学评价和应用分析

随着社会经济文化的发展，各类水质的卫生安全、水污染的控制已成为人类生存和发展亟待解决的迫切问题。目前常见的水质消毒技术方法。如液氯、次氯酸钠发生器、二氧化氯、臭氧、紫外线等方法，均不同程度存在有副产物多、易在水中形成致癌危险物质（如卤代烃）、水中溶解浓度不稳定、易产生新的环境污染、使用管理不方便、存在安全性隐患和运行成果较高等问题。鉴于目前水质消毒处理技术中的诸多不足和缺陷，同时考虑到各类水质处理的现场要求和条件，我们研制了电激水质消毒装置，对其水质杀菌消毒处理的效果、卫生安全和应用特点进行实验室卫生学评价。     

Effect of prospective reimbursement on nursing home costs.

OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.     

A study of the efficacy of various home filtration substrates in the removal of microcystin-LR from drinking water

This study was conducted to determine whether common water filtration and purification systems bought by consumers and used in the home would remove cyanotoxins from water. Commonly used universal filter housings and filter sizes were utilized to identify filter media that may be effective in the removal of microcystin-LR in deionized water. Results suggest that the efficacy of home filtration devices in removing microcystin-LR varies considerably with the type of device being used. Carbon filters successfully removed microcystin-LR allowing only 0.05-0.3% of the toxin load to pass through the filter. On the other hand, pleated paper and string wound filters allowed > 90% of microcystin-LR present in the sample to pass through the filters. Theoretically, the use of carbon home filtration devices tested in this study may provide protection against human exposure to cyanotoxin in addition to protection provided by water treatment methodologies utilized in water treatment facilities. Further studies need to be done to assess the efficacy of home filtration devices for various cyanotoxins and for other filtering conditions such as increased toxin load, the presence of other contaminants in drinking water, and the repetitive use of the same filter over longer time intervals.     

Home health and skilled nursing facility use: 1982-90

In this article, analyses are made of home health and skilled nursing facility (SNF) use for the period 1982-90 using Medicare records linked to data on community and institutional residents from the National Long-Term Care Surveys (NLTCSs) of 1982, 1984, and 1989. The combined survey and administrative data analyses are performed to ascertain how the chronic health and functional characteristics of community and institutional residents using Medicare-reimbursed services changed during the period. During this period, changes had been made in the Medicare system that affected the use of services for persons with specific health and functional problems.     

FRED: an innovative approach to nursing home level-of-care assignments.

A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED.     

Evaluation of disinfectants in the domestic environment under 'in use' conditions

An 'in use' test was developed to investigate effectiveness of disinfectant application and of detergent of hot water cleaning at kitchen, bathroom and toilet sites in the domestic environment. Detergent and hot water cleaning produced no observable reduction in microbial contamination. Single and daily application tests demonstrated that hypochlorite and phenolic disinfectants can be used to produce substantial reductions in bacterial contamination in the home. Results indicate that maximum protection afforded by disinfection is relatively brief; 3-6 h after disinfection, contamination levels were only marginally less than those observed at pretreatment. Some suggestions are made for improvements in home hygiene.     

Evaluation of disinfectants in the domestic environment under 'in use' conditions.

An ''in use'' test was developed to investigate effectiveness of disinfectant application and of detergent of hot water cleaning at kitchen, bathroom and toilet sites in the domestic environment. Detergent and hot water cleaning produced no observable reduction in microbial contamination. Single and daily application tests demonstrated that hypochlorite and phenolic disinfectants can be used to produce substantial reductions in bacterial contamination in the home. Results indicate that maximum protection afforded by disinfection is relatively brief; 3-6 h after disinfection, contamination levels were only marginally less than those observed at pretreatment. Some suggestions are made for improvements in home hygiene.     

Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario,Canada: A Population-Based Cohort Study

ObjectiveWe investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program.DesignPopulation-based retrospective cohort study.Setting and ParticipantsLinked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977).MethodsAccess to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis.ResultsThere were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period.Conclusions and ImplicationsThe rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.     

Preliminary Assessment of Appropriateness of Emergency Care Service Use: Actions Taken and Consultations Obtained Before Emergency Care Presentation

Inappropriate use of emergency care services can increase hospital readmissions and related costs. This pilot, cross-sectional survey project determined whether home health care patients who receive emergency care services during a Medicare-approved home care episode sought consultation from health care professionals before they made the emergency care visit. The two research questions were: (a) What actions were taken by the patient before making an emergency care visit?; (b) If prior consultation was obtained, what were the suggestions? Preliminary data were obtained from a Michigan-based, Medicare-certified, not-for-profit home health agency affiliated with a university health system. A two-page questionnaire recorded up to three emergency care visits. Volunteer participants were Medicare patients who had no cognitive deficits and were able to communicate with home health care providers (HHCPs) by themselves. Thirty-five emergency care visits were reported; 31 (88.6%) Medicare patients participated and 4 (11.4%) of them had two emergency care visits. Before the patients made an emergency care visit, they most often called their primary care physicians (PCPs; N = 20, 57.1%), followed by the HHCPs (N = 10, 28.6%). All 20 patients who contacted their PCPs and 7 patients who contacted their HHCPs were advised to seek emergency care services. In 20 emergency care visits the patient was admitted for an acute hospital stay; the other 15 patients went home. Most patients contacted their PCPs or HHCPs before they went to an emergency department or urgent care facility. These results implied that PCPs and HHCPs seemed to perceive that the need for emergency care should be determined at an emergency room or urgent care facility. This study was unable to differentiate the need for emergency care services or the appropriateness of the advice given by PCPs or HHCPs when the home care patients were under the care of a medical team.     

Preliminary assessment of appropriateness of emergency care service use: actions taken and consultations obtained before emergency care presentation

Inappropriate use of emergency care services can increase hospital readmissions and related costs. This pilot, cross-sectional survey project determined whether home health care patients who receive emergency care services during a Medicare-approved home care episode sought consultation from health care professionals before they made the emergency care visit. The two research questions were: (a) What actions were taken by the patient before making an emergency care visit?; (b) If prior consultation was obtained, what were the suggestions? Preliminary data were obtained from a Michigan-based, Medicare-certified, not-for-profit home health agency affiliated with a university health system. A two-page questionnaire recorded up to three emergency care visits. Volunteer participants were Medicare patients who had no cognitive deficits and were able to communicate with home health care providers (HHCPs) by themselves. Thirty-five emergency care visits were reported; 31 (88.6%) Medicare patients participated and 4 (11.4%) of them had two emergency care visits. Before the patients made an emergency care visit, they most often called their primary care physicians (PCPs; N = 20, 57.1%), followed by the HHCPs (N = 10, 28.6%). All 20 patients who contacted their PCPs and 7 patients who contacted their HHCPs were advised to seek emergency care services. In 20 emergency care visits the patient was admitted for an acute hospital stay; the other 15 patients went home. Most patients contacted their PCPs or HHCPs before they went to an emergency department or urgent care facility. These results implied that PCPs and HHCPs seemed to perceive that the need for emergency care should be determined at an emergency room or urgent care facility. This study was unable to differentiate the need for emergency care services or the appropriateness of the advice given by PCPs or HHCPs when the home care patients were under the care of a medical team.     

Reducing hospital admissions from a skilled nursing home

With good nursing care and the resources of a dedicated skilled nursing facility, many nursing home patients usually admitted to a hospital for various medical illnesses can be handled within the framework of the skilled nursing facility without necessarily incurring an increased nursing home death rate. The medical advantage to the patient and to the usually overburdened hospitals, as well as the economic advantage to the public in general, calls for a full evaluation and consideration of this alternative to the regular and ongoing practice of hospital admissions of the elderly nursing home patient. The experiences of Carmel Richmond Nursing Home, a skilled nursing facility, have shown that this alternate level of approach and care can be quite successful and beneficial to all involved, especially the nursing home patient.