某铅酸蓄电池生产企业通风设施评价及改造

目的了解某铅酸蓄电池生产企业多年来频发职业性铅中毒的原因,探讨有效措施降低铅中毒的发病率。方法对某铅酸蓄电池生产企业进行职业病危害因素检测,对通风设施进行评价与改造。结果该企业原作业场所铅监测点的超标率为62．9％,最高点超标207倍;工种的超标率为64．6％,最高超标139倍;通风不良的排风口占72．0％,主要是通风管道堵塞或破损,造成控制风速不达标。对原有通风设施进行重新疏通,更换排铅烟管道,更新铅尘除尘器的过滤袋。改造后作业场所铅监测点的超标率下降为13．2％,最高浓度超标5倍。企业铅中毒新发病例数由每年17例下降为每年3例。结论该企业由于通风系统维护不当造成作业场所空气中铅浓度严重超标,导致铅中毒发病率较高,对通风系统改造后,作业场所铅浓度明显改善,铅中毒患者减少。     

Assessment of the hepatitis B birth dose vaccination program,Papua New Guinea, 2014

IntroductionPapua New Guinea (PNG) implemented hepatitis B birth dose (BD) vaccination in 2005 yet since that time coverage has remained low, allowing mother-to-child transmission to occur. We conducted a field assessment of the BD vaccination program to develop strategies for improving the BD coverage.MethodsWe selected five provinces with higher hepatitis B prevalence and five with lower prevalence based on the results of a 2013 hepatitis B serological survey. Within each province, we interviewed district and provincial health officers, health workers, village volunteers, and caregivers from ten randomly selected health facilities. Data were collected on knowledge, practice, vaccine management and data recording/reporting. To identify enabling factors and barriers, we compared health facilities with higher BD coverage with those with lower coverage, and compared caregivers whose children received BD with those whose children did not.ResultsOverall timely BD coverage was 31% and BD vaccination was taking place in 81% of sampled health facilities. Lack of cold chain and vaccine were the major reasons for not providing the BD. Insufficiencies in supervision, vaccine management, community outreach, and data management were identified as obstacles to achieving high timely hepatitis B BD coverage. Good supervision, knowledge of hepatitis B and hepatitis B vaccination, antenatal care including information about the hepatitis B BD, provision of vaccine refrigerators in maternity wards, and outreach vaccination for home deliveries were associated with higher timely BD coverage.DiscussionSeveral steps will likely be effective in improving BD coverage: strengthening training and supervision among health workers and officers, educating caregivers on the benefits of the BD and delivery in health facilities, improving vaccine management, and improving data quality. Considerable effort and leadership will be needed to achieve these steps.     

广州市越秀区中小学学校卫生现状调查

目的了解广州市越秀区中小学学校卫生状况,为各级学校调整卫生资源和制定评价学校卫生保健措施提供依据。方法对广州市越秀区90所中小学的监督监测结果进行综合评价,并对小学一年级至高三年级共540间教室的人均面积、照明和课桌椅等分项进行比较。结果 90所学校综合评价均合格,但存在环境噪声、课桌椅和教室采光单项不合格情况,不合格率分别为68.64%2,8.67%和5.02%。教室卫生问题以小学为多,较突出的是灯具设置不符合卫生要求、课桌椅和环境噪声不合格率高。结论《学校工作卫生条例》需要配套的实施细则,以规范学校卫生工作,提高监督成效;学校必须科学合理执行相关卫生法则。     

γ辐照装置辐射安全审查公众剂量估算及管理须知

为优化y辐照装置项目的公众剂量估算及管理,降低营运成本,对y辐照装置的辐射公众剂量估算及管理较突出的问题进行探讨。不合适的剂量估算与管理导致营运成本较高及监管方、项目营运方等产生争议。在一些情形下分别采取引入第3组工作人员,具体分析公众受照、项目运行信息,设置隔离区域的措施有利于在人员及环境得到保护的前提下进行监管和使项目营运顺利。     

Maplnfo软件在市容环卫设施管理中的应用

介绍了Maplnfo软件,阐述了该软件在市容环卫设施地图编辑,市容环卫设施数据表管理,环卫设施查询,汇总并生成环卫设施数据报表,制作环卫设施分布专题地图,文件格式转换,使用布局输出环卫设施点位分布地图等方面的应用。     

Nutrition Screening Practices in Adult Day Care Centers

Older adults have been identified as one of the largest groups at risk of malnutrition in America and represent the target population of the Nutrition Screening Initiative. At the University of Delaware Adult Day Care Center, nutrition screening is an integral component of basic services provided to clients and their caregivers. To determine the extent of current nutrition screening practices in other adult day care centers, centers across the United States were surveyed. A total of 160 centers (53%) responded, 101 indicated nutrition screening was an on-going service. A number of differences and similarities in nutrition screening parameters was evident. Most centers responding assessed the following parameters: food intolerance, medical history, weight, height, swallowing difficulties, and bowel habits. Hematological parameters and other anthropometric measurements were evaluated with least frequency. Interest in nutrition screening appeared great. Further research should examine relationships between nutrition screening and other factors such as staffing patterns, center settings, and funding sources.     

我国农村卫生"三项建设"存在的问题分析

对农村卫生“三项建设”（即乡镇卫生院、县级卫生防疫站、妇幼保健站建设）实施10年以来情况给出一个外部评估，主要从资金投入、资金利用、机构管理和项目监督等4个方面分析项目存在的问题，为今后的实施提供监督。     

Post-Acute Care and ACOs — Who Will Be Accountable?

Objective

To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs).

Data Sources

Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Association Group Practice data identifying provider groups sufficiently large to be eligible for ACO program participation.

Study Design

We calculated the fraction of community-dwelling beneficiaries whose assignment shifted, as a consequence of including post-acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post-acute care.

Principal Findings

Assignment shifts occurred for 27.6 percent of 25,992 community-dwelling beneficiaries with at least one post-acute skilled nursing facility stay, and they were more common for those incurring higher Medicare spending. Those whose assignment shifted constituted only 1.3 percent of all community-dwelling beneficiaries cared for by large ACO-eligible organizations (n = 535,138), but they accounted for 8.4 percent of total Medicare spending for this population.

Conclusions

Under current Medicare assignment rules, ACOs may not be accountable for an influential group of post-acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions.     

Costs and impact of meningitis epidemics for the public health system in Burkina Faso

Background

Epidemic meningococcal meningitis remains a serious health threat in the African meningitis belt. New meningococcal conjugate vaccines are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics.

Methods

We evaluated the cost and impacts to the public health system of the 2007 epidemic bacterial meningitis season in Burkina Faso through a survey at the different level of the health system. A micro-economic approach was used to evaluate direct medical and non medical costs for both the public health system and households, as well as indirect costs for households.

Results

The total national cost was 9.4 million US$ (0.69 US$ per capita). Health system costs were 7.1 million US$ (1.97% of annual national health spending), with 85.6% for reactive vaccination campaigns. The remaining 2.3 million US$ was borne by households of meningitis cases. The mean cost per person vaccinated was 1.45 US$; the mean cost of case management per meningitis case was 116.3 US$ when including household costs and 26.4 US$ when including only health sector costs. Meningitis epidemics disrupted all health services from national to operational levels with the main contributor being a large increase in medical consultations.

Conclusions

Preventive meningococcal conjugate vaccines should contribute to more efficient use of funds dedicated to meningitis epidemics and limit the disruption of routine health services.