Work experiences among nurses and physicians in the beginning of their professional careers – analyses using the effort–reward imbalance model

Scand J Caring Sci; 2013; 27; 36–43 Work experiences among nurses and physicians in the beginning of their professional careers – analyses using the effort–reward imbalance model The aim of the study was to scrutinise how nurses and physicians, employed by the county councils in Sweden, assess their work environment in terms of effort and reward at the start of their career. The aim was also to estimate associations between work satisfaction and the potential outcomes from the effort–reward imbalance (ERI) questionnaire. The study group, 198 nurses and 242 physicians who graduated in 1999, is a subsample drawn from a national cross‐sectional survey. Data were collected in the third year after graduation among the nurses and in the fourth year after graduation among registered physicians. The effort–reward imbalance questionnaire, together with a question on work satisfaction, was used to evaluate psychosocial factors at work. The results reveal that nurses scored higher on effort, lower on reward and experienced higher effort–reward imbalance, compared with physicians. Women scored higher on work‐related overcommitment (WOC) compared with men. Among the physicians, logistic regression analysis revealed a statistically significant association between WOC and ERI, sex, effort and reward. Logistic regression analysis also revealed a statistically significant association between WOC and ERI and between WOC and effort among the nurses. Dissatisfaction with work was significantly higher among those who scored worst on all three ERI subscales (effort, reward and WOC) and also among those with the highest ERI ratios compared with the other respondents. In conclusion, to prevent future work‐related health problems and work dissatisfaction among nurses and physicians in the beginning of their professional careers, signs of poor psychosocial working conditions have to been taken seriously. In future work‐related stress research among healthcare personnel, gender‐specific aspects of working conditions must be further highlighted to develop more gender‐sensitive analyses.     

紫外分光光度法测定不同产地黄花蒿中青蒿素的含量

目的:研究云阳县不同产地的黄花蒿所含的青蒿素的差异。方法:采用紫外分光光度法测定,检测波长292nm。结果:对照品在0.02～0.14mg/mL范围内具有良好的线性关系,r=0.9998,平均回收率为98.81%(n=7),方法精密度试验RSD=0.38%。结论:该方法简便、快速、准确;云阳县不同产地的黄花蒿的青蒿素含量接近,适合在当地大规模栽培。     

高效液相色谱法测定浙江平阳栀子熊果酸含量

目的:为控制浙江平阳栀子的质量,建立高效液相色谱法测定浙江平阳栀子中熊果酸含量的方法。方法:采用高效液相色谱法,以熊果酸为化学对照品,固定相:UltimateTMC18键合硅胶柱(4.6mm×250mm,5μm),流动相:甲醇:水:冰醋酸:三乙胺(90∶10∶0.03∶0.06),流速:0.6mL.min-1,温度:25℃,波长:210nm测定浙江平阳栀子熊果酸含量。结果:熊果酸在0.1~3.0μg范围内峰面积A与进样量M呈现良好的线性关系,其回归方程为:A=-12954.8829+452850.9603M,γ=0.9996,n=7;三批浙江平阳栀子中熊果酸的含量分别为(0.586±0.010)%,RSD%=1.72,n=3;(0.537±0.020)%,RSD%=3.689,n=4;(0.497±0.012)%,RSD%=2.405,n=4;精密度试验RSD%=1.754,仪器精密度良好;稳定性试验RSD%=3.493,在3.5h内测定熊果酸的含量是稳定的;重复性试验RSD%=2.849,平均回收率为101.9%。结论:高效液相色谱法适合浙江平阳栀子中熊果酸的含量测定,该方法操作简便,结果稳定,精密度、重现性、回收率较好,值得推广。     

农村区县级医院存在问题及对策

结合良乡医院的实际情况,论述了农村区县级医院特点及现状,分析了存在的问题及其产生的原因,在此基础上提出对策建议:强化政府责任;落实卫生经济政策,加大对农村区县级医院的财政投入;针对农村卫生实际情况,制订留住人才的各种优惠政策;提高区县医院管理水平;因地制宜,明确农村区县级医院功能定位。     

云南勐腊县疟疾疫情漏报调查

目的 了解勐腊县目前疟疾病例漏报情况，为制订疟疾防治计划及全球基金疟疾项目实施后的效果评价提供基线数据。方法 用分层随机抽样，将抽取的乡（镇）村、社疟疾发病，疾疫情报告等基础数据进行调查，对居民2002年是否患过疟疾进行回顾性逐户逐人问卷记录。结果 用以捕获一再捕获（CMR）方法，推算勐腊县2002年疟疾的发病人数为4464例，是疫情报告数443例的10．1倍。疫情报告符合率仅为9．9％，漏报率达90．1％。结论 目前勐腊县疟疾漏报数量大，疟疾发病形势严峻。因此，要加强疫情管理，加大疟疾防治力度，同时应引起各级政府、卫生行政部门高度重视。     

西部贫困地区县级医疗机构门诊处方费用分析

目的：通过对西部贫困地区县级医疗机构门诊处方费用的深入分析,探讨导致不合理处方费用的多种原因.结果：门诊平均处方费用为32.60元,超过百元的大处方占抽样处方的5.99%,单张处方随用药种数增加其平均处方费用相应增加,使用注射、特别是抗生素注射以及多种抗生素联用注射时,平均处方费用明显增加（P＜0.01）.结论：西部贫困地区县级医疗机构多种药物联合使用、注射的提供以及抗生素注射的滥用是导致平均处方费用迅速增加的内在原因,建议完善处方费用的监控机制,增强医务人员的责任意识,降低处方费用.     

5．12汶川大地震极重灾区青川卫生工作概况

汶川大地震，青川县是极重灾区，卫生系统幸存人员与国内外援救人员一道，在应急抢救、灾后救治、防疫、卫生监管、灾后重建方面认真履行自身职责，但随着灾后重建工作的逐步展开，暴露出了一些亟需解决的困难。     

Neonatal hearing loss in the indigent

OBJECTIVE: To compare the risk factor profile for neonatal hearing loss (HL), and the follow-up rate of those identified with HL in an indigent population with those in an insured population. STUDY DESIGN: Retrospective review. METHODS: We studied 4526 neonates from the high-risk nursery or neonatal intensive care unit from two adjacent hospitals in Houston, Texas. Ben Taub General Hospital (BTGH) is a county public hospital that serves mainly the indigent. Texas Children's Hospital (TCH) is a private tertiary care center that serves patients with private insurance and Medicaid. RESULTS: Overall, 133 infants failed the screening test. Follow-up diagnostic testing identified 48 patients with definite HL. Although nearly twice as many patients at BTGH failed screening compared with TCH (88 vs. 45), four times as many patients at BTGH did not return for diagnostic testing (43 vs. 10). When a hearing aid was needed, there was a delay in getting one at BTGH (P <.05). There was a higher prevalence of dysmorphic facial features and central nervous system disease and a lower prevalence of long-term ventilatory support at BTGH (P <.05). There were no differences between BTGH and TCH in the prevalence of low birth weight, neonatal asphyxia, syndromic stigmata, neonatal infection, family history of HL, or neonatal transfusion (P >.1). CONCLUSIONS: Significant differences in the risk factor profile for neonatal HL exist between the indigent and the general population. A worrisome problem exists with the timely intervention in hearing-impaired indigent neonates.     

The Impact of Realignment on Utilization and Cost of Community-Based Mental Health Services in California

Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988–1990 and FY 1992–1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.     

基层医院清洁手术抗菌药物应用与费用分析

目的了解基层医院清洁手术预防应用抗菌药物情况,规范抗菌药物的预防应用,降低医疗成本。方法设计统一调查表,调查某市13家县级医院2004年9月份清洁手术应用抗菌药物情况。结果共调查639例清洁手术患者,抗菌药物预防使用率为98.28%(628/639);抗菌药物平均使用时间为(7.60±2.57)d;单一用药占55.25%(347/628),联合用药占44.75%(281/628);用第三代头孢菌素以上及广谱抗菌药物者占50.64%(318/628);人均抗菌药物费用为人民币(1 064.64±286.51)元,占药品费用的43.38%,心胸外科、神经外科患者平均抗菌药物费用较高,分别为(2 783.10±653.39)元、(1 991.56±623.32)元。结论基层医院清洁手术抗菌药物预防使用率高,用药时间长、起点高等是不合理用药的主要表现,也是造成抗菌药物费用高的主要原因。