三级医院全科医学科联合社区综合干预对高血压管理效果分析

［摘要］ 目的 探讨三级医院全科医学科联合社区综合干预对高血压管理的效果。 方法 随机选取石家庄市5家社区卫生服务中心作为研究对象来源,选取高血压患者500例,采取随机数字表法将所有患者分成为对照组（250例）和干预组（250例）。对照组患者由社区卫生服务中心进行常规健康管理,主要包括定期血压监测、用药指导和常规健康教育等。干预组实施三级医院全科医学科联合社区卫生服务中心进行综合干预模式,2组管理时间均为6个月。所有入组人员采用自行设计的高血压相关问卷,对2组干预前后的防治知识、自我管理行为进行评分。 结果 干预前,干预组与对照组的防治知识、自我管理得分差异无统计学意义（P＞0.05）,干预6个月后,干预组的防治知识、自我管理得分均高于对照组,差异有统计学意义（P＜0.05）,干预组患者血压较对照组更早达到平稳水平。 结论 三级医院全科医学科联合社区综合干预高血压管理的模式有利于改善社区高血压人群防治知识及自我管理水平。     

Does smoking cannabis affect work commitment?

Aims This study aimed to examine the associations between cannabis use and work commitment Design We used a 25‐year panel survey initiated in 1985 with follow‐ups in 1987, 1989, 1993, 2003 and 2010. Registered data from a range of public registers were matched with individual responses for the entire period. Setting The panel survey was a nation‐wide study set in Norway. Participants A total of 1997 respondents born between 1965 and 1968 were included in the panel. Measurements Work involvement scale (WIS) was used to assess work commitment. Involvement with cannabis was based on self‐reported smoking of cannabis within the last 12 months and exposure to cannabis through friends. This information was categorized into ‘abstaining’, ‘exposed’, ‘experimented’ and ‘involved’. Control measures included socio‐economic background, mental health (HSCL‐10), education, work satisfaction, unemployment, receipt of social assistance, consumption of alcohol, alcohol‐related problems and use of other illicit drugs. Findings The level of work commitment was associated with involvement with cannabis. In 1993, when the respondents were in their mid‐20s, those who were involved or had experimented with cannabis displayed lower levels of work commitment than those who were abstaining or merely exposed to cannabis through friends (P < 0.05). Work commitment among those who experimented with cannabis converged towards the levels reported by abstainers and the exposed as they grew older, whereas those involved reported decreasing work commitment into adulthood (P < 0.001). Using linear regression models for panel data, an association with continued use of cannabis across the life‐course and a lowering of work commitment was established. Results remained significant even when controlling for a range of other factors known to be related to work commitment, such as socio‐economic background, education, labour market experiences, mental health and family characteristics (P < 0.05). Conclusions In Norway the use of cannabis is associated with a reduction in work commitment among adults.     

Ciliogenesis and autophagy are coordinately regulated by EphA2 in the cornea to maintain proper epithelial architecture

PurposeTo understand the relationship between ciliogenesis and autophagy in the corneal epithelium.MethodssiRNAs for EphA2 or PLD1 were used to inhibit protein expression in vitro. Morpholino-anti-EphA2 was used to knockdown EphA2 in Xenopus skin. An EphA2 knockout mouse was used to conduct loss of function studies. Autophagic vacuoles were visualized by contrast light microscopy. Autophagy flux, was measured by LC3 turnover and p62 protein levels. Immunostaining and confocal microscopy were conducted to visualize cilia in cultured cells and in vivo.ResultsLoss of EphA2 (i) increased corneal epithelial thickness by elevating proliferative potential in wing cells, (ii) reduced the number of ciliated cells, (iii) increased large hollow vacuoles, that could be rescued by BafA1; (iv) inhibited autophagy flux and (v) increased GFP-LC3 puncta in the mouse corneal epithelium. This indicated a role for EphA2 in stratified epithelial assembly via regulation of proliferation as well as a positive role in both ciliogenesis and end-stage autophagy. Inhibition of PLD1, an EphA2 interacting protein that is a critical regulator of end-stage autophagy, reversed the accumulation of vacuoles, and the reduction in the number of ciliated cells due to EphA2 depletion, suggesting EphA2 regulation of both end-stage autophagy and ciliogenesis via PLD1. PLD1 mediated rescue of ciliogenesis by EphA2 depletion was blocked by BafA1, placing autophagy between EphA2 signaling and regulation of ciliogenesis.ConclusionOur findings demonstrate a novel role for EphA2 in regulating both autophagy and ciliogenesis, processes that are essential for proper corneal epithelial homeostasis.     

Dropout revisited: Patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability

Abstract

Objective: To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. Method: Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. Results: High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. Conclusions: The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.     

Occupational stress among Swedish audiologists in clinical practice: Reasons for being stressed

Objective: The present study reports on the application of a Swedish translation of the audiologist occupational stress questionnaire (AOSQ) on audiologists working in Sweden. The relations between AOSQ scores and perceived effort, perceived rewards, coping strategies at work, demographic variables such as salary, education length, practise length, and practice type were tested. Design: A cross-sectional e-mail survey using the AOSQ, effort-reward imbalance questionnaire, and demographic questions. Study sample: Four-hundred and four Swedish licensed audiologists working with clients. Results: The Swedish AOSQ translation demonstrated high inter-item correlations and high internal consistency. Several stress factors were identified: time spent at work, accountability, leadership at the workplace, paperwork and practice demands, equipment and clinical protocols, own health concerns, and job control. The outcome on the complete AOSQ questionnaire was related to perceived effort, perceived rewards, coping strategies at work, and age. Conclusions: The Swedish AOSQ translation seems to provide a valid measure of occupational stress among audiologists.     

重塑组织边界:深圳医务社会工作的经验与反思

医务社会工作是医院与社会工作机构跨越组织边界的合作。通过对深圳医务社会工作的调查分析,揭示了医院与社会工作机构之间存在制度边界、物理边界、认同边界,具体表现为业务流程与管理规范的隔离、服务空间与信息流通的壁垒、主体间的认同困境,阻碍了医务社会工作的开展。医院主动开放边界的举措与社会工作机构主动渗透的策略促进了组织合作,重塑了组织边界,但也存在一定的不足。     

The principal–agent problem and owner‐managers: An instrumental variables application to nursing home quality

The literature on provider ownership has primarily focused broadly on for‐profits compared with nonprofits and chains versus nonchains. However, the understanding of more nuanced ownership arrangements within individual facilities is limited. Utilizing the principal–agent and managerial control frameworks, we study the role of managerial ownership and its relationship to quality among for‐profit nursing homes (NHs). We identify NH administrators with more than 5% ownership (owner‐manager) from Ohio Medicaid Cost Reports (2005–2010) and link these data to long‐stay resident records in the Minimum Data Set. Using differential distance to the nearest NHs with a salaried manager relative to an owner‐manager, we address the differential selection into these two types of NHs. After instrumenting for admissions to owner‐managed NHs, quality among long‐stay residents at owner‐managed NHs is generally better than NHs with salaried managers. We find suggestive evidence that the magnitudes of quality difference are larger when the principal–agent problem is likely more pronounced, such as when NHs that are part of a multifacility chain and located in more concentrated markets.     

Self‐reported musculoskeletal disorder pain: The role of job hazards and work‐life interaction

Background

Previous research identified an association between work‐family conflict and musculoskeletal pain. This study explores how the work‐life interface might affect pain experienced by residential aged care staff.

Methods

A cross‐sectional survey of 426 employees in residential aged care was analyzed to assess the impacts of workplace hazards, work‐family conflict, and work‐life balance on self‐reported musculoskeletal pain.

Results

Work‐family conflict acts as a mediator of the relationships between workplace hazards and the total number of body regions at which musculoskeletal pain was experienced. Work‐life balance only acts as a mediator for particular hazards and only if work‐family conflict is not taken into account.

Conclusions

Addressing work‐life interaction, and in particular work‐family conflict, warrants further investigation as a legitimate means through which musculoskeletal disorder risk can be reduced. Policies and practices to improve work‐life interaction and reduce work‐family conflict should be considered as integral components of musculoskeletal disorder risk management strategies.

     

Does hospital ownership influence hospital referral region health rankings in the United States

Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.