衡水市医疗照射应用频度调查分析

目的 了解衡水市放射诊疗机构医疗照射诊疗现况。方法 采用普查的形式对衡水市开展医用诊断、介入治疗、放射治疗、临床核医学项目的各级各类医疗机构进行调查分析,并结合衡水市人口资料计算放射诊疗应用频度。结果 衡水市2016年取得放射诊疗许可证的医疗卫生机构数为105家,医用诊断应用频度为253.72人次/千人口,介入放射学的应用频度为1.42人次/千人口,放射治疗的应用频度为0.36例/千人口,临床核医学的应用频度为0.33人次/千人口。全市只有4个县区开展介入放射学,7个县区开展放射治疗,临床核医学只有桃城区一家医院开展,医疗照射发展很不平衡。结论 初步掌握了本市放射诊疗机构的医疗照射频度水平,充实了本市医疗放射卫生项目的基本资料,要发挥二级医院“中流砥柱”、一级医院“基础分流”的作用,减轻三级医院的就医压力。为今后放射诊疗发展提供参考,为进一步开展放射卫生工作打下基础。     

廊坊市放射工作人员医疗照射频度及受照剂量调查分析

目的 了解廊坊市不同级别医院的各类放射工作人员的医疗照射频度与外照射个人剂量,评估放射工作人员职业健康风险,为放射防护工作提供技术依据。方法 对廊坊市6家不同级别医院2016年全部医疗照射频度、外照射个人剂量开展调查,对调查数据进行统计分析。结果 6家医院中,三级、二级、一级医院放射诊断人员医疗照射人均人次数分别为4 217、3 066、883;三级、二级医院介入放射人员医疗照射人均人次数分别为174、115;一家三级医院的放疗人员医疗照射人均人次数为30;各类放射人员全年有效剂量范围为0.78~1.29 mSv;介入、放射治疗、牙科、放射诊断放射工作人员单次暴露有效剂量分别为0.005 6~0.011、0.038、0.001 3~0.004 2、0.000 27~0.002 3 mSv。结论 从事介入、放射治疗的放射工作人员单次电离辐射暴露的健康损害风险远高于其他放射工作人员;应以介入、放射治疗人员和低级别医院为重点,加强放射防护工作。     

杭州市放射诊疗应用频度调查分析

通过对杭州市所有取得放射诊疗许可的医疗机构的基本信息及诊疗服务情况进行普查,为医疗照射放射防护合理化管理及卫生资源的合理配置提供依据和参考。结果显示,杭州市共有放射诊疗机构636家,放射诊疗设备1 952台,放射工作人员4 777人。常规X射线诊断、CT诊断、牙科及乳腺摄影检查诊断频度分别为915.1、503.3、141.9人次/千人口;介入放射学、放射治疗、核医学诊断和核医学治疗频度分别为12.0、29.3、8.6、 0.9人/千人口。省级医疗机构各类型医疗照射频度最高,乡级医疗机构医疗照射频度较低。提示,杭州市应加强对医疗机构的放射卫生监督管理,合理配置卫生资源,确保放射诊疗技术应用的正当性。     

杭州市放射诊疗应用频度调查分析

通过对杭州市所有取得放射诊疗许可的医疗机构的基本信息及诊疗服务情况进行普查,为医疗照射放射防护合理化管理及卫生资源的合理配置提供依据和参考。结果显示,杭州市共有放射诊疗机构636家,放射诊疗设备1 952台,放射工作人员4 777人。常规X射线诊断、CT诊断、牙科及乳腺摄影检查诊断频度分别为915.1、503.3、141.9人次/千人口;介入放射学、放射治疗、核医学诊断和核医学治疗频度分别为12.0、29.3、8.6、 0.9人/千人口。省级医疗机构各类型医疗照射频度最高,乡级医疗机构医疗照射频度较低。提示,杭州市应加强对医疗机构的放射卫生监督管理,合理配置卫生资源,确保放射诊疗技术应用的正当性。     

北京市放射诊疗资源分布现状与集聚度分析

目的 开展北京市放射诊疗资源分布现状与集聚度分析,为合理统筹放射诊疗资源配置、制定政策、促进放射诊疗资源稳定发展与高效利用提供参考。方法 基于2019—2020年北京市医疗卫生机构医用辐射防护监测数据,通过放射诊疗资源数量、平均服务量、资源构成等指标描述放射诊疗资源现状,借助集聚度指标评价北京市放射诊疗资源分布均衡程度。结果 三级医院放射诊断设备配备数量、服务人次及放射工作人员数最多;单台设备服务人次三级医院占比较大,且放射治疗、核医学服务集中于三级医院。三级医院的人力资源与设备服务压力均相对较大,一级医院主要承担放射诊断服务,二级医院与三级医院人均放射诊断服务量差别不大,三级医院核医学和放射治疗人均服务量显著高于二级医院。放射诊疗资源在城区集聚程度较大。结论 不同级别医院放射诊疗资源利用率存在明显差异,各区放射诊疗资源存在显著集聚现象,北京市放射诊疗资源存在一定程度的分布不均衡、利用不充分问题。     

徐州市2013-2015年医疗照射水平调查分析

目的 了解和掌握徐州市放射诊疗水平和发展趋势,为合理配置放射诊疗资源及放射诊疗的监管提供科学依据,促进放射诊疗的合理发展。方法 以徐州市所有放射诊疗机构为调查对象,采用信访方式对全市放射诊疗机构进行调查。结果 本次共调查放射诊疗机构314家,2013-2015年徐州市放射诊疗设备和放射工作人员总数均不断增加,但每台设备占放射工作人员无明显变化,设备区域分布不均;徐州市医疗照射总频次呈上升趋势,其中核医学治疗增长最快。一级及其他医疗机构X射线诊断频次最多,放射治疗、介入放射学和临床核医学的照射主要集中于三级医疗机构。结论 徐州市放射诊疗资源在逐年增加,区域范围内资源分配不均,医疗照射水平呈逐年上升趋势,但是放射诊疗总体水平远低于苏南等经济发达地区。控制放射诊疗工作人员和公众的受照射剂量,做好医疗照射防护工作,是当前放射卫生监督的主要任务。     

江苏省2016年度医疗照射频度调查

目的 本研究旨在探讨我省医疗照射频度发展状况,寻找医疗照射频度调查有效方法。方法 随机抽取31家医疗机构开展医疗照射频度调查,调查2016年相关放射诊疗活动,采用门急诊量、工作人员数和住院人数3因素回归拟合,建立线性预测模型并根据全省3因素总量估算2016年江苏省医疗照射总频度。结果 2016年江苏省医疗照射总频度为926.62 人次/千人口,其中X射线诊断911.70 人次/千人口,放射治疗1.85 人次/千人口,核医学应用（诊断和治疗）7.97人次/千人口。CT检查、放射治疗和核医学的五年平均增长率依次为158%、58.7%和107%。结论 多因素回归估算医疗照射频度好于单因素估算,本次调查结果受样本量和代表性限制,有待进一步调查研究核实。CT检查和核医学诊断发展速度占前两位,应加强医疗照射防护,实现医疗照射利益最大化。     

宁夏地区放射诊疗资源配置现状及对策

目的 掌握宁夏地区放射诊疗资源配置情况，为卫生健康行政部门进一步优化医疗资源配置提供科学的政策数据。方法 采用发放调查表和现场调查相结合的方法。结果 宁夏放射诊疗设备共计928台，其中X射线影像诊断设备883台，放射治疗设备8台，介入放射学设备33台，核医学设备4台。放射工作人员1 676人，持证率为99.64%。平均每万人拥有放射诊疗设备1.36台，其中45.91%分布在银川市，其余4市明显分布较少。另外，介入放射学设备银川市约占50%，放射治疗设备和核医学设备只分布在银川市。结论 宁夏放射诊疗资源整体配置落后且分布不均衡，大部分集中在银川市，尤其是放射治疗和核医学等高端设备分布差异尤为明显。     

河南省2003～2007年放射诊疗工作人员个人剂量水平调查

目的 分类调查河南省31个医疗卫生机构2003~2007年放射诊疗工作人员外照射个人剂量水平。方法 依据GBZ 128-2002,采用热释光剂量方法监测工作人员深部剂量当量Hp(10),对从事介入治疗的医护人员进行铅衣内、外剂量监测,统计并转换为年有效剂量。结果 5年共监测4 325人次,人均年有效剂量为0.984mSv,从事放射治疗、核医学、介入放射学、X射线影像诊断4类工作的人均年有效剂量分别为1.003,1.124,1.708,0.813mSv。结论 绝大多数诊疗人员剂量水平都在安全范围之内。4类放射诊疗工作中,受照剂量由高至低排序为:介入放射学、核医学、放射治疗和X射线影像诊断。     

2016年度福建省医疗照射频度调查与分析

目的 通过对福建省的37家样本医院进行放射诊疗情况调查,研究福建省放射诊疗的基本情况,估算全省各类放射诊疗项目的照射频度。方法 采用全国统一的调查表,通过医院信息管理系统或手工登记本搜集样本医院的门急诊量、住院量、放射诊疗设备和放射工作人员的基本情况,以及各类诊疗项目的受检者性别、年龄、检查类型、检查部位等分布信息,并对调查结果进行统计分析。结果 37家医院各类放射诊疗项目合计照射人次4 496 833,基于该调查结果估算的福建省各类诊疗项目照射频度分别为X射线影像诊断459.1人次/千人口、介入放射学1.8人次/千人口、核医学2.4人次/千人口、放射治疗0.50例/千人口。结论 通过本次调查能够掌握福建省医疗照射频度的大体情况,可为我省放射诊疗技术的应用以及医疗照射防护安全提供许多的启发。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.