本文基于住院医师培训方面的国家政策法规和文件,梳理了我国住院医师规范化培训制度的历史演变进程,将其发展分为前期探索、局部试点、全国试行和落实完善4个阶段;并就其发展规律和未来走向提出了制度改革应遵循自上而下式的行政命令和指示性计划、制度应注重总结实践经验基础上的渐进式推行、制度还需从整体式视角继续落实和完善的几点现实思考.

目的:探讨情景模拟教学在"5+3"模式下提升医学专硕研究生临床综合能力的影响.方法:采用情景模拟教学对实验组进行干预与对照组的随机对照研究.结果:情景模拟教学干预后实验组理论成绩高于对照组,而且在答题时间和每题答题时间用时更短;在医患沟通能力,急诊中处理常见病能力,团队协作敬业精神,处理医患纠纷能力4个方面得到很好的提升,相比对照组得分更高(P<0.05),而在常见病多发病治疗,抢救危重病人能力方面与对照组相比提升不显著(P>0.05).结论:情景模拟教学有利于加深对医学知识理解,提升了临床综合能力,在"5+3"模式下高等医学院校应加强情景模拟教学课程建设,达到提高专硕研究生培养质量的目的.

澳大利亚飞行医生服务是澳大利亚基层医疗服务内容之一,对解决偏远地区居民就医问题具有重要作用.通过概述澳大利亚飞行医生的背景、发展历程、服务内容、优缺点、面临的挑战等几方面内容,以获取对卫生资源再分配、健康知识宣传、鼓励社会力量提供医疗服务以及提高医疗服务的可及性等方面的经验,对探索我国偏远地区居民健康状况差、居民自我保健意识薄弱以及卫生服务资源供给不足等问题具有重要借鉴意义.

自我医疗是公众提升自身健康水平的途径之一,但在农村地区,患者采取的自我医疗行为往往带有盲目意识,这可能会给农村居民造成经济和健康双重的损失.文章从行为经济学视角出发,对农村地区居民自我医疗药品消费决策过程进行了分析,旨在为引导农村居民采取合理的健康促进行为决策提供理论支持.

目的 了解疫苗及相关态度领域研究中的前沿与研究热点,进一步巩固我国计划免疫政策带来的公共卫生成就.方法 在Web of science数据库中运用"TS=(vaccine* AND attitude)"检索文献,运用CiteSpace筛查除重后对2537篇文献进行主要研究力量、高被引期刊、高影响力作者、高频关键词、突变词等进行可视化分析.结果 以美、澳、英为首的发达国家分别以发文量1 096、198、197篇和中心性0.44、0.21、0.21成为该领域主要研究力量,美国疾控中心以135篇的发文量和0.30的中心性成为该领域中最具影响力的研究机构,影响力较大的研究机构多数为大学;《Vaccine》以被引2 037次和0.43的中心性在高被引期刊中位列第一;作者Brewer N T被引309次,被引频次最高,Dempsey AF中心性最高,为0.23,Zimet GD是近10年最高产作者;主要的高频关键词有态度、疫苗、HPV疫苗接种;突变权重最高的词为疫苗犹豫.结论 我国应进一步加强与发达国家与其所属机构的项目合作,多向高影响力作者与高被引期刊学习,紧跟国际前沿研究方向,从而提高本国此领域的研究质量、丰富研究成果.

Background With increasing urbanization in developing countries, sanitation workers are frequently involved in road traffic collisions. Our purpose was to study specific collisions involving sanitation workers and provide decision-making suggestions and reference measures for the sanitation industry and urban managers to reduce the occurrence of collisions. Methods We obtained online news data about sanitation worker road traffic collisions in China between 2013 and 2017 and analyzed occurrence time and location, victim characteristics, and causes of collisions. Results In China, between 2013 and 2017, 511 road traffic collisions were reported, with the fewest in February and July. Most occurred around 5:00 a.m. in Eastern regions and in urban areas. Victims were mainly over 50 years old, with more females than males. Collisions usually resulted in death at the scene. The ambiguity of laws, the exploitation of workers through industry outsourcing, and the difficulty of processing claims may be the main factors preventing victims from obtaining legal compensation. Conclusions The most common cause of collisions was drivers’ speeding, but workers also regularly risk death by crossing the road in pursuit of their duties. The absence of legal controls for environmental protection, the excessive pursuit of efficiency in urban governance, and the lack of basic education of sanitation workers are underlying causes of collisions. Raising awareness about sanitation worker road traffic collisions will help protect the work safety rights of this vulnerable group.

院外心博骤停是影响公众健康的严重问题.自动体外除颤器(AED)在公共场所的配备和使用可有效地提高院外心博骤停者的存活率.AED在国外已经得到了广泛的普及,利用率较高,配套设施较为完善.我国目前只有少数城市在公共场所配置了AED,且数量很少.我国公共场所推行AED面临公民急救素养较低,推行成本较高,缺乏培训机制,急救免责法落实有待加强等问题.应普及宣传急救知识,加大政府资金投入,利用公众利益取向带动急救培训,加强急救免责法的宣传和执行力度等.

近年来,医院工作场所暴力不仅对医务人员造成严重的伤害,对社会也造成巨大的影响.从行为经济学的视角出发,运用有限理性、损失厌恶、禀赋效应、羊群效应等理论对医院工作场所暴力发生的原因进行剖析,试图运用行为经济学的相关理论,助推医院工作场所暴力的防范与管理.

Resident standardized training plays an irreplaceable role in the training of medical students in China, including the construction of training bases, and the implementation of national graded diagnosis and treatment. From the perspective of medical education history, this project combined historical research methods and historical thinking methods into the field of standardized training for residents through literature review and expert consultation. The project selected the training mode, training content, tutor system and integration of the system. The four main aspects were historically and longitudinally explored, and the historical evolution of the standardized training of residents in China was described in a point-by-point manner. The regular trends hidden in the history in the system were further explored, and history was transformed into reality logic, so as to build a new pattern of medical and health industry from the cultivation of medical talents.

BackgroundTo evaluate the impact of a restricted access policy on workplace violence in a healthcare setting.MethodsWe surveyed healthcare workers before and after the implementation of a restricted-access policy at a tertiary hospital in north-eastern China. Data were collected in April 2017 and January 2019. Fisher's exact test were used to compare the difference in workplace violence prevalence between responses to two surveys. Survey 1 (S1) collected data from 345 healthcare professionals who had worked in the inpatient ward for at least 12months. Survey 2 (S2) included 338 healthcare workers from the same ward who had been employed for more than two years. The effective response rates for the two studies was 79.31 and 83.25%, respectively. All 18 female security guards were included in the investigation in S2.ResultsThe prevalence of psychological violence was 62.03% in S1 and 34.62% in S2, the difference in prevalence showing statistical significance (P=0.000), while the prevalence of physical violence was 3.77 and 4.73% respectively, showing no statistical significance (P=0.573). The change in the rate of injury caused by physical violence was also statistically significant at 76.92 and 31.25% (P=0.025), respectively. Security guards were at high risk of workplace violence under the policy. Most healthcare professionals thought this policy ameliorated treatment order, the sense of security, anxiety about workplace violence, and so forth, but one-third of the respondents thought that it caused patient dissatisfaction.ConclusionWhile the restricted access policy may be effective for healthcare professionals in avoiding or dealing with violence, such policy could contribute to new problems regarding the safety of security guards and the potential dissatisfaction of patients. The policy should be further developed to alleviate this phenomenon.

Background The Coronavirus Disease 2019 (COVID-19) that first occurred in Wuhan, China, is currently spreading throughout China. The majority of infected patients either traveled to Wuhan or came into contact with an infected person from Wuhan. Investigating members of the public with a travel history to Wuhan became the primary focus of the Chinese government’s epidemic prevention and control measures, but several instances of withheld histories were uncovered as localized clusters of infections broke out. This study investigated the public’s willingness and beliefs associated with reporting travel history to high-risk epidemic regions, to provide effective suggestions and measures for encouraging travel reporting. Methods A cross-sectional study was conducted online between February 12 and 19, 2020. Descriptive analysis, chi-squared test, and Fisher’s exact test were used to identify socio-demographic factors and beliefs associated with reporting, as well as their impact on the willingness to report on travel history to high-risk epidemic regions. Results Of the 1344 respondents, 91 (6.77%) expressed an inclination to deliberately withhold travel history. Those who understood the benefits of reporting and the legal consequences for deliberately withholding information, showed greater willingness to report their history ( P < 0.05); conversely, those who believed reporting would stigmatize them and feared being quarantined after reporting showed less willingness to report ( P < 0.05). Conclusions As any incident of withheld history can have unpredictable outcomes, the proportion of people who deliberately withhold information deserves attention. Appropriate public risk communication and public advocacy strategies should be implemented to strengthen the understanding that reporting on travel history facilitates infection screening and prompt treatment, and to decrease the fear of potentially becoming quarantined after reporting. Additionally, social support and policies should be established, and measures should be taken to alleviate stigmatization and discrimination against potential patients and reporters of travel history. Reinforcing the legal accountability of withholding travel history and strengthening systematic community monitoring are the measures that China is currently taking to encourage reporting on travel history to high-risk epidemic regions. These non-pharmaceutical interventions are relevant for countries that are currently facing the spread of the epidemic and those at risk of its potential spread.

Objective The purpose of this study is to examine workplace violence (WPV) towards healthcare professionals in a multiethnic area in China, including prevalence, influencing factors, healthcare professionals’ response to WPV, expected antiviolence training measures and content, and evaluation of WPV interventions. Design A cross-sectional study. Setting A grade III, class A hospital in the capital of Yunnan Province, which is the province with the most diverse ethnic minority groups in China. Participants In total, 2036 healthcare professionals participated, with a response rate of 83.79%. Results The prevalence of physical and psychological violence was 5.5% and 43.7%, respectively. Healthcare professionals of ethnic minority were more likely to experience psychological violence (OR=1.54, 95% CI 1.16 to 2.05). Stratified by gender, male healthcare professionals of ethnic minority suffered from more physical violence (OR=3.31, 95% CI 1.12 to 9.79), while female healthcare professionals suffered from psychological violence (OR=1.71, 95% CI 1.24 to 2.36). We also found a unique work situation in China: overtime duty on-call work (18:00–07:00) was a risk factor for psychological violence (OR=1.40, 95% CI 1.02 to 1.93). Healthcare professionals of ethnic minority are less likely to order perpetrators to stop or to report to superiors when faced with psychological violence. They are also more interested in receiving training in force skills and self-defence. Both Han and ethnic minority participants considered security measures as the most useful intervention, while changing the time of shift the most useless one. Conclusion Our study comprehensively described WPV towards healthcare professionals in a multiethnic minority area. More research on WPV conducted in multiethnic areas is needed.

Purpose Physicians and Standardised Residency Training physicians (SRTPs) have relatively high exposure to psychological violence. Its adverse effects are far greater than those of physical violence. However, no previous research has paid attention to the problem of psychological violence among them. This study aims to evaluate the extent, characteristics, and risk factors of psychological violence among SRTPs in comparison to physicians, and also to highlight the psychological violence experienced by SRTPs and suggest preventive measures. Methods A cross-sectional survey was conducted in northern China. 884 physicians and 537 SRTPs completed a questionnaire which compiled by the ILO, ICN, WHO and PSI in 2003 to measure violence in the workplace. Descriptive statistics and logistic regression analysis were used to analyse results. Results The effective response rates of physicians and SRTPs were 63.1%(884/1400) and 86.3%(537/622) respectively. 73.0%(645/884) of physicians and 24.8%(133/537) of SRTPs suffered psychological violence in the past year. Compared to physicians (29/645, 4.5%), SRTPs (42/133, 31.6%) experience more internal violence. Further, after experiencing psychological violence, physicians are willing to talk to family and friends, but SRTPs generally take no action. Shift work was a risk factor for both physicians (OR 1.440, 95% CI 1.014–2.203) and SRTPs (OR 1.851, 95% CI 1.217–2.815) suffering from psychological violence. In contrast, no anxiety symptoms protected physicians (OR 0.406, 95% CI 0.209–0.789) and SRTPs (OR 0.404, 95% CI 0.170–0.959) against psychological violence. Conclusions SRTPs and physicians in northern China have a high risk of experiencing psychological violence, and physicians experience more. Meanwhile, there are obvious differences in responses to psychological violence and risk factors between them. Therefore, medical institutions should pay more attention to psychological violence, especially among SRTPs, such as supporting the reporting of psychological violence, strengthening team relationships, and providing psychological comfort and counselling. Trial registration number (Project Identification Code: HMUIRB20160014), Registered May 10, 2016.

Objective Through the visual analysis of the medical students' empathy field from 1999 to 2019,the research hotspots and frontier trends in this field are described to provide data support and results reference for China's research in the field.Methods Bibliometrics was used.Using CiteSpace visual analysis software as a research tool,statistical analysis was carried out on research power,high-impact authors,highimpact journals,high-frequency keywords and mutation words of 1 146 literatures in the field of empathy of medical students retrieved from the core collection of Web of Science on February 25,2019.Results The research strength in the field of empathy of medical students was mainly concentrated in the United States,accounting for 45.20％ (518/1 146) of the total number of papers published in the past 20 years.The first of high-yield and high-cited authors were Hojat M,published 36 articles and cited 573 times.Acad Med was ranked first in the cited frequency,cited 899 times in 20 years.The high-frequency keywords included empathy,medical student,education,gender and so on.The mutation words included communication-skills,internal-medicine and personal-qualities.Conclusions From 1999 to 2019,the research hotspots in the field of empathy of medical students cover empathy education,gender differences in empathy.The frontier trends mainly focus on empathy communication skills,empathy of internal medicine students,empathy and personal qualities.

推动医疗工作重心下移、资源下沉,解决人民群众“看病难”、“看病贵”的问题是公立医院改革的主要任务.为此,我国各地开展了医联体的建设,但模式、进展以及成效不尽相同.其中云南省临沧市云县实施的紧密型县乡村医疗服务一体化管理取得了良好的成效.在云县的紧密型县乡村医共体中,充分考虑了各利益相关者的利益需求,从而将各方利益与医共体的发展建设有效整合,使医疗机构的发展以及分级诊疗的落实富有成效.文章以云县的紧密型县乡村医疗服务一体化为例,结合利益相关者理论,分析各类措施对于各方利益需求情况的影响,总结经验,为其他地区建设县域医共体提供借鉴.

目的 探讨校园欺凌领域的研究热点及发展趋势,为校园欺凌领域的研究提供参考.方法 使用CiteSpace 软件对Web of Science核心数据库中2008-2018年校园欺凌领域的研究力量、高影响力作者、高被引期刊、高频关键词及突变词进行可视化分析,数据采集时间为2018年5月9日.结果 通过创建检索式导出并去重后,共得出3 561条文献数据.发文量最高的国家是美国,共发文1 398篇,占10年发文总量的39.3％;英格兰的中心性最高,在研究中处于关键地位.芬兰的图尔库大学是核心研究机构,10年发文76篇,在研究网络中的中心性为0.16;高产作者为Salmivalli,发文量57篇;高被引作者为Olweus,被引频次为1 981.高被引期刊为《Aggressive Behavior》,影响因子2.747,10年被引共1 729次.在高频关键词方面,bully,adolescence,victim等核心词汇频次较高;在研究对象上,middle school出现频次较高;在欺凌形式上,violence,aggression,cyberbully出现频次较高;在欺凌后果上,depression,mental health,health出现的频次较高.突变词包括school children,bullying victimization,relational aggression等.结论 校园欺凌领域近10年的研究热点包括暴力行为、性别差异、社会支持、心理健康等,针对大学生群体的校园欺凌研究将会是未来的研究热点.

OBJECTIVES:This study aims to investigate patient safety culture in secondary hospitals of Heilongjiang, Northeast China, and explore the implications of patient safety culture and practices through the perspectives of various healthcare workers. METHODS:A cross-sectional survey using the Safety Attitude Questionnaire (SAQ) was conducted to ascertain the status of patient safety culture in nine secondary hospitals across the six dimensions of the SAQ. Among the 900 staff members who were invited to participate, 665 completed the questionnaire. Descriptive statistics were used to calculate the general means and standard deviations of the patient safety culture dimensions and other numerical variables, and F-test and a multivariate regression analysis were used to statistically analyze the differences in perceptions of safety culture considering the differences in demographic characteristics. All statistical analyses were performed using SPSS v. 22.0. RESULTS:The respondents rated job satisfaction as the highest among all six dimensions of the SAQ, followed in order by teamwork climate, working conditions, and stress recognition (the lowest). There were significant differences among the dimensions of patient safety culture and other factors, such as gender, age, job position, and education. Compared with previous studies, teamwork climate and working conditions scores were quite high, while stress recognition score was very low. We also found differences in patient safety culture by demographic characteristics. CONCLUSIONS:The findings revealed the patient safety culture attitudes of healthcare workers in secondary hospitals of Heilongjiang, and provided baseline data for related future research. This evidence may also help government health policymakers and hospital administrators understand related challenges and develop strategies to improve patient safety culture in secondary hospitals of China and perhaps also in other developing countries.

Objective To retrospectively examine the status and influencing factors of school bullying during junior high school period among college students for developing effective measures to prevent school bullying. Methods We conducted a questionnaire survey among 949 college students selected using cluster sampling in a college in Harbin city of Heilongjiang province between September and December 2017. Information on bullying and bullying victimization during junior high school were collected retrospectively and analyzed and measures for school bullying prevention were explored based on the evidences provided by the participants. Results Experience of bullying and bullying victimization in junior high schools was reported by 148 (15.60％, including 84 males and 64 females) of the participants. Gender (χ2 = 16.772, P ＜ 0.01) and in a single parent family (χ2 = 8.185, P = 0.004) are associated with bullying victimization. Female gender (odds ratio [OR] = 0.435, 95％ confidence interval [95％ CI]: 0.299 – 0.633), better family economic condition (OR = 0.289, 95％ CI: 0.145 – 0.576), with choleric temperament (OR = 0.295, 95％ CI: 0.160 – 0.544) and sanguineous temperament (OR = 0.351, 95％ CI: 0.209 – 0.590) are hindering factors for bullying victimization; whereas with a single parent family (OR = 1.291, 95％ CI: 1.009 – 1.652), poor family economic condition (OR = 3.394, 95％ CI: 1.641 – 7.019) and good academic achievement (OR = 2.253, 95％ CI: 1.320 – 3.847) are risk factors for bullying victimization. There were 65.54％ and 56.69％ of the participants considering relevant regulation making and improvement of social environment being the most and the second effective measure to prevent school bullying. Conclusion Risk factor-specific intervention measures for school bullying prevention should be developed based on evidences provided by the students with school bullying experience.

Objectives Medical school education plays an important role in promoting patient safety. In this study, we assess medical students' perceptions of patient safety culture, identify their educational needs and provide evidence on the most important content relating to patient safety for the medical school curriculum. Method This cross-sectional study was conducted in four medical universities in Heilongjiang province. Medical students in the first through five years completed an anonymous questionnaire-the Attitudes toward Patient Safety Questionnaire III. We analysed the differences in responses across the four universities and their cohorts. Results The overall perceptions of patient safety culture across the four medical universities were positive. The highest positive response rate was for 'I have a good understanding of patient safety issues as a result of my undergraduate medical training' (range: 58.4%-99.8%), whereas the lowest positive response rate was for 'medical errors are a sign of incompetence' (14.7%-47.9%). Respondents in the earlier years of school tended to have more positive responses for items concerning working hours and team work; however, fourth and fifth year students had more positive responses for error inevitability. Items with the lowest positive response rates across the cohorts included items related to 'professional incompetence as a cause of error' and 'disclosure responsibility'. Conclusions While students generally had positive views of patient safety culture, none of them had been exposed to any formal curriculum content on patient safety. Policymakers should focus more on how educational needs vary across schools and cohorts in order to establish appropriate curricula.

建立和完善家庭医生制度是推进分级诊疗制度的关键,对于实现基层首诊、双向转诊、急慢分治、上下联动的就医模式具有重要意义.以系统理论为基础,从当前家庭医生签约机制存在的问题入手,从居民、医疗机构、政府3方面进行探讨分析,提出相应的对策建议,进而完善家庭医生签约机制、促进分级诊疗的更好实现.