目的 了解天津市某三级甲等医院医务人员对卫生技术评估(health technology assessment,HTA)接受度及其影响因素,为推进 HTA在卫生领域的广泛开展提出相应对策.方法 于 2021 年 1-4 月,运用整群抽样法选取天津市某三级甲等医院 694 名医务人员作为研究对象,采用自行设计的《医务人员卫生技术评估认知情况调查问卷》进行问卷调查.采用多因素 Logistic回归分析探讨影响医务人员对 HTA接受度的主要因素.结果 441例(63.5%)医务人员表示了解 HTA,599 例(86.31%)医务人员认为有必要在医院内建立 HTA机制.多因素 Lo-gistic回归分析结果显示,医生(OR=5.649,95%CI:1.584～20.148)、了解 HTA(OR=10.322,95%CI:5.792～18.394)、希望获得 HTA相关培训(OR=4.691,95%CI:2.367～9.296)的医务人员对 HTA 接受度较高(P<0.05).结论 医务人员对 HTA认知度较好,对医院内建立 HTA 机制需求较高.医务人员的认知情况是实现HTA的基础,医务人员的积极参与是影响 HTA 机制的重要因素.建议借助新媒体平台、医院宣传及大学教育,传播 HTA知识及研究成果,提高医务人员对 HTA的内涵认知.

目的 了解临床医务人员对疾病诊断相关分组(diagnosis related groups,DRGs)的接受度及其影响因素,为DRGs试点的开展提出相应对策.方法 抽取天津市某三甲医院在岗临床医务人员694人作为调查对象,采用自行设计的《DRGs认知情况调查表》对纳入调查对象进行调查,主要内容包括调查对象的基本情况、对DRGs的接受度和认知.采用多因素Logistic回归分析探讨医务人员对DRGs接受度的影响因素.结果 527例(77.8％)表示接受DRGs改革.性别、岗位、是否了解DRGs政策、实行DRGs是否影响您对病情的诊断、用药或操作、是否希望获得DRGs相关培训是临床医务人员对开展DRGs接受度的影响因素(P<0.05).结论 临床医务人员对实行DRGs的接受度较高,建议将临床医生作为DRGs推广的重点目标人群,提高临床医务人员对DRGs内涵的认知;制定合理完善的绩效指标考核方案,实现医院、医务人员与医保的价值共创.

背景 近年来深圳市家庭医生签约服务开展已取得一定进展,但"签而不约""服务不到位"等现象依然存在.居民作为服务的需求方,研究其对家庭医生服务的评价及续签意愿对促进签约服务的有效开展具有重要意义.目的 了解深圳市签约居民对家庭医生服务的评价及续签意愿,为推进家庭医生服务提供科学依据.方法 于2016年7月—2017年9月,采取多阶段分层随机抽样法,对深圳市宝安区3个社区健康服务中心的1000例签约居民开展基本情况、家庭医生服务利用与评价、家庭医生续签意愿及原因等内容的问卷调查.共发放问卷1000份,获得有效问卷900份,问卷有效回收率为90.0％.结果 900例调查对象中,807例(89.7％)签约居民满意家庭医生的服务,家庭医生服务态度平均得分为(92±8)分.820例(91.1％)签约居民表示愿意继续和家庭医生签约,其中729例(88.9％)签约居民愿意续签家庭医生的原因是认为签约家庭医生就诊更方便;80例(8.9％)不愿意续签的居民中,56例(70.0％)选择的原因是认为签约家庭医生没有用.χ2检验结果显示,是否熟悉家庭医生姓名及坐诊时间、家庭医生主动联系次数、家庭医生服务态度、是否认为家庭医生看病比非家庭医生更仔细、是否满意家庭医生工作及对家庭医生的信任度条目选项不同者的续签意愿不同,差异具有统计学意义(P<0.05).结论 深圳市签约居民对医疗卫生服务评价较好,家庭医生服务续签意愿较高,建议加大宣传推广力度,提升家庭医生服务质量,完善家庭医生服务体系,进而促进家庭医生服务的长远发展.

本研究在总结英国、美国、德国、澳大利亚等国家的家庭医生签约服务现状及其经验的基础上,结合我国在家庭医生签约过程中存在的问题,提出针对性的解决措施或建议.鉴于缺乏相关制度保障、财政支持不到位、家庭医生能力不足,未建立良好医患关系等问题,本研究指出应强化相关政策倾斜力度、增加相关经费投入、加强家庭医生队伍建设、建立良好医患关系等,探索适合中国特色的家庭医生签约服务模式.

脑卒中已成为威胁全球居民生命健康的重大疾病,是我国亟需解决的重大公共卫生问题.高死亡率、高致残率、高复发率的疾病特点不仅严重影响居民的生命健康和生活质量,也给家庭和社会造成极大的经济负担.脑卒中是多种因素长期综合作用引起的疾病,分析脑卒中的流行趋势,明确脑卒中危险因素,进行积极有效的一级预防,是降低脑卒中发病的重要措施之一.本文针对国内外脑卒中的最新流行趋势和影响因素研究进展进行了综述,为全面了解脑卒中的流行情况、深入研究脑卒中相关的影响因素,为针对性地开展脑卒中早期干预提供参考依据.

目的 了解签约居民对家庭医生的信任度及其影响因素,为推进家庭医生签约服务提供科学依据.方法 采取简单随机抽样方法,于2016年7月—2017年9月对深圳市宝安区3个社区健康服务中心签约居民进行问卷调查,采用Logistic逐步回归分析方法探讨签约居民对家庭医生信任度的影响因素.结果 在900名调查对象中,93.7％ 的签约居民对家庭医生比较信任.Logistic逐步回归分析结果显示,签约居民对家庭医生的满意度(OR=6.246,95％CI:3.913～12.219)、家庭医生看病的仔细程度(OR=2.725,95％CI:1.414～5.252)以及服务态度(OR=1.085,95％C I:1.047～1.125)是影响签约居民对家庭医生信任度的主要因素.结论 深圳市签约居民对家庭医生信任度较高.建议完善家庭医生签约服务体系,加强医患沟通,提高家庭医生服务质量,从而进一步提升签约居民对家庭医生的信任度.

护理人员是医疗卫生工作的重要组成部分,直接关系到医疗质量和病人生命安危,是医疗安全的基础.频发的涉医暴力事件不仅危害护理人员生命安全,对其心理健康产生不良影响,也严重影响了医疗安全.国内外研究提示,超过一半的护理人员遭受过工作场所暴力,其中最常见的工作场所暴力类型为言语暴力,其次为身体暴力和性骚扰.医疗卫生法律法规不健全、涉医暴力事件处置不完善、护患沟通不畅和患者就医体验差是导致工作场所暴力事件的主要因素.建议完善医疗工作者工作场所暴力预防指南,建立健全医疗场所工作暴力处理规范;提高护理人员对工作场所暴力事件的预见与应急处理能力;加强与患者之间的有效沟通,改善患者就诊体验,从而有效减少涉医暴力事件的发生.

目的 了解医院感染现状和抗菌药物使用情况,提高医院感染防控能力.方法 采用横断面调查方法对天津市某三甲医院调查日所有住院患者进行调查,对资料进行描述性分析,采用 χ2检验对样本率进行比较.结果 被调查患者疾病诊断多集中于恶性肿瘤(29.82％)和循环系统疾病(17.64％).共74例患者存在医院感染,医院感染率3.45％.是否存在手术切口、住院科室、患者疾病诊断是患者是否发生医院感染的影响因素(P<0.05).医院感染的主要感染部位为下呼吸道感染(32.91％),感染菌株主要为肺炎克雷伯菌(15.07％)、铜绿假单胞菌(12.33％).患者使用抗菌药物率为35.42％,475例(62.58％)患者用药前已送细菌培养.多数医院感染细菌对抗菌药物耐药率低.结论 该医院医院感染率总体较低,医院感染预防控制取得了良好成效;用药规范率明显提高.建议在预防与控制医院感染时要针对重点人群和危险因素制定相应防治措施,提高医务人员合理使用抗菌药物意识,以降低细菌耐药率.

BACKGROUND:Gatekeeper policy, requiring a patient to visit a primary care provider first, and the patient needs to get his or her primary care provider's referral before seeing a specialist or going to a hospital, has been implemented in China for about ten years, and it is necessary to assess the patients' acceptance of gatekeeper policy and to explore the factors influencing patients' acceptance.METHODS:A cross-sectional study with 1162 respondents was conducted between July and September 2015 at four community health centers (CHCs) in Wuhan, China. Face-to-face interview was used to collect information on demographics, acceptance of the gate keeper policy and satisfaction with community health services. Patients' satisfaction with community health service was evaluated using the European Patients Evaluate General/Family Practice scale and binary logistic regression model was used to examine the factors influencing patients' acceptance of community health services as gate keepers.RESULTS:A total of 512 (43.06%) patients accepted gatekeeper policy. Mandatory reimbursement provision (OR: 1.63, 95% CI: 1.23-2.15), patient satisfaction with the aspects of medical care (OR: 1.92, 95% CI: 1.12-3.29) and organization of care (OR: 1.66, 95% CI: 1.05-2.62) were associated with acceptance of gatekeeper policy, after adjusting for potential confounders. Moreover, young people (OR: 0.35, 95%CI: 0.22-0.56) seemed to be more reluctant to accept the policy, when compared with the elder.CONCLUSIONS:Our study suggests that mandatory reimbursement provision greatly affects patients' acceptance of gatekeeper policy, therefore, the policy-maker should pay attention to the negative effect of its mandatory reimbursement provision on patients' acceptance of the policy. However, improving the aspects of medical care and organization of care will contribute to implementation of gatekeeper policy.

Epidemiological studies have clarified the potential associations between regular aspirin use and cancers. However, it remains controversial on whether aspirin use decreases the risk of cancers risks. Therefore, we conducted an updated meta-analysis to assess the associations between aspirin use and cancers.

OBJECTIVES:To assess the prevalence and factors associated with physical and nonphysical violence in a sample of general practitioners (GPs).METHODS:We used a cross-sectional design to collect data from December 2014 to March 2015 with a structured self-administered questionnaire from 1015 GPs in Hubei Province, Central China (response rate, 85.6%). We used a multivariable logistic regression model to identify the predictors associated with workplace violence toward GPs.RESULTS:Of the respondents, 62.2% of respondents reported exposure to workplace violence in the preceding year, including 18.9% and 61.4% who encountered physical and nonphysical violence, respectively. Multivariable logistic regression analysis suggested that GPs who were male, at a higher professional level, and who had a lower average monthly income were more likely to experience physical violence. Male GPs, less-experienced GPs, and those with administrative responsibility were more likely than their counterparts to encounter nonphysical violence.CONCLUSIONS:This study shows that the prevalence of workplace violence against GPs is high in Hubei, China. Creating a prevention strategy and providing safer workplace environments for GPs should be urgently prioritized.

Observational studies suggest that shift work may be associated with prostate cancer. However, the results are inconsistent. The objective of this study is to quantitatively assess the association between shift work and the risk of prostate cancer. Relevant studies were identified by a comprehensive search of the PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases to September 2017. We also reviewed the reference lists from retrieved articles. Observational studies that reported relative risk (RR) with 95% confidence intervals (CIs) for the association between shift work and the risk of prostate cancer were included. Linear and non-linear dose-response meta-analyses were performed. Fifteen studies with 16 independent reports involving 2 546 822 individuals and 10 715 patients with prostate cancer were included. The pooled adjusted RR for the association between ever exposure to shift work and prostate cancer risk was 1.23 (95% CI, 1.08-1.41; P < 0.001). A non-linear association of prostate cancer risk with duration of shift work was identified (P for non-linearity = 0.001). Subgroup analysis demonstrated a higher pooled RR of prostate cancer for studies among Asian populations (RR = 1.98, 95% CI, 1.34-2.93; P = 0.618). A positive association was observed in rotating shift groups (RR = 1.10, 95% CI, 1.00-1.26; P = 0.156), but not in other shift groups. Integrated evidence from this meta-analysis suggests that shift work is significantly associated with an increased risk of prostate cancer, and a non-linear association between duration of shift work and prostate cancer was found.

Objective To investigate the acceptance of gatekeeper system among patients with state medicine and to explore its influence factors. Methods Four community health service centers( CHCs)held by non - medical institutions of higher learning in Wuhan from July to November in 2015 were randomly selected,and 1 200 patients with state medicine and came to CHCs for medical treatment during this period were selected. The Questionnaire Survey of Community Residents designed by research groups was used in this study,and it mainly included patients' basic data,seeking health care behaviors,health condition,intention and cognition of gatekeeper system and evaluation of CHCs. Multivariate Logistic regression analysis were used to explore the influencing factors of the acceptance of gatekeeper system among patients with state medicine. Results A total of 1 162 valid questionnaires were collected,and the effective response rate was 96. 8%. Of these,782(67. 3% )patients with state medicine were familiar with the gatekeeper system and 862(74. 2% )were willing to accept it. There was no significant difference in the acceptance rate of the gatekeeper system among patients with different gender,educational degree,family monthly income and self - rated health status scores(P ﹥ 0. 05);there was significant difference in the acceptance rate of the&nbsp;gatekeeper system among patients with different age,different annual visiting times,and whether patients understand the gatekeeper system,whether patients believed that the diagnosis and treatment level,the medical equipment or drugs supply of CHCs can meet the diagnosis and treatment requirement of common diseases,and whether patients are satisfied with CHCs services(P ﹤ 0. 05). The results of multivariate Logistic regression analysis showed that age,whether patients understand the gatekeeper system,whether patients are satisfied with CHCs services significantly influence the acceptance of the gatekeeper system(P ﹤ 0. 05). Conclusion The acceptance of gatekeeper system among patients with state medicine is relatively high, and it is feasible to implement gatekeeper system from the analyzing perspectives of patients. Age,whether patients understand the relevant policies of the gatekeeper system and whether they are satisfied with the CHCs services are its influencing factors. It is suggested to enhance propaganda work of gatekeeper system,improve patients' understanding of its connotation,and further improve community health services levels at the same time,so as to promote the full implementation of gatekeeper system.

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service (CHS) under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor-patient relationships, information and support, organization of care, and accessibility (P < 0.001). One or more factors such as gender and self-perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients' satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

A meta-analysis was performed to assess the association of coffee consumption with colorectal cancer and to investigate the shape of the association. Relevant prospective cohort studies were identified by a comprehensive search of the PubMed, Embase and Web of Science databases from their inception through August 2015. Either a random-effects model or fixed-effects model was used to compute the pooled risk estimates when appropriate. Linear and nonlinear dose-response meta-analyses were also performed. Nineteen prospective cohort studies involving 2,046,575 participants and 22,629 patients with colorectal cancer were included. The risk of colon cancer was decreased by 7% for every 4 cups per day of coffee (RR=0.93, 95%CI, 0.88-0.99; P=0.199). There was a threshold approximately five cups of coffee per day, and the inverse association for colorectal cancer appeared to be stronger at a higher range of intake. However, a nonlinear association of rectal cancer with coffee consumption was not observed (P for nonlinearity = 0.214). In conclusion, coffee consumption is significantly associated with a decreased risk of colorectal cancer at ≥ 5 cups per day of coffee consumption. The findings support the recommendations of including coffee as a healthy beverage for the prevention of colorectal cancer.

BACKGROUND:As a developing country with the world's largest population in a state of economic transition, reforms to China's health system, including community health services (CHS), are very complex and difficult. The aim of this study is to provide evidence and policy recommendations for the sustainable development of CHS for China, which could also be applicable to other developing countries.METHODS:A cross-sectional survey was conducted door-to-door and face-to-face in Wuhan city, central China with a sample of 1134 individuals aged 15 and older. The independent variables were duration of residence, previous treatment experience, familiarity with health staff, self-reported family economic status and health insurance. The dependent variables were views on the usefulness of CHS and willingness to use them. Sociodemographic variables and health status were used as control variables. Multiple logistic regression analysis was used to analyse the influence of the independent variables on the dependent variables.FINDINGS:This study shows that 26.10% of participants reported that the CHSs are not useful and 37.74% reported they did not want to use their CHS. The results found 'familiarity with health staff' and 'previous experience of using services' had a negative influence on their views on usefulness of and willingness to use CHS.CONCLUSION:The aim of CHS to see 'minor illnesses treated in the community and serious illness treated in hospital' is not being fully realized. The key to increasing the use of CHS may be to enhance the quality of services and health staff. A policy pathway of targeting older residents and those with higher education levels as the priority population, and using these groups to encourage the rest of the community to seek minor services at CHS, may be an effective and sustainable development mechanism.

In recent decades, the increasing use of radiation-based diagnostic and therapeutic modalities has brought concerns about radiation safety to the forefront of patient care and public health [ 1 Ikuta I. Sodickson A. Wasser E.J. Warden G.I. Gerbaudo V.H. Khorasani R. Exposing exposure: enhancing patient safety through automated data mining of nuclear medicine reports for quality assurance and organ dose monitoring. Radiology. 2012; 264: 406-413 Crossref PubMed Scopus (11) Google Scholar , 2 Martin C.J. A survey of incidents in radiology and nuclear medicine in the West of Scotland. Br J Radiol. 2005; 78: 913-921 Crossref PubMed Scopus (21) Google Scholar , 3 Hiles P. Brennen S. Scott S. Davies J. A survey of patient dose and image quality for computed tomography scanners in Wales. J Radiol Prot. 2001; 21: 345-354 Crossref PubMed Scopus (13) Google Scholar , 4 Holmberg O. Malone J. Rehani M. McLean D. Czarwinski R. Current issues and actions in radiation protection of patients. Eur J Radiol. 2010; 76: 15-19 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar , 5 FitzGerald R. Radiological error: analysis, standard setting, targeted instruction and teamworking. Eur Radiol. 2005; 15: 1760-1767 Crossref PubMed Scopus (73) Google Scholar ]. The vast majority of existing radiation safety studies have focused on radiation exposure among physicians working in a hospital environment [ 6 Borgen L. Stranden E. Espeland A. Clinicians' justification of imaging: do radiation issues play a role?. Insights Imaging. 2010; 1: 193-200 Crossref PubMed Google Scholar , 7 Reagan J.T. Slechta A.M. Factors related to radiation safety practices in California. Radiol Technol. 2010; 81: 538-547 PubMed Google Scholar , 8 Etard C. Celier D. Roch P. Aubert B. National survey of patient doses from whole-body FDG PET-CT examinations in France in 2011. Radiat Prot Dosimetry. 2012; 152: 334-338 Crossref PubMed Scopus (48) Google Scholar , 9 Divrik Gökçe S. Gökçe E. Coşkun M. Radiology residents' awareness about ionizing radiation doses in imaging studies and their cancer risk during radiological examinations. Korean J Radiol. 2012; 13: 202-209 Crossref PubMed Scopus (20) Google Scholar , 10 Wong C.S. Huang B. Sin H.K. Wong W.L. Yiu K.L. Chu Yiu Ching T. A questionnaire study assessing local physicians, radiologists and interns' knowledge and practice pertaining to radiation exposure related to radiological imaging. Eur J Radiol. 2012; 81: e264-e268 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 11 Birnbaum S. Radiation safety in the era of helical CT: a patient-based protection program currently in place in two community hospitals in New Hampshire. J Am Coll Radiol. 2008; 5: 714-718 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar ]. The existing studies demonstrate a lack of knowledge about radiation dose, exposure, and risk among physicians [ 12 Lee R.K. Chu W.C. Graham C.A. Rainer T.H. Ahuja A.T. Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emerg Med J. 2012; 29: 306-308 Crossref PubMed Scopus (59) Google Scholar , 13 Arslanoğlu A. Bilgin S. Kubal Z. Ceyhan M.N. Ilhan M.N. Maral I. Doctors' and intern doctors' knowledge about patients' ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol. 2007; 13: 53-55 PubMed Google Scholar , 14 Söylemez H. Sancaktutar A.A. Silay M.S. et al. Knowledge and attitude of European urology residents about ionizing radiation. Urology. 2013; 81: 30-35 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar , 15 Yucel A. Karakas E. Bulbul E. Kocar I. Duman B. Onur A. Knowledge about ionizing radiation and radiation protection among patients awaiting radiological examinations: a cross-sectional survey. Med J Kocatepe. 2009; 10: 25-31 Google Scholar , 16 Lee C.I. Haims A.H. Monico E.P. Brink J.A. Forman H.P. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004; 231: 393-398 Crossref PubMed Scopus (565) Google Scholar ]. For example, survey data from Hong Kong showed that the overall accuracy of knowledge about radiation exposure was 40% for radiologists and 16% for nonradiologists [ 12 Lee R.K. Chu W.C. Graham C.A. Rainer T.H. Ahuja A.T. Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emerg Med J. 2012; 29: 306-308 Crossref PubMed Scopus (59) Google Scholar ]. There are only a handful of studies on radiation safety knowledge among patients, and there is a lack of related studies on influencing factors. In addition, according to the bio-psycho-social medical model [ 17 Engel G.L. The need for a new medical model: a challenge for biomedicine. Science. 1977; 196: 129-136 Crossref PubMed Scopus (7568) Google Scholar ], the factors affecting disease need to be extended from the individual to society, and accordingly, this model must also be extended to the factors influencing patients' radiation safety. Furthermore, medical/hospital personnel must work together with patients and their accompanying family members to ensure the radiation safety of patients.

BACKGROUNDThe family, together with the individual and society, and the state and market are the three pillars of well-being and social security over the life course, with responsibility for the health of older adults.OBJECTIVEThe aim of current study was to explore the effect of intergenerational and intragenerational support on perceived health of older adults.METHODSA cross-sectional survey with 64.36% (1318/2048) response rate was conducted door to door in rural China with a sample of 1318 individuals aged 60 years and older. There were three sets of independent variables: intergenerational support from children as well as intragenerational spousal support and intragenerational sibling support, sociodemographic variables, and behaviour variables. Multiple logistic regression analysis was used to analyse the influence of family member support on physical and psychological health.RESULTSAfter adjusting for potential confounding variables (sociodemographic variables and behaviour variables), it was observed that intergenerational support from children had a significant effect on the self-rated physical health and psychological health of older adults [odds ratios (OR) = 1.48, 95% confidence interval (CI): 1.10-2.00; OR = 1.82, 95% CI: 1.36-2.44, respectively]. However, intragenerational support from spouse and siblings was not significant.CONCLUSIONThe importance of intergenerational support from children would suggest that family practice and health-related policy of older adults may need to be extended to their children. With the rapid development of global population movements, family practices need to pay attention to the changes of family support among migrant families.